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医疗保健中的代谢策略:新时代。

Metabolic Strategies in Healthcare: A New Era.

作者信息

Phillips Matthew Cl

机构信息

Department of Neurology, Waikato Hospital, Hamilton, New Zealand.

出版信息

Aging Dis. 2022 Jun 1;13(3):655-672. doi: 10.14336/AD.2021.1018. eCollection 2022 Jun.

Abstract

Modern healthcare systems are founded on a disease-centric paradigm, which has conferred many notable successes against infectious disorders in the past. However, today's leading causes of death are dominated by non-infectious "lifestyle" disorders, broadly represented by the metabolic syndrome, atherosclerosis, cancer, and neurodegeneration. Our disease-centric paradigm regards these disorders as distinct disease processes, caused and driven by disease targets that must be suppressed or eliminated to clear the disease. By contrast, a health-centric paradigm recognizes the lifestyle disorders as a series of hormonal and metabolic responses to a singular, lifestyle-induced disease of mitochondria dysfunction, a disease target that must be restored to improve health, which may be defined as optimized mitochondria function. Seen from a health-centric perspective, most drugs target a response rather than the disease, whereas metabolic strategies, such as fasting and carbohydrate-restricted diets, aim to restore mitochondria function, mitigating the impetus that underlies and drives the lifestyle disorders. Substantial human evidence indicates either strategy can effectively mitigate the metabolic syndrome. Preliminary evidence also indicates potential benefits in atherosclerosis, cancer, and neurodegeneration. Given the existing evidence, integrating metabolic strategies into modern healthcare systems should be identified as a global health priority.

摘要

现代医疗保健系统建立在以疾病为中心的范式之上,这种范式在过去对抗感染性疾病方面取得了许多显著成功。然而,如今的主要死因是非感染性“生活方式”疾病,以代谢综合征、动脉粥样硬化、癌症和神经退行性疾病为广泛代表。我们以疾病为中心的范式将这些疾病视为不同的疾病过程,由疾病靶点引起并驱动,必须抑制或消除这些靶点才能清除疾病。相比之下,以健康为中心的范式将生活方式疾病视为对线粒体功能障碍这一由生活方式引起的单一疾病的一系列激素和代谢反应,线粒体功能障碍这一疾病靶点必须恢复才能改善健康,而健康可定义为优化的线粒体功能。从以健康为中心的角度来看,大多数药物针对的是一种反应而非疾病,而禁食和低碳水化合物饮食等代谢策略旨在恢复线粒体功能,减轻引发和驱动生活方式疾病的内在动力。大量的人体证据表明,这两种策略都能有效减轻代谢综合征。初步证据还表明,它们在动脉粥样硬化、癌症和神经退行性疾病方面也有潜在益处。鉴于现有证据,应将代谢策略纳入现代医疗保健系统确定为全球卫生重点。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9667/9116908/53cf3dceaffa/AD-13-3-655-g1.jpg

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