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肥胖与胰腺疾病:从炎症到肿瘤发生以及减肥干预措施的影响

Obesity and Pancreatic Diseases: From Inflammation to Oncogenesis and the Impact of Weight Loss Interventions.

作者信息

Souto Mariana, Cúrdia Gonçalves Tiago, Cotter José

机构信息

Gastroenterology Department, Unidade Local de Saúde do Alto Ave, 4835-044 Guimarães, Portugal.

Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4704-553 Braga, Portugal.

出版信息

Nutrients. 2025 Jul 14;17(14):2310. doi: 10.3390/nu17142310.


DOI:10.3390/nu17142310
PMID:40732935
Abstract

: Obesity is a growing global health concern and a modifiable risk factor for multiple pancreatic diseases, including acute pancreatitis (AP), chronic pancreatitis (CP), and pancreatic cancer (PC). While these conditions have distinct clinical courses, obesity contributes to their pathogenesis through shared mechanisms, such as visceral adiposity, systemic inflammation, insulin resistance, and ectopic pancreatic fat deposition. : This narrative review synthesizes current evidence from clinical, epidemiological, and mechanistic studies exploring the relationship between obesity and pancreatic diseases. We also critically evaluate the effects of weight loss interventions-including lifestyle modifications, pharmacologic therapies, endoscopic approaches, and bariatric surgery-on the risk and progression of disease. : Obesity increases the risk and severity of AP via mechanisms such as gallstone formation, hypertriglyceridemia, and lipotoxicity. In CP, obesity-related intrapancreatic fat and metabolic dysfunction may influence disease progression, although some data suggest a paradoxical protective effect. In PC, obesity accelerates tumorigenesis through chronic inflammation, adipokine imbalance, and activation of oncogenic signaling pathways. Weight loss interventions, particularly bariatric surgery and incretin-based therapies (e.g., GLP-1 receptor agonists and dual agonists such as tirzepatide), show promising effects in reducing disease burden and improving metabolic and inflammatory profiles relevant to pancreatic pathology. : Obesity plays a multifaceted role in the pathophysiology of pancreatic diseases. Therapeutic strategies targeting weight loss may alter disease trajectories, improve outcomes, and reduce cancer risk. Further research is needed to define optimal intervention strategies and to identify and validate biomarkers for personalized risk assessment and prevention.

摘要

肥胖是一个日益严重的全球健康问题,是多种胰腺疾病的可改变风险因素,包括急性胰腺炎(AP)、慢性胰腺炎(CP)和胰腺癌(PC)。虽然这些疾病有不同的临床病程,但肥胖通过共同机制促进其发病,如内脏肥胖、全身炎症、胰岛素抵抗和胰腺异位脂肪沉积。

本叙述性综述综合了临床、流行病学和机制研究的现有证据,探讨肥胖与胰腺疾病之间的关系。我们还批判性地评估了减肥干预措施(包括生活方式改变、药物治疗、内镜方法和减肥手术)对疾病风险和进展的影响。

肥胖通过胆结石形成、高甘油三酯血症和脂毒性等机制增加AP的风险和严重程度。在CP中,肥胖相关的胰腺内脂肪和代谢功能障碍可能影响疾病进展,尽管一些数据显示存在矛盾的保护作用。在PC中,肥胖通过慢性炎症、脂肪因子失衡和致癌信号通路的激活加速肿瘤发生。减肥干预措施,特别是减肥手术和基于肠促胰岛素的疗法(如GLP-1受体激动剂和替尔泊肽等双激动剂),在减轻疾病负担以及改善与胰腺病理相关的代谢和炎症特征方面显示出有前景的效果。

肥胖在胰腺疾病病理生理学中起多方面作用。针对减肥的治疗策略可能改变疾病进程、改善结局并降低癌症风险。需要进一步研究来确定最佳干预策略,并识别和验证用于个性化风险评估和预防的生物标志物。

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本文引用的文献

[1]
Unraveling the Burden of Pancreatic Cancer in the 21st Century: Trends in Incidence, Mortality, Survival, and Key Contributing Factors.

Cancers (Basel). 2025-5-9

[2]
Tirzepatide as Compared with Semaglutide for the Treatment of Obesity.

N Engl J Med. 2025-7-3

[3]
The Impact of Exercise Training Plus Dietary Interventions on Ectopic Fat in Population with Overweight/Obesity with and without Chronic Disease: A Systematic Review, Meta-analysis, and Metaregression of Randomized Clinical Trials.

Curr Dev Nutr. 2025-2-21

[4]
The Effects of Metabolic Bariatric Surgery on Intra-pancreatic Fat Deposition and Total Pancreas Volume: a Systematic Review and Meta-analysis.

Obes Surg. 2025-4

[5]
Efficacy of Metabolic and Bariatric Surgery for the Treatment of Recurrent Hypertriglyceridemia-Induced Acute Pancreatitis.

Obes Surg. 2025-4

[6]
Global, regional, and national prevalence of adult overweight and obesity, 1990-2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021.

Lancet. 2025-3-8

[7]
Geriatric Nutritional Risk Index (GNRI) and Survival in Pancreatic Cancer: A Retrospective Study.

Nutrients. 2025-1-30

[8]
Tirzepatide and Cancer Risk in Individuals with and without Diabetes: A Systematic Review and Meta-Analysis.

Endocrinol Metab (Seoul). 2025-2

[9]
Pancreatic Safety of Tirzepatide and Its Effects on Islet Cell Function: A Systematic Review and Meta-Analysis.

Obes Sci Pract. 2024-12-24

[10]
Metabolic syndrome and acute pancreatitis: Current status and future prospects.

World J Gastroenterol. 2024-12-7

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