Obesity epidemic: overview, pathophysiology, and the intensive care unit conundrum.
Obesity epidemic: overview, pathophysiology, and the intensive care unit conundrum.
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DOI：
10.1177/0148607111415110
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发表时间：
2011-09-01
期刊：
影响因子：
--
通讯作者：
Kaplan, Lee M
中科院分区：
文献类型：
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作者：
Hurt, Ryan T;Frazier, Thomas H;Kaplan, Lee M
肥胖是美国可预防死亡的主要原因之一，仅次于吸烟。据估计，每年因肥胖死亡的人数高达40万人。近70%的美国成年人口超重或肥胖。对肥胖的历史观点认为它是一种生活方式选择或性格缺陷。然而，考虑到对肥胖及其相关并发症的发展的新兴研究，我们的观点正在改变。现在很清楚，肥胖是一种具有许多不同亚型的异质性疾病，这涉及到遗传和环境因素之间的相互作用。目前肥胖症的流行是肥胖环境(包括高能量食物和缺乏体力活动)的结果，这些人具有患肥胖症的遗传易感性。与体重增加相关的病理生理学比最初认为的要复杂得多。这种疾病的异质性使得制定肥胖症的治疗策略变得困难。一般来说，肥胖与全因死亡率和特定原因死亡率(心血管、糖尿病、肝脏和肿瘤原因)的增加有关。然而，尽管总体死亡率上升，但目前的证据表明，当这些患者进入重症监护病房(ICU)时，肥胖对死亡率提供了一些保护。目前，对于这一危重疾病中的肥胖难题，还没有明确的解释。
Obesity is one of the leading causes of preventable death in the United States, second only to smoking. The annual number of deaths attributed to obesity is estimated to be as high as 400,000. Nearly 70% of the adult U.S. population is overweight or obese. The historical viewpoint toward obesity has deemed it to be a lifestyle choice or characterological flaw. However, given the emerging research into the development of obesity and its related complications, our perspective is changing. It is now clear that obesity is a heterogeneous disease with many different subtypes, which involves an interplay between genetic and environmental factors. The current epidemic of obesity is the result of an obesogenic environment (which includes energy-dense foods and a lack of physical activity) in individuals who have a genetic susceptibility for developing obesity. The pathophysiology associated with weight gain is much more complex than originally thought. The heterogeneous nature of the disease makes the development of treatment strategies for obesity difficult. Obesity in general is associated with increased all-cause mortality and cause-specific mortality (from cardiovascular, diabetic, hepatic, and neoplastic causes). Yet despite increased overall mortality rates, current evidence suggests that when these same patients are admitted to the intensive care unit (ICU), the obesity provides some protection against mortality. At present, there is no clear explanation for this obesity conundrum in critical illness.