脂肪细胞型脂肪酸结合蛋白与肥胖及代谢综合征

脂肪细胞型脂肪酸结合蛋白(A-FABP)主要在脂肪组织中大量表达,其主要生理作用为参与细胞内部的脂肪酸转运和靶向定位.近期的研究发现,A-FABP是全身胰岛素敏感性以及糖脂代谢的重要调节冈素,与肥胖及代谢综合征的发生发展有紧密联系.     

脂肪细胞型脂肪酸结合蛋白与代谢综合征

脂肪细胞型脂肪酸结合蛋白(A-FABP)是近年来新发现的脂肪因子.动物实验表明其可以促进代谢综合征各组分如胰岛素抵抗、血脂紊乱、2型糖尿病和动脉粥样硬化的发生、发展.人群研究也发现,其过度表达而导致血浆中含量增加是反映代谢综合征的一个可靠生物标志物.随着研究的深入,A-FABP对于治疗代谢综合征的作用也日益受到人们的关注.以下主要就近年来有关A-FABP的分布、结构、特性及其与代谢综合征组分的关系作一综述.     

脂肪细胞型脂肪酸结合蛋白研究进展

脂肪细胞型脂肪酸结合蛋白(A-FABP)是脂肪酸结合蛋白家族成员之一,与体重、糖脂代谢及胰岛素敏感性有密切关系,有助于代谢综合征的诊断及危险性预测,可能是代谢综合征一个独立的危险因子.此外,A-FABP还与多囊卵巢综合征以及动脉粥样硬化的发生和进展有关,为代谢性疾病的药物预防和治疗提供了新的潜在靶点.     

不伴代谢综合征相关状态的肥胖儿童在青春期启动前已进入炎症和血栓前状态

近30年来,美国青少年超重人数增加了2倍.在6～19岁的孩子中,体重超标者达17%.这与青少年和成人2型糖尿病发病率增加相一致.当腹型肥胖、高甘油三酯、低高密度蛋白、高血压和糖耐量受损同时存在时,我们称之为代谢综合征(又称X综合征).     

不伴代谢综合征相关状态的肥胖儿童在青春期启动前已进入炎症和血栓前状态

近30年来,美国青少年超重人数增加了2倍.在6～19岁的孩子中,体重超标者达17%.这与青少年和成人2型糖尿病发病率增加相一致.当腹型肥胖、高甘油三酯、低高密度蛋白、高血压和糖耐量受损同时存在时,我们称之为代谢综合征(又称X综合征).     

不伴代谢综合征相关状态的肥胖儿童在青春期启动前已进入炎症和血栓前状态

近30年来,美国青少年超重人数增加了2倍.在6～19岁的孩子中,体重超标者达17%.这与青少年和成人2型糖尿病发病率增加相一致.当腹型肥胖、高甘油三酯、低高密度蛋白、高血压和糖耐量受损同时存在时,我们称之为代谢综合征(又称X综合征).     

秦皇岛市12～18岁青少年肥胖与代谢综合征现状调查

目的 了解秦皇岛市青少年中肥胖及代谢综合征的现状,分析其流行病学特点.方法 通过分层整群随机抽样,测定4604名秦皇岛地区12～18岁青少年身高、体重、腰围、臀围、血压、空腹血糖(FPG)、血甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白-胆固醇、高密度脂蛋白-胆固醇(HDL-C)水平.结果 调查人群中超重和肥胖的发生率分别为12.1%和7.3%.与体重正常组相比,超重组及肥胖组的体重指数、腰臀比、血压、FPG、TG、TC、低密度脂蛋白-胆固醇水平均显著升高,HDL-C显著降低(P＜0.01).体重升高组(超重及肥胖组)高TG、高收缩压、高舒张压、高FPG及低HDL-C的检出分别为16.9%,12.1%,7.3%,4.9%,15.0%,与体重正常组相比差异均有统计学意义(P＜0.05).体重正常人群无代谢综合征发生,而体重升高组有60人诊断为代谢综合征.调查人群中代谢综合征的患病率为1.3%.结论 青少年肥胖与代谢综合征的患病率持续升高,加强对青少年肥胖及代谢综合征的监控与防治,有助于心血管疾病的早期预防.     

血清脂肪因子与代谢综合征的关系

121例代谢综合征(MS)患者和120名对照者入选本研究以探讨血清脂肪因子与MS的关系.对照组、非腹型肥胖MS组及腹型肥胖MS组的血清抵抗素和脂肪细胞型脂肪酸结合蛋白(A-FABP)依次增高,而脂联素水平依次降低(均P<0.05).MS组抵抗素与体重指数(BMI)、腰围、收缩压、空腹血糖和A-FABP呈正相关(P<0.05或P<0.01);脂联素与高密度脂蛋白胆固醇呈正相关,而与BMI、腰围、空腹胰岛素、甘油三酯、稳态模型评估的胰岛素抵抗指数(HOMA-IR)呈负相关.     

国内动态

南宁地区儿童青少年肥胖与代谢综合征相关的流行病学研究陈少科,罗静思,秦映芬,范歆,唐晴,冯莹中华流行病学杂志,2011,32(10):969-972.该文分析儿童青少年肥胖与代谢综合征(meta-bolicsyndrome,MS)相关性及危险因素。方法:采用分层整群随机抽样方法从南宁市396所中小学抽取14所学校6～18岁中小学生7893人,进行体格检查     

青少年代谢综合征与睡眠呼吸障碍的关系

背景与目的:代谢综合征是指一组糖和脂代谢异常,被认为是由胰岛素抵抗或中心性肥胖所致.代谢综合征在青少年中的发病率为4%～10%,其危险因素包括超重、男性、西班牙裔等.     

Abdominal obesity,chronic inflammation and the risk of non-alcoholic fatty liver disease

Introduction and ObjectivesThe purpose of this study was to evaluate the effect of abdominal obesity and chronic inflammation on risk of non-alcoholic fatty liver disease (NAFLD) among Chinese population.Materials and MethodsOverall, 50776 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed after examination. The correlations of waist-to-height ratio (WHtR) or serum high-sensitivity C-reactive protein (hs-crp) with NAFLD were analyzed. Then, we categorized all participants into four groups: non-abdominal obesity and non-chronic inflammation group, abdominal obesity and non-chronic inflammation group, non-abdominal obesity and chronic inflammation group, abdominal obesity and chronic inflammation group, and non-abdominal obesity and non-chronic inflammation group was used as a control group. The combined effects of abdominal obesity and chronic inflammation with NAFLD were analyzed using the Cox proportional hazard regression model.ResultsAfter a mean follow-up of 5.59±1.79 years, a total of 15451 NAFLD cases occurred. We found the WHtR and hs-crp increase the risk for NAFLD, respectively. Compared with the non-abdominal obesity and non-chronic inflammation group, the risk of NAFLD was significantly increased in the abdominal obesity and non-chronic inflammation group (HR 1.21, 95%CI 1.11-1.32), non-abdominal obesity and chronic inflammation group (HR 1.32, 95%CI 1.27-1.38), abdominal obesity and chronic inflammation group (HR 1.60, 95% CI 1.52-1.70). And, a significant interaction effect was found of abdominal obesity and chronic inflammation on NAFLD.ConclusionsIn this study, it was demonstrated in the Chinese population that both abdominal obesity and chronic inflammation increase the risk of NAFLD, and there is an interaction between the two factors in the incidence of NAFLD.     

Prevalence and secular changes in abdominal obesity in Canadian adolescents and adults, 1981 to 2007–2009

The purposes of this study were to: (i) provide contemporary estimates of the prevalence of abdominal obesity, as assessed by waist circumference (WC), in Canadian adolescents and adults; (ii) provide estimates of the prevalence of abdominal obesity within normal weight, overweight and obese body mass index categories and (iii) examine secular changes in abdominal obesity. Data were based on three national health surveys conducted in 1981, 1988 and 2007–2009. WC was measured at the mid‐point between the last rib and iliac crest in all three surveys. The prevalence of Canadians with abdominal obesity increased with age and was higher in females than in males. In 12‐ to 19‐year‐old adolescents, the estimated prevalence of abdominal obesity was 1.8% in 1981, 2.4% in 1988 and 12.8% in 2007–2009. The corresponding values for 20‐ to 69‐year‐old adults were 11.4%, 14.2% and 35.6%. Between 1981 and 2007–2009, mean WC values increased by 4.2 cm in adolescent males, 6.7 cm in adolescent females, 6.5 cm in men and 10.6 cm in women. Within the 2007–2009 survey, 2.6% of normal weight adults had abdominal obesity, 35.3% of overweight adults had abdominal obesity and 93.0% of obese adults had abdominal obesity.     

Racial/ethnic differences in prehypertension in American adults: population and relative attributable risks of abdominal obesity

To estimate the risk and population attributable risk of prehypertension that is due to abdominal obesity in White, Black and Hispanic American adults. To determine how much of the relative difference in the risk of prehypertension between high-risk Blacks and Hispanics and the low-risk group Whites that is attributable to their differences in abdominal obesity. Data (n=4016) from the 1999 to 2000 US National Health and Nutrition Examination Surveys were used in this study. Abdominal obesity was defined as waist circumference >/=102 and >/=88 cm in men and women, respectively. Prehypertension was defined as not being on antihypertensive medication and having systolic blood pressure of 120-139 mmHg or diastolic blood pressure of 80-89 mmHg. Odds ratio from the logistic regression analysis was used to estimate the risk of prehypertension that was due to abdominal obesity. To estimate prehypertension risk differences between low-risk Whites and high-risk Blacks and Hispanics that was due to abdominal obesity, we estimated relative attributable risk. Statistical adjustments were made for age, blood glucose, total cholesterol, current smoking and exercise. Abdominal obesity was associated with increased odds of prehypertension in Whites, Blacks and Hispanics. In men, abdominal obesity was associated with 44, 90 and 98% increased odds of prehypertension in Whites, Blacks and Hispanics, respectively. The corresponding values in women were 112, 198 and 104%. Proportions of risk of prehypertension explained by abdominal obesity were 15.2, 22 and 25.8% in White men, Black men and Hispanic men, respectively. The corresponding values in women were 38.8, 58.6 and 32.5%. Approximately, 7% of the differences in the risk of developing prehypertension between White and Black men and between White and Hispanic men may be attributable to differences in rates of abdominal obesity. The analogous values for women were approximately 39.7 and approximately 16.5%, respectively. In conclusion, despite having lower rates of abdominal obesity than their counterparts, Black men, Hispanic men and Hispanic women had high population attributable risks, indicating that factors other than abdominal obesity may have important explanatory power for racial differences in prehypertension in these groups. However, in Black women reduction in risk of prehypertension could be possible by instituting public health measures to reduce abdominal obesity to the levels seen in White women. Intervention programmes designed to reduce overall obesity may also lead to reduction of abdominal obesity, and consequently may curb prehypertension in these population groups. Life-style modification, including diet and exercise, may have public health significance in reducing the incidence of prehypertension in these populations.     

高尿酸血症与腹型肥胖的关系

研究表明,高尿酸血症和腹型肥胖密切相关,但其机制尚不十分清楚.本文在对比血尿酸与腹型肥胖评估指标关系的基础上,探讨了腹型肥胖引起高尿酸血症的可能成因,对内脏脂肪的蓄积和多种脂肪因子的分泌在参与高尿酸血症形成中的地位和研究进展予以了特别关注,从而为阐明高尿酸血症与腹型肥胖的关系,有效防治高尿酸血症提供了科学依据.     

高尿酸血症与腹型肥胖的关系

研究表明,高尿酸血症和腹型肥胖密切相关,但其机制尚不十分清楚.本文在对比血尿酸与腹型肥胖评估指标关系的基础上,探讨了腹型肥胖引起高尿酸血症的可能成因,对内脏脂肪的蓄积和多种脂肪因子的分泌在参与高尿酸血症形成中的地位和研究进展予以了特别关注,从而为阐明高尿酸血症与腹型肥胖的关系,有效防治高尿酸血症提供了科学依据.     

Abdominal obesity defined as a larger than expected waist girth is associated with racial/ethnic differences in risk of hypertension

OBJECTIVE: Waist circumference (WC) cut-points of > or =102 cm and > or =88 cm for men and women, respectively, representing abdominal obesity have been recommended for determining obesity related co-morbidities. However, these cut-points carry the component of generalised obesity estimated by body mass index (BMI). The aim of this investigation was to determine whether abdominal obesity free of the influence of overall heaviness is associated with increased risk of hypertension in a representative sample of white and black Americans. METHODS: Data (n = 11114) from the Third US National Health and Nutrition Examination Survey were used in this investigation. Standardised residual values from the linear regression of WC on BMI were used to define abdominal obesity status. The risk of hypertension associated with abdominal obesity was estimated from the logistic regression model, adjusting for age, smoking and alcohol. We also estimated the public health consequences of abdominal obesity from the population attributable fraction of hypertension. RESULTS: Relative to white, black race/ethnicity was associated with approximately 1.8 and approximately 2.7 greater risk of hypertension in men and women, respectively, adjusting for abdominal obesity, age, smoking and alcohol consumption. Having larger than expected waist girths were associated with 1.58 and 1.39 increased risk of hypertension in black men and black women, respectively, adjusting for confounders. Population attributable risks of hypertension due to abdominal obesity were approximately 24.9% and 15.9%, in black men and black women, respectively. CONCLUSIONS: In Americans, hypertension is a public health problem that is closely linked to abdominal adiposity. An important research challenge therefore is to determine the best way to regulate body weight under conditions of food abundance. There is a need to clarify how lifestyle habits promote large waist sizes leading to abdominal adiposity and associated cardiovascular disease in the US, particularly among black Americans.     

高尿酸血症与腹型肥胖的关系

研究表明,高尿酸血症和腹型肥胖密切相关,但其机制尚不十分清楚.本文在对比血尿酸与腹型肥胖评估指标关系的基础上,探讨了腹型肥胖引起高尿酸血症的可能成因,对内脏脂肪的蓄积和多种脂肪因子的分泌在参与高尿酸血症形成中的地位和研究进展予以了特别关注,从而为阐明高尿酸血症与腹型肥胖的关系,有效防治高尿酸血症提供了科学依据.     

Impact of hypertension, overall obesity and abdominal obesity on diabetes incidence in Shanghai residents with different glucose levels

The impact of hypertension, overall obesity and abdominal obesity, individually or collectively, on diabetes incidence over a period of 5 years in residents with different glucose levels is diverse, with abdominal obesity having an impact in both non-diabetic hyperglycaemia and normal groups.     

伴腹型肥胖的2型糖尿病患者的临床特点分析

目的:探讨伴腹型肥胖的2型糖尿病(T2DM)患者的临床特点。方法:选取T2DM住院患者171例,按腰围分为腹型肥胖组(AO组,男性>90 cm,女性>85 cm)和非腹型肥胖组(NAO组,男性≤90 cm,女≤85 cm),比较各组的糖代谢、脂代谢、新稳态模型(HOMA2)胰岛B细胞分泌指数(HOMA2-B)和胰岛素敏感性指数(HOMA2-S)。结果:AO组血压、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)、血糖和C肽(CP0、CP30、CP120)均较NAO组显著升高,而高密度脂蛋白胆固醇(HDL-C)、HOMA2-S则明显降低。结论:伴腹型肥胖的T2DM患者多伴TG水平升高,且血糖失控和胰岛素抵抗程度更重。     

腹型肥胖脑血栓患者阿司匹林抵抗的初步研究

目的探讨腹型肥胖脑血栓患者是否存在阿司匹林抵抗及其原因。方法选择病情稳定的脑血栓患者125例,根据腰围分为腹型肥胖组和非腹型肥胖组,测定两组的血小板聚集率、TNF-a、IL-6和C反应蛋白。Logistic多元回归分析用于评价阿司匹林抵抗和各种危险因素的联系程度。结果腹型肥胖组阿司匹林抵抗的发生率、TNF-a、IL-6和C反应蛋白均明显高于非腹型肥胖组（P〈0．05）,年龄、TNF—a、IL-6和C反应蛋白是脑血栓患者发生阿司匹林抵抗的独立危险因素。结论腹型肥胖脑血栓患者易发生阿司匹林抵抗,可能与患者体内的炎症介质增加有关,临床工作中要高度重视该类患者。