Department of Pediatrics, Federico II University, Napoli, Italy.
Department of Pediatrics, Kansas University Medical Center, Kansas City, KS, United States.
Front Endocrinol (Lausanne). 2023 Jan 17;14:1062341. doi: 10.3389/fendo.2023.1062341. eCollection 2023.
Pediatric obesity has become in the last forty years the most common metabolic disease in children and adolescents affecting about 25% of the pediatric population in the western world. As obesity worsens, a whole-body insulin resistance (IR) occurs. This phenomenon is more pronounced during adolescence, when youth experience a high degree of insulin resistance due the production of growth hormone. As IR progresses, the blunted control of insulin on adipose tissue lipolysis causes an increased flux of fatty acids with FFA deposition in ectopic tissues and organs such as the liver, leading to the development of NAFLD. In this brief review, we will discuss the clinical implications of IR and NAFLD in the context of pediatric obesity. We will review the pathogenesis and the link between these two entities, the major pathophysiologic underpinnings, including the role of genetics and metagenomics, how these two entities lead to the development of type 2 diabetes, and which are the therapeutic options for NAFLD in youth.
在过去的四十年中，儿科肥胖已成为西方世界儿童和青少年中最常见的代谢性疾病，影响了约 25%的儿科人群。随着肥胖的加重，会出现全身性胰岛素抵抗（IR）。这种现象在青春期更为明显，此时由于生长激素的产生，年轻人会经历高度的胰岛素抵抗。随着 IR 的进展，胰岛素对脂肪组织脂解作用的控制减弱，导致脂肪酸通量增加，FFA 在肝外组织和器官（如肝脏）沉积，导致非酒精性脂肪性肝病（NAFLD）的发生。在这篇简要综述中，我们将讨论儿科肥胖中 IR 和 NAFLD 的临床意义。我们将回顾这两种疾病之间的发病机制和联系，主要的病理生理基础，包括遗传和宏基因组学的作用，这两种疾病如何导致 2 型糖尿病的发生，以及青少年 NAFLD 的治疗选择。
