Department of Medicine, Obesity, Metabolism and Nutrition Institute, Massachusetts General Hospital; University of Hong Kong, 102 Pokfulam Road, Pok Fu Lam, Hong Kong.
Gastroenterol Clin North Am. 2023 Jun;52(2):363-380. doi: 10.1016/j.gtc.2023.03.006.
Obesity is associated with a wide range of comorbidities that transverse multiple specialties in clinical medicine. The development of these comorbidities is driven by various mechanistic changes including chronic inflammation and oxidative stress, increased growth-promoting adipokines, insulin resistance, endothelial dysfunction, direct loading and infiltrative effect of adiposity, heightened activities of the renin-angiotensin-aldosterone system and sympathetic nervous system, impaired immunity, altered sex hormones, altered brain structure, elevated cortisol levels, and increased uric acid production, among others. Some of the comorbidities might develop secondary to one or more other comorbidities. Considering the obesity-associated comorbidities in the context of the mechanistic changes is helpful in understanding these conditions and in guiding treatment and future research.
肥胖与多种合并症相关,这些合并症涉及临床医学的多个专业。这些合并症的发展是由多种机制变化驱动的,包括慢性炎症和氧化应激、促生长脂肪因子增加、胰岛素抵抗、内皮功能障碍、脂肪的直接负荷和浸润作用、肾素-血管紧张素-醛固酮系统和交感神经系统活性增加、免疫受损、性激素改变、大脑结构改变、皮质醇水平升高和尿酸生成增加等。其中一些合并症可能继发于一种或多种其他合并症。考虑肥胖相关合并症与机制变化的关系有助于理解这些情况,并指导治疗和未来的研究。