Janjic D
Praxis (Bern 1994). 1996 Dec 3;85(49):1578-83.
There are several types of obesity, and the metabolic conditions associated with these phenotypes are also heterogeneous. Obesity of the male (android) type shows a dominant visceral and upper thoracic distribution of adipose tissue, whereas in the feminine (gynecoid) type adipose tissue is found predominantly in the lower part of the body (hips and thighs). Android obesity is clearly a cardiovascular risk factor, more so than gynecoid obesity. Hereditary factors contribute significantly to the occurrence of this pathology in families, although environmental factors play a role in its development. Android obesity is associated with metabolic anomalies which also characterize the syndrome X: resistance to insulin, arterial hypertension and dyslipidemia. The predisposition of individuals with android obesity to become diabetic rests in part on genetic and in part on environmental factors. Hyperinsulinemia and a high flux of free fatty acids act at the level of liver and endocrine pancreas to increase resistance to insulin and to decrease insulin secretion, two determining factors for type II diabetes. Other functional anomalies have been involved to explain android obesity such as dysregulation of adrenocortical and sexual steroids or a global derangement of stress mechanisms. No significant proof, however, seems to support either one of these hypotheses.
肥胖有几种类型，与这些表型相关的代谢状况也各不相同。男性（腹部型）肥胖表现为脂肪组织主要分布在内脏和上胸部，而女性（臀部型）肥胖的脂肪组织主要分布在身体下部（臀部和大腿）。腹部型肥胖显然是一种心血管危险因素，比臀部型肥胖更甚。遗传因素在家族中这种病理状况的发生中起重要作用，尽管环境因素在其发展过程中也发挥作用。腹部型肥胖与代谢异常有关，这些异常也是X综合征的特征：胰岛素抵抗、动脉高血压和血脂异常。腹部型肥胖个体患糖尿病的易感性部分基于遗传因素，部分基于环境因素。高胰岛素血症和高游离脂肪酸通量在肝脏和内分泌胰腺水平起作用，增加胰岛素抵抗并减少胰岛素分泌，这是II型糖尿病的两个决定性因素。其他功能异常也被用来解释腹部型肥胖，如肾上腺皮质和性类固醇的调节异常或应激机制的整体紊乱。然而，似乎没有重要证据支持这些假设中的任何一个。
