代谢健康型肥胖和代谢不健康型肥胖人群的心血管疾病风险研究现状

Research status of cardiovascular disease risk in metabolically healthy obesity and metabolically unhealthy obesity

摘要:

肥胖已被世界卫生组织(WHO)认定为一种全球性公共健康问题,并与2型糖尿病、高血压、血脂异常及心血管疾病(CVD)等代谢性疾病的风险增加密切相关。根据是否伴有代谢紊乱,肥胖人群可划分为代谢健康型肥胖(MHO)和代谢不健康型肥胖(MUO)。本综述旨在探讨MHO和MUO个体在病理生理机制、临床特征及心血管疾病(CVD)风险等方面的显著差异。与MHO个体相比,MUO个体表现出更明显的胰岛素抵抗、炎症持续状态及脂质异位积累,因而其CVD风险更高,需采取积极有效的干预措施。此外,越来越多的证据表明,MHO并非一种长期稳定的代谢状态,而可能向MUO转变,因此其长期CVD风险仍不容忽视。本文还讨论了MHO与MUO代谢异质性的潜在机制,包括遗传及环境因素对脂肪组织分布和功能的调控,以及生活方式干预在改善代谢健康方面的潜在作用。未来研究应进一步深入探索MHO和MUO的病理生理基础,以期早期识别肥胖相关CVD风险,并制定有效的预防和治疗策略。

Abstract:

Obesity has been recognized by the World Health Organization (WHO) as a global public health issue and is closely associated with an increased risk of metabolic diseases such as type 2 diabetes, hypertension, dyslipidemia, and cardiovascular disease (CVD). Based on the presence or absence of metabolic abnormalities, obese individuals can be categorized into metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO). This review aims to explore the significant differences between MHO and MUO individuals in terms of pathophysiological mechanisms, clinical characteristics, and cardiovascular disease risk. Compared to those with MHO, MUO individuals exhibit more pronounced insulin resistance, persistent state of inflammation, and ectopic lipid accumulation, resulting in a higher risk of CVD and necessitating active and effective interventions. Furthermore, growing evidence suggests that MHO is not a stable long-term metabolic condition but may transition to MUO; hence, its long-term CVD risk should not be overlooked.This article also discusses the potential mechanisms underlying metabolic heterogeneity in MHO and MUO, including the regulation of adipose tissue distribution and function by genetic and environmental factors, as well as the potential role of lifestyle interventions in improving metabolic health. Future research should further investigate the pathophysiological basis of MHO and MUO to facilitate early identification of obesity-related CVD risk and develop effective prevention and treatment strategies.