New obesity classification criteria as a tool for bariatric surgery indication
New obesity classification criteria as a tool for bariatric surgery indication
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DOI：
10.3748/wjg.v22.i2.681
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发表时间：
2016-01-14
影响因子：
4.3
通讯作者：
Di Renzo, Laura
中科院分区：
文献类型：
--
作者：
De Lorenzo, Antonino;Soldati, Laura;Di Renzo, Laura
肥胖在健康问题的发展中起着相关的病理生理作用，是遗传、营养和代谢等因素复杂相互作用的结果。由于脂肪组织在脂质和糖代谢中的作用，以及低度炎症，因此有必要根据身体脂肪的组成和分布来对肥胖进行分类，而不是简单地根据体重的增加和身体质量指数进行分类。脂肪病的新术语（“病态脂肪”）清楚地定义了脂肪组织的致病作用。肥胖个体有四种表型：(1)正常体重肥胖（NWO）；(2)代谢性肥胖，体重正常；(3)代谢健康型肥胖；(4)代谢不健康的肥胖或“危险”肥胖。此外，肌肉减少型肥胖与所有表型都有关。以代谢健康的正常体重为代表的正常体重瘦的类别已被分类，以区别于NWO。在推荐减肥手术时，要考虑到脂肪病和随着脂肪块扩大而发生的病态脂肪，改变患者的炎症和代谢特征，这一点至关重要。体脂率和基因多态性必须进行评估，以个性化最佳减肥手术干预。
Obesity plays relevant pathophysiological role in the development of health problems, arising as result of complex interaction of genetic, nutritional, and metabolic factors. Due to the role of adipose tissue in lipid and glucose metabolism, and low grade inflammation, it is necessary to classify obesity on the basis of body fat composition and distribution, rather than the simply increase of body weight, and the Body Mass Index. The new term of adiposopathy ("sick fat'') clearly defines the pathogenic role of adipose tissue. Four phenotypes of obese individuals have been described: (1) normal weight obese (NWO); (2) metabolically obese normal weight; (3) metabolically healthy obese; and (4) metabolically unhealthy obese or "at risk" obese. Moreover, sarcopenic obesity has been related to all the phenotypes. The category of normal weight lean, represented by metabolically healthy normal weight has been classified to distinguish from NWO. It is crucial to recommend a bariatric surgery taking into account adiposopathy and sick fat that occurs with the expansion of fat mass, changing the inflammatory and metabolic profile of the patient. Body fat percentage and genetic polymorphism have to be evaluated to personalize the best bariatric surgery intervention.