Ожирение как фактор риска заболеваний пищеварительной системы - Журнал Терапевтический архив №8 Вопросы лечения 2021
Ожирение как фактор риска заболеваний пищеварительной системы
Андреев Д.Н., Кучерявый Ю.А. Ожирение как фактор риска заболеваний пищеварительной системы. Терапевтический архив. 2021; 93 (8): 954–962. DOI: 10.26442/00403660.2021.08.200983
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Аннотация
В настоящее время глобальная распространенность ожирения среди взрослого населения мира составляет около 650 млн человек, что позволяет рассматривать данное хроническое заболевание обмена веществ как неинфекционную пандемию XXI в. Доказано, что ожирение ассоциировано с целым рядом заболеваний гастроэнтерологического профиля, при этом механизмы этих связей крайне гетерогенны и мультифакториальны. Гипертрофия и гиперплазия адипоцитов при ожирении приводят к изменению профиля продукции адипокинов (снижение адипонектина, повышение лептина), повышению продукции провоспалительных цитокинов (интерлейкин-1, 6, 8, фактор некроза опухоли α), С-реактивного белка, свободных жирных кислот, а также активных форм кислорода (супероксидные радикалы, H2O2). Все перечисленное индуцирует развитие хронического медленно прогрессирующего воспаления, оксидативного стресса, а также инсулинорезистентности. Помимо этого, пептиды, секретируемые адипоцитами (адипонектин, лептин, несфатин-1 и апелин), способны модулировать моторику желудочно-кишечного тракта, действуя как центрально, так и периферически. Наблюдаемые у пациентов с ожирением качественные и количественные изменения микробиоты кишечника (повышение Firmicutes и снижение Bacteroidetes) приводят к сокращению продукции короткоцепочечных жирных кислот и росту проницаемости кишечной стенки вследствие нарушения межклеточных плотных контактов, что ведет к повышенной транслокации бактерий и эндотоксинов в системный кровоток. Многочисленными исследованиями продемонстрирована ассоциация ожирения с заболеваниями пищевода (гастроэзофагеальная рефлюксная болезнь, пищевод Баррета, аденокарцинома пищевода, нарушения моторики пищевода), желудка (функциональная диспепсия, рак желудка), желчного пузыря (желчнокаменная болезнь, рак желчного пузыря), поджелудочной железы (острый панкреатит, рак поджелудочной железы), печени (неалкогольная жировая болезнь печени, гепатоцеллюлярная карцинома), кишечника (дивертикулярная болезнь, синдром раздраженного кишечника, колоректальный рак).
Ключевые слова: ожирение, избыточная масса тела, гастроэзофагеальная рефлюксная болезнь, пищевод Баррета, аденокарцинома пищевода, желчнокаменная болезнь, острый панкреатит, неалкогольная жировая болезнь печени, гепатоцеллюлярная карцинома, дивертикулярная болезнь, колоректальный рак
Keywords: obesity, overweight, gastroesophageal reflux disease, Barrett’s esophagus, esophageal adenocarcinoma, gallstone disease, acute pancreatitis, non-alcoholic fatty liver disease, hepatocellular carcinoma, diverticular disease, colorectal cancer
Ключевые слова: ожирение, избыточная масса тела, гастроэзофагеальная рефлюксная болезнь, пищевод Баррета, аденокарцинома пищевода, желчнокаменная болезнь, острый панкреатит, неалкогольная жировая болезнь печени, гепатоцеллюлярная карцинома, дивертикулярная болезнь, колоректальный рак
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Keywords: obesity, overweight, gastroesophageal reflux disease, Barrett’s esophagus, esophageal adenocarcinoma, gallstone disease, acute pancreatitis, non-alcoholic fatty liver disease, hepatocellular carcinoma, diverticular disease, colorectal cancer
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2. Kumar RB, Aronne LJ. Obesity. In.: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Ed. by M Feldman, LS Friedman, LJ Brandt. 11th ed. USA, Philadelphia, Saunders, 2020.
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4. Blüher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15(5):288-98. DOI:10.1038/s41574-019-0176-8
5. Haththotuwa RN, Wijeyaratne CN, Senarath Upul. Worldwide epidemic of obesity. Elsevier. 2020. DOI:10.1016/B978-0-12-817921-5.00001-1
6. WHO. Obesity and overweight (2021). Available at: https://www.who.int/news-room/factsheets/detail/obesity-and-overweight. Accessed: 20.05.2021.
7. Jia P, Zhang L, Yu W, et al. Impact of COVID-19 lockdown on activity patterns and weight status among youths in China: the COVID-19 Impact on Lifestyle Change Survey (COINLICS). Int J Obes (Lond). 2021;45(3):695-9. DOI:10.1038/s41366-020-00710-4
8. Katsoulis M, Pasea L, Lai AG, et al. Obesity during the COVID-19 pandemic: both cause of high risk and potential effect of lockdown? A population-based electronic health record study. Public Health. 2021;191:41-7. DOI:10.1016/j.puhe.2020.12.003
9. Senthilingam M. COVID-19 has made the obesity epidemic worse, but failed to ignite enough action. BMJ. 2021;372:n411. DOI:10.1136/bmj.n411
10. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2017 (GBD 2017) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2018.
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12. Van den Bussche H, Koller D, Kolonko T, et al. Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health. 2011;11:101. DOI:10.1186/1471-2458-11-101
13. Klatte J, Sperhake J, Gehl A, Püschel K. Obesity – comorbidities and causes of death. Arch Kriminol. 2015;236(1-2):31-42. PMID: 26399120
14. Schienkiewitz A, Mensink GB, Scheidt-Nave C. Comorbidity of overweight and obesity in a nationally representative sample of German adults aged 18-79 years. BMC Public Health. 2012;12:658. DOI:10.1186/1471-2458-12-658
15. Acosta A, Camilleri M. Gastrointestinal morbidity in obesity. Ann N Y Acad Sci. 2014;1311:42-56. DOI:10.1111/nyas.12385
16. Camilleri M, Malhi H, Acosta A. Gastrointestinal Complications of Obesity. Gastroenterology. 2017;152(7):1656-70.
DOI:10.1053/j.gastro.2016.12.052
17. Emerenziani S, Guarino MPL, Asensio TLM, et al. Role of Overweight and Obesity in Gastrointestinal Disease. Nutrients. 2019;12(1):111. DOI:10.3390/nu12010111
18. Karczewski J, Begier-Krasińska B, Staszewski R, et al. Obesity and the Risk of Gastrointestinal Cancers. Dig Dis Sci. 2019;64(10):2740-9. DOI:10.1007/s10620-019-05603-9
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Авторы
Д.Н. Андреев*1, Ю.А. Кучерявый2
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 АО «Ильинская больница», Красногорск, Россия
*dna-mit8@mail.ru
1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Ilyinsky Hospital, Krasnogorsk, Russia
*dna-mit8@mail.ru
1 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия;
2 АО «Ильинская больница», Красногорск, Россия
*dna-mit8@mail.ru
________________________________________________
1 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia;
2 Ilyinsky Hospital, Krasnogorsk, Russia
*dna-mit8@mail.ru
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