Archer Edward, Hill James O
EvolvingFX, LLC, IN, USA.
University of Alabama at Birmingham, Birmingham, AL, USA.
Prog Cardiovasc Dis. 2023 Jul-Aug;79:56-64. doi: 10.1016/j.pcad.2022.10.003. Epub 2022 Oct 23.
This paper presents two inter-dependent frameworks for understanding the etiology of obesity and the regain of body and fat mass after weight loss. The 'Invisible Hand of Metabolism' illustrates how physiologic states such as body and fat mass and blood glucose levels arise from the unregulated, uncontrolled, yet competitive behavior of trillions of semi-autonomous cells. The 'Competition Model of Metabolism' is an explanatory (mechanistic) framework that details how organismal and cell-specific behaviors generate the apparent stability of physiologic states despite metabolic perturbations (e.g., weight-loss and exercise). Together, these frameworks show that body and fat mass and blood glucose levels are not regulated, controlled, or defended but emerge from the complexity and functional plasticity of competitive cellular relations. Therefore, we argue that the use of abstract constructs such as 'regulation', 'control', 'glucostats', 'adipostats', and 'set-/settling-points' hinders the understanding of obesity and cardiometabolic diseases in human and nonhuman mammals.
本文提出了两个相互依存的框架,用于理解肥胖的病因以及减肥后体重和脂肪量的反弹。“新陈代谢的无形之手”说明了诸如体重、脂肪量和血糖水平等生理状态是如何从数万亿个半自主细胞的无调节、无控制但具有竞争性的行为中产生的。“新陈代谢竞争模型”是一个解释性(机制性)框架,详细阐述了尽管存在代谢扰动(如减肥和运动),机体和细胞特异性行为是如何产生生理状态的明显稳定性的。总之,这些框架表明,体重、脂肪量和血糖水平并非受到调节、控制或维持,而是从竞争性细胞关系的复杂性和功能可塑性中产生的。因此,我们认为使用诸如“调节”“控制”“葡萄糖稳态”“脂肪稳态”和“设定/稳定点”等抽象概念会妨碍对人类和非人类哺乳动物肥胖及心血管代谢疾病的理解。