肥胖专家呼吁关注内脏肥胖和肝脏脂肪

Obesity Experts Urge Focus on Visceral Adiposity, Fat in Liver

肥胖专家呼吁关注内脏型肥胖，肝脏中的脂肪

 

March 4, 2011 ? Measures of excess visceral adiposity and liver fat are better indicators of impaired plasma glucose homeostasis and cardiometabolic risk than BMI. And excess fat appears to accumulate more quickly ? and with potentially more dire consequences ? in Asians than in other ethnic groups.海南医学院附属医院内分泌科王新军

2011年3月4日，与BMI相比，测量过多的内脏脂肪和肝脏脂肪是血糖稳态受损和代谢危险的更好指标。亚洲人与其他族裔群体相比，多余的脂肪积聚更快，潜在的后果更严重。

These findings, from the largest international study to date on abdominal obesity, were presented here at the 2nd International Congress on Abdominal Obesity. The study involved 4504 patients in 29 countries across a wide range of ethnicities.

这是一项迄今为止最大的关于腹型肥胖的国际研究，研究结果公布于第二届国际腹型肥胖大会上。该研究涉及29个国家多个种族，共4504例患者。

"," principal investigator Jean-Pierre Després, PhD, FAHA, from Laval University in Québec City, Quebec, told Medscape Medical News in an interview. "It"s clear we need to seriously redefine what it means to be overweight and obese."

主要研究者魁北克市拉瓦勒大学的Jean-Pierre Després博士，在接受Medscape医学新闻采访时说：“很显然，我们需要认真地重新定义什么是超重和肥胖。”

 

The study, known as the International Study of Prediction of Intra-Abdominal Adiposity and its Relationships With Cardiometabolic Risk/Intra-Abdominal Adiposity (INSPIRE ME IAA), is the first large international study to use standardized cardiometabolic data and computed tomography (CT) imaging to assess risk in people with impaired plasma glucose homeostasis but no diagnosis of type 2 diabetes.

这项研究被称为国际腹内脂肪和心血管代谢的风险关系预测/内脏型肥胖（(INSPIRE ME IAA）研究，是第一个使用标准化的心脏代谢数据和计算机断层扫描（CT）成像评估糖稳态受损但无糖尿病人群的大型国际研究。

 

 

 "We found a strong relationship between the presence of visceral fat and liver fat, regardless of ethnicity," Dr. Després said. "We also found a steeper increase in visceral fat, with a concomitant increase in BMI, in Asians [than in whites]. In other words, Asians tend to have more visceral fat at lower BMI values."

“我们发现不论在哪个种族，内脏脂肪和肝脏脂肪之间存在很强的相关性” Després博士说。“我们还发现，与白人相比，伴随着体重指数的增加，亚洲人内脏脂肪呈直线增加。换言之，亚洲人在较低的BMI值时倾向有更多的内脏脂肪。”

When presenting the findings, the investigators did not report the precise magnitude of that difference, but Dr. Després said anecdotally that researchers found Asians with a BMI of 23 kg/m² who had the same amount of visceral fat as whites with a BMI of 27 to 28 kg/m².

研究人员没有报告差异的精确程度，但Després博士说，研究者们发现，体重指数23 kg/m2的亚洲人与体重指数为27~28 kg/m2的白人内脏脂肪量相同。

"The greater susceptibility to visceral fat deposition in Asians also resulted in a greater accumulation of liver fat, and that led to several metabolic abnormalities," he said.

“亚洲人内脏脂肪沉积易感性较强的结果是更多的肝脏脂肪堆积，导致代谢异常，”他说。

"It"s clear that Asians cannot afford to gain weight because they will put on more visceral fat, more liver fat, and, as a consequence, they will be at greater risk of developing type 2 diabetes than whites with the same BMI."

“很明显，亚洲人不能承受体重的增加，因为他们将会有更多的内脏脂肪，更多的肝脏脂肪，而且，结果是，他们与体重指数相同的白人相比，将面临更大的发展为2型糖尿病的风险。”

He noted that the observation is especially noteworthy because sedentary lifestyles are becoming increasingly common among Asians as modernization sweeps the world, especially China. "Given what we saw in terms of ethnic risk factors," he said, "the cardiovascular effects of modernization on that population could be devastating."

他指出，这项研究重要是因为随着现代化席卷全球，久坐不动的生活方式在亚洲人尤其是中国正越来越普遍。 “由于我们所看到的种族危险因素”他说，“对现代化人口的心血管影响可能是灾难性的。”

 

Peter Libby, MD, chief of cardiovascular medicine at Harvard Medical School in Boston, Massachusetts, said that elucidating ethnic differences is vitally important.

马萨诸塞州波士顿哈佛医学院心血管内科主任Peter Libby博士说，阐明种族差异是非常重要的。

Another important finding of the study is that statins do not seem to significantly blunt the cardiovascular risks for excess visceral fat or fat in the liver. This was true in patients with and without type 2 diabetes.

这项研究的另一个重要发现是，他汀类药物似乎并不明显减少过量的内脏脂肪或肝脏中脂肪的心血管风险。这在2型糖尿病患者或非2型糖尿病患者均是如此。

Clinicians tend to treat complications of excess fat accumulation in isolation ? including hypertension, dyslipidemia, type 2 diabetes, and cardiovascular disease ? rather than focusing on the root of the problem, Dr. Després said. "It is increasing clear that the primary cause of many of those issues is accumulation of excess body fat stored in the abdominal cavity and in the liver ? even in patients who are only what we think of as "moderately" overweight."

临床医生倾向于治疗过多脂肪堆积的单个并发症：包括高血压、血脂异常、2型糖尿病和心血管疾病，而不是针对问题的根源，Després博士说。“问题越来越明显，许多问题的主要原因是体内多余的脂肪堆积在腹腔和肝脏，即使是在我们认为仅仅是中度超重的患者。”

Dr. Després emphasized that primary care physicians should make sure they measure waist circumference when conducting physical exams and evaluating patients for diseases associated excess weight.

Després博士强调，基层医师在进行体格检查和评估疾病相关的超重时应测量腰围腰围。

When high BMIs are coupled with high levels of fasting triglycerides, the effects on cardiovascular risk are even more elevated, Dr. Després said. "We know that people with BMIs around 27 kg/m² who also have elevated fasting triglycerides have about an 80% chance of harboring excess adipose tissue in the abdomen, as well as in the liver."

当高BMI与空腹甘油三酯水平升高同时存在时，对心血管风险的影响更大，Després博士说。 “我们知道， BMI在27 kg/m2左右的人群其空腹甘油三酯特升高，其腹内脂肪和肝脏脂肪过多的几率超过80%。”

 

Dr. Després emphasized that much more work needs to be done to determine the impact of excess body weight. In commenting on the study, Dr. Libby emphasized its importance, but echoed Dr. Després" caution that a limitation of the study is its use of biomarkers to measure risk rather than hard end points.

Després博士强调，需要进行更多的工作以确定超重的影响。在对本文的评论中，Libby博士强调其重要性，但Després博士认为这项研究的局限性是它使用的是生物标志物来衡量其风险，而不是硬终点。

Another limitation is that it failed to include large numbers of blacks. He noted that a study that did include a sizable cohort of black subjects clearly demonstrated that blacks carry many of the same risks as other groups, such as Asians, and in some cases their risks were greater (J Am Coll Cardiol. 2004;44:1011-1017).

另一个限制是，它没有包括大量的黑人。他注意到一项包括较大数量的黑人的队列研究清楚地表明，黑人具有其他群体如亚洲人，同样多的风险，在某些情况下，它们的风险更大（J Am Coll Cardiol. 2004;44:1011-1017）。

 

2nd International Congress on Abdominal Obesity (ICAO). Presented February 26, 2011.