Behandlung der Adipositas bei Diabetes mellitus

Visceral obesity represents a risk in the development of a metabolic syndrome and type 2 diabetes mellitus. An increase both in the prevalence of obesity and type 2 diabetes mellitus may be observed not only in Germany but worldwide. One important treatment element of obesity and the metabolic syndrome are psycho-educative measures to change the life style with the goal of inducing a change in nutritional intake (a reasonable energy-reduced, low-fat nutritional balance), weight reduction and an improvement in metabolic status. However, the mean and long-term results of conservative weight reduction programs especially in people with diabetes mellitus are inadequate. The adjuvant application of weight-reducing medication may be applied to support psycho-educative measures. If a distinct improvement of the metabolic status (HbA1c < 6.5%) can not be achieved, an oral application of antidiabetica is indicated. Obesity surgery is, as a rule, the method of choice for people with type 2 diabetes mellitus and obesity grade 2 3. In contrast to conservative measures, surgical procedures lead to an improvement of metabolic and cardiovascular parameters as well as the quality of life.     

The Obese Person as an Adolescent

Obesity constitutes a major health problem in the United States. Hypertension, atherosclerosis, coronary artery disease, diabetes and gout are often associated with obesity and may be a direct result of persistent obesity in adult life.Obesity frequently has its beginnings in childhood and adolescence. Unfortunately, obesity which develops in early life is a progressive problem. Eighty per cent of overweight children and adolescents will continue to be overweight as adults.¹² Furthermore, adults with a history of obesity in childhood are the most resistant to treatment.Recent studies have shown there is more than one body constitutional type among obese adolescents. Obese adolescents tend to eat less than non-obese controls. While obesity may be found to have many different causative factors, efforts to control this disease may be most successful in the area of primary prevention.     

Control of metabolism by nutrient-regulated nuclear receptors acting in the brain

Today, we are witnessing a rising incidence of obesity worldwide. This increase is due to a sedentary life style, an increased caloric intake and a decrease in physical activity. Obesity contributes to the appearance of type 2 diabetes, dyslipidemia and cardiovascular complications due to atherosclerosis, and nephropathy. Therefore, the development of new therapeutic strategies may become a necessity. Given the metabolism controlling properties of nuclear receptors in peripheral organs (such as liver, adipose tissues, pancreas) and their implication in various processes underlying metabolic diseases, they constitute interesting therapeutic targets for obesity, dyslipidemia, cardiovascular disease and type 2 diabetes. The recent identification of the central nervous system as a player in the control of peripheral metabolism opens new avenues to our understanding of the pathophysiology of obesity and type 2 diabetes and potential novel ways to treat these diseases. While the metabolic functions of nuclear receptors in peripheral organs have been extensively investigated, little is known about their functions in the brain, in particular with respect to brain control of energy homeostasis. This review provides an overview of the relationships between nuclear receptors in the brain, mainly at the hypothalamic level, and the central regulation of energy homeostasis. In this context, we will particularly focus on the role of PPARα, PPARγ, LXR and Rev-erbα.     

Adipose tissue macrophage in immune regulation of metabolism

The prevalence of obesity and type 2 diabetes is escalating to an epidemic proportion worldwide.Obesity is known to be associated with a state of chronic,low-grade inflammation.Emerging lines of evidence have shown that both innate and adaptive immune responses play crucial roles in the control of metabolic homeostasis.Macrophages in adipose tissues are the essential effector cells in orchestrating metabolic inflammation,which is thought to promote the pathogenic progression of obesity and obesity-related disorders.Here we discuss our current understanding of the distinct modes of activation of adipose tissue macrophages,which can sense the metabolic cues and exert profound effects upon adipose homeostasis.Targeting macrophages in adipose tissues may provide new avenues for developing immunomodulation-based therapeutics against obesity and obesity-associated metabolic diseases.     

Decreased energy levels can cause and sustain obesity

Obesity has reached epidemic proportions and has become one of the major health problems in developed countries. Current theories consider obesity a result of overeating and sedentary life style and most efforts to treat or prevent weight gain concentrate on exercise and food intake. This approach does not improve the situation as may be seen from the steep increase in the prevalence of obesity. This encouraged us to reanalyse existing information and look for biochemical basis of obesity. Our approach was to ignore current theories and concentrate on experimental data which are described in scientific journals and are available from several databases. We developed and applied a Knowledge Discovery in Databases procedure to analyse metabolic data. We began with the contradictory information: in obesity, more calories are consumed than used up, suggesting that obese people should have excess energy. On the other side, obese people experience fatigue and decreased physical endurance that indicates diminished energy supply in the body. The result of our work is a chain of metabolic events leading to obesity. The crucial event is the inhibition of the TCA cycle at the step of aconitase. It disturbs energy metabolism and results in ATP deficiency with simultaneous fat accumulation. Further steps in obesity development are the consequences of diminished energy supply: inhibition of beta-oxidation, leptin resistance, increase in appetite and food intake and a decrease in physical activity. Thus, our theory shows that obesity does not have to be caused by overeating and sedentary life-style but may be the result of the "obese" change in metabolism which is forcing people to overeat and save energy to sustain metabolic functions of cells. This "obese" change is caused by environmental factors that activate chronic low-grade inflammatory process in the body linking obesity with the environment of developed countries.     

Fat cell turnover in humans

Obesity is a condition where excess body fat accumulates to such an extent that one’s health may be affected. Owing to the cardiovascular and metabolic disorders associated with obesity, and the epidemic of obesity facing most countries today, life expectancy in the developed world may start to decrease for the first time in recent history. Other conditions, such as anorexia nervosa and cachexia, are characterised by subnormal levels of adipose tissue and as with obesity lead to morbidity and mortality. Given the significant personal and economic costs of these conditions and their increasing prevalence in society, understanding the factors that determine the fat mass is therefore of prime interest and may lead to effective treatments and/or interventions for these disorders. Fat mass can be regulated in two ways. The lipid filling of pre-existing fat cells could be altered and the number of fat cells could be changed by the generation of new fat cells or the dying of old ones (i.e. adipocyte turnover). This review summarizes what is known about fat cell turnover in humans and the potential clinical implications.     

Genetic aspects of susceptibility to obesity and related dyslipidemias

Obesity has a multifactorial origin. However, although environmental variables undoubtedly play a role in the development of obesity, it is now clear that genetic variation is also involved in the determination of an individual's susceptibility to body fat accumulation. In addition, it is also widely accepted that obesity is not a single homogeneous phenotype. It is also heterogeneous regarding its causes and metabolic complications. The regional distribution of body fat appears to be an important correlate of the metabolic complications that have been related to obesity. Due to their higher accumulation of abdominal fat, men are generally more at risk for the metabolic complications of obesity than women whereas some obese women, with large gluteal-femoral adipose depots may have a cosmetic problem which may not necessarily require medical intervention. Several studies have been conducted to understand the mechanisms by which abdominal obesity is related to diabetes, hypertension and cardiovascular disease. It appears that the increased risk of abdominal obesity is the result of complex hormonal and metabolic interactions. Studies in genetic epidemiology have shown that both total body fatness and the regional distribution of body fat have a significant genetic component. Standardized intervention studies using an identical twin design have shown that individuals that have the same genetic background tend to show similar changes in body fat and in plasma lipoprotein levels when exposed to standardized caloric excess or energy restriction. Finally, although abdominal obesity is a significant risk factor for cardiovascular disease, not every abdominal obese subject will experience metabolic complications, suggesting that some obese individuals may be more susceptible than others. Variation in several genes relevant to lipid and lipoprotein metabolism may alter the relation of abdominal obesity to dyslipoproteinemias. Abdominal obesity should therefore be considered as a factor that exacerbates an individual's susceptibility to cardiovascular disease.     

Developmental programming by maternal obesity in 2015: Outcomes,mechanisms, and potential interventions

This article is part of a Special Issue “SBN 2014”.Obesity in women of child-bearing age is a growing problem in developed and developing countries. Evidence from human studies indicates that maternal BMI correlates with offspring adiposity from an early age and predisposes to metabolic disease in later life. Thus the early life environment is an attractive target for intervention to improve public health. Animal models have been used to investigate the specific physiological outcomes and mechanisms of developmental programming that result from exposure to maternal obesity in utero. From this research, targeted intervention strategies can be designed. In this review we summarise recent progress in this field, with a focus on cardiometabolic disease and central control of appetite and behaviour. We highlight key factors that may mediate programming by maternal obesity, including leptin, insulin, and ghrelin. Finally, we explore potential lifestyle and pharmacological interventions in humans and the current state of evidence from animal models.     

Thinking Evolutionarily About Obesity

Obesity, diabetes, and metabolic syndrome are growing worldwide health concerns, yet their causes are not fully understood. Research into the etiology of the obesity epidemic is highly influenced by our understanding of the evolutionary roots of metabolic control. For half a century, the thrifty gene hypothesis, which argues that obesity is an evolutionary adaptation for surviving periods of famine, has dominated the thinking on this topic. Obesity researchers are often not aware that there is, in fact, limited evidence to support the thrifty gene hypothesis and that alternative hypotheses have been suggested. This review presents evidence for and against the thrifty gene hypothesis and introduces readers to additional hypotheses for the evolutionary origins of the obesity epidemic. Because these alternate hypotheses imply significantly different strategies for research and clinical management of obesity, their consideration is critical to halting the spread of this epidemic.     

Early intake of long-chain polyunsaturated fatty acids preserves brain structure and function in diet-induced obesity

Worldwide, the incidence of obesity is increasing at an alarming rate, and the number of children with obesity is especially worrisome. These developments raise concerns about the physical, psychosocial and cognitive consequences of obesity. It was shown that early dietary intake of arachidonic acid (ARA) and docosahexaenoic acid (DHA) can reduce the detrimental effects of later obesogenic feeding on lipid metabolism and adipogenesis in an animal model of mild obesity. In the present study, the effects of early dietary ARA and DHA on cognition and brain structure were examined in mildly obesogenic ApoE*3Leiden mouse model. We used cognitive tests and neuroimaging during early and later life. During their early development after weaning (4–13 weeks of age), mice were fed a chow diet or ARA and DHA diet for 8 weeks and then switched to a high-fat and high-carbohydrate (HFHC) diet for 12 weeks (14–26 weeks of age). An HFHC-diet led to increased energy storage in white adipose tissue, increased cholesterol levels, decreased triglycerides levels, increased cerebral blood flow and decreased functional connectivity between brain regions as well as cerebrovascular and gray matter integrity. ARA and DHA intake reduced the HFHC-diet-induced increase in body weight, attenuated plasma triglycerides levels and improved cerebrovasculature, gray matter integrity and functional connectivity in later life. In conclusion, an HFHC diet causes adverse structural brain and metabolic adaptations, most of which can be averted by dietary ARA and DHA intake early in life supporting metabolic flexibility and cerebral integrity later in life.     

Obesity alters the ovarian glucidic homeostasis disrupting the reproductive outcome of female rats

Obesity constitutes a health problem of increasing worldwide prevalence related to many reproductive problems such as infertility, ovulation dysfunction, preterm delivery, fetal growth disorders, etc. The mechanisms linking obesity to these pathologies are not fully understood. Cafeteria diet (CAF) is the animal model used for the study of obesity that more closely reflects western diet habits. Previously we described that CAF induces obesity associated to hyperglycemia, reduced ovarian reserve, presence of follicular cysts and ovulatory impairments. The aim of the present study was to contribute in the understanding of the physiological mechanisms altered as consequence of obesity. For that purpose, female Wistar rats were fed ad libitum with a standard diet (control group) or CAF (Obese group). We found that CAF fed-rats developed obesity, glucose intolerance and insulin resistance. Ovaries from obese rats showed decreased glucose uptake and became insulin resistant, showing decreased ovarian expression of glucotransporter type 4 and insulin receptor gene expression respect to controls. These animals showed an increased follicular nitric oxyde synthase expression that may be responsible for the ovulatory disruptions and for inflammation, a common feature in obesity. Obese rats resulted subfertile and their pups were macrosomic. We conclude that obesity alters the systemic and the ovarian glucidic homeostasis impairing the reproductive outcome. Since macrosomia is a risk factor for metabolic and obstetric disorders in adult life, we suggest that obesity is impacting not only on health and reproduction but it is also impacting on health and reproduction of the offspring.     

高脂饮食诱导肥胖易感和肥胖抵抗的表型差异

超重与肥胖是许多代谢相关疾病的危险因素,严重威胁人类健康和生命。通常认为肥胖的发生是遗传因素与环境因素相互作用的结果。在构建饮食性肥胖模型过程中,动物常出现两种截然不同的表型,即肥胖易感和肥胖抵抗。既往研究主要基于体重、体成分、物质与能量代谢、行为学（如摄食偏好）等探讨肥胖易感型和肥胖抵抗型表型差异,然而其内部调控机制,仍没有较为明确而系统的阐述。本文在综述表型特征的基础上,从脂质代谢、胃肠道激素水平和肠道炎症、肠道微生物群和肠-脑轴信号通路、下丘脑-垂体-甲状腺轴、下丘脑弓状核食欲调节系统功能改变以及表观遗传学等方面探讨高脂饮食诱导肥胖表型差异的可能机制。     

Postprandial consequences of lipid absorption in the onset of obesity: Role of intestinal CD36

Obesity has reached epidemic proportions and its incidence is still increasing. Obesity is an excess of fat, which can have harmful consequences such as inflammation, insulin resistance or dyslipidemia. Taken together, these conditions are known as metabolic syndrome (MetS). More and more studies consider obesity from a postprandial perspective: parameters such as triglyceridemia, endotoxemia or hormone secretion may have deeper postprandial metabolic consequences than during the fasting state. These effects take even more importance when we consider that humans spend more than half of the day in a postprandial state. This review focuses on the postprandial state in a fat-enriched diet and on the consequences of intestinal lipid absorption, putting the intestine in a central place in the development of obesity / MetS. Finally, we describe the crucial role of the lipid receptor cluster of differentiation 36 (CD36) for gut lipid absorption and the alterations that occur in CD36 dysfunction.     

Obesity and vulnerability of the CNS

The incidence of obesity is increasing worldwide, and is especially pronounced in developed western countries. While the consequences of obesity on metabolic and cardiovascular physiology are well established, epidemiological and experimental data are beginning to establish that the central nervous system (CNS) may also be detrimentally affected by obesity and obesity-induced metabolic dysfunction. In particular, data show that obesity in human populations is associated with cognitive decline and enhanced vulnerability to brain injury, while experimental studies in animal models confirm a profile of heightened vulnerability and decreased cognitive function. This review will describe findings from human and animal studies to summarize current understanding of how obesity affects the brain. Furthermore, studies aimed at identifying key elements of body-brain dialog will be discussed to assess how various metabolic and adipose-related signals could adversely affect the CNS. Overall, data suggest that obesity-induced alterations in metabolism may significantly synergize with age to impair brain function and accelerate age-related diseases of the nervous system. Thus, enhanced understanding of the effects of obesity and obesity-related metabolic dysfunction on the brain are especially critical as increasing numbers of obese individuals approach advanced age.     

OB gene not linked to human obesity in Mexican American affected sib pairs from Starr County,Texas

Obesity is a highly prevalent disease, which is associated with a number of chronic conditions and, as such, represents a major public health burden. Numerous studies indicate that there is a genetic component contributing to interindividual variability in obesity. The discovery of the ob gene in mice, mutations in which produce extreme obesity and non-insulin-dependent diabetes mellitus (NIDDM), provides a prime candidate gene for human obesity. We investigated linkage between the human OB gene and obesity in a sample of Mexican Americans from Starr County, Texas. Markers D7S635 and D7S1875, estimated to lie within a region approximately 290 to 400 kb proximal to the OB gene, were used to genotype 177 obese individuals distributed in 64 sibships. Obesity was defined as a body mass index (BMI) above 30 kg/m². Linkage analyses for affected sibling pairs provided no evidence for linkage in this sample. In addition, differences between siblings for weight, BMI, systolic and diastolic blood pressure, percent body fat, waist-to-hip ratio, and blood lipid measures were not significantly related to number of alleles shared identical by state (IBS) for either of the two markers. While the OB gene may be involved in the metabolic sequences leading to obesity, the present linkage results do not support the existence of common genetic variation at or near the OB locus that increases risk for human obesity. Received: 17 April 1996 / Revised: 18 June 1996     

Genetic Obesity Affects Neural Ketone Body Utilization in the Rat Brain

Obesity causes various physiological disorders between the central nervous system and peripheral tissues. Ketone bodies have a neuro‐protective role and are strongly affected by obesity‐related metabolic disorders. To clarify the effects of obesity on ketone body utilization in brain, we examined the mRNA localization of acetoacetyl‐CoA synthetase (AACS), which activates ketone bodies for the synthesis of fatty acid and cholesterol, in various brain regions of Zucker fatty rats by in situ hybridization. The AACS mRNA level was increased in the paraventricular thalamic nucleus (PVT) but not affected in the cerebrum and hippocampus in Zucker fatty rats. In contrast, the AACS mRNA level was reduced in the arcuate hypothalamic nucleus (Arc) and ventromedial hypothalamic nucleus (VMH) in the hypothalamus. Succinyl‐CoA:3‐oxoacid CoA‐transferase (SCOT) mRNA level was decreased only in the PVT but not affected in the Arc and VMH. These data raise the possibility that AACS is regulated by the leptin signaling pathway in the hypothalamus but not in the PVT. As AACS was expressed in neural‐like cells, ketone bodies are assumed to be utilized for the synthesis of lipidic substances and to cause metabolic disorders in the nervous system.     

Diet-induced metabolic disturbances as modulators of brain homeostasis

A number of metabolic disturbances occur in response to the consumption of a high fat western diet. Such metabolic disturbances can include the progressive development of hyperglycemia, hyperinsulemia, obesity, metabolic syndrome, and diabetes. Cumulatively, diet-induced disturbances in metabolism are known to promote increased morbidity and negatively impact life expectancy through a variety of mechanisms. While the impact of metabolic disturbances on the hepatic, endocrine, and cardiovascular systems is well established there remains a noticeable void in understanding the basis by which the central nervous system (CNS) becomes altered in response to diet-induced metabolic dysfunction. In particular, it remains to be fully elucidated which established features of diet-induced pathogenesis (observed in non-CNS tissues) are recapitulated in the brain, and identification as to whether the observed changes in the brain are a direct or indirect effect of peripheral metabolic disturbances. This review will focus on each of these key issues and identify some critical experimental questions which remain to be elucidated experimentally, as well as provide an outline of our current understanding for how diet-induced alterations in metabolism may impact the brain during aging and age-related diseases of the nervous system.     

Maternal Obesity Caused by Overnutrition Exposure Leads to Reversal Learning Deficits and Striatal Disturbance in Rats

Maternal obesity caused by overnutrition during pregnancy increases susceptibility to metabolic risks in adulthood, such as obesity, insulin resistance, and type 2 diabetes; however, whether and how it affects the cognitive system associated with the brain remains elusive. Here, we report that pregnant obesity induced by exposure to excessive high fatty or highly palatable food specifically impaired reversal learning, a kind of adaptive behavior, while leaving serum metabolic metrics intact in the offspring of rats, suggesting a much earlier functional and structural defects possibly occurred in the central nervous system than in the metabolic system in the offspring born in unfavorable intrauterine nutritional environment. Mechanically, we found that above mentioned cognitive inflexibility might be associated with significant striatal disturbance including impaired dopamine homeostasis and disrupted leptin signaling in the adult offspring. These collective data add a novel perspective of understanding the adverse postnatal sequelae in central nervous system induced by developmental programming and the related molecular mechanism through which priming of risk for developmental disorders may occur during early life.     

Suppression of fat deposition for the life time with gene therapy

Unexpended energy is stored as fat in the body and increased rate of fat accretion culminates in obesity. Obesity increases the risks of many diseases several folds and shortens life span. A progressive deficit in the central feedback effects of leptin, a peptide produced by fat cells and hypothalamus, results in increased weight gain and obesity. This article summarizes our experimental findings to show that a stable increase in leptin availability in the hypothalamus alone with the aid of leptin gene therapy suppresses fat accretion and metabolic hormones for nearly the lifetime of laboratory rodents. Consequently, central leptin gene therapy is a novel modality that offers a viable therapeutic option to reduce fat depots and attendant metabolic sequelae implicated in obesity-related illnesses.     

Endocrine disrupting chemicals and the developmental programming of adipogenesis and obesity

Obesity and related disorders are a burgeoning public health epidemic, particularly in the U.S. Currently 34% of the U.S. population is clinically obese (BMI > 30) and 68% are overweight (BMI > 25), more than double the worldwide average and 10-fold higher than Japan and South Korea. Obesity occurs when energy intake exceeds energy expenditure; however, individuals vary widely in their propensity to gain weight and accrue fat mass, even at identical levels of excess caloric input. Clinical, epidemiological, and biological studies show that obesity is largely programmed during early life, including the intrauterine period. The environmental obesogen hypothesis holds that prenatal or early life exposure to certain endocrine disrupting chemicals can predispose exposed individuals to increased fat mass and obesity. Obesogen exposure can alter the epigenome of multipotent stromal stem cells, biasing them toward the adipocyte lineage at the expense of bone. Hence, humans exposed to obesogens during early life might have an altered stem cell compartment, which is preprogrammed toward an adipogenic fate. This results in a higher steady state number of adipocytes and potentially a lifelong struggle to maintain a healthy weight, which can be exacerbated by societal influences that promote poor diet and inadequate exercise. This review focuses on the developmental origins of the adipocyte, the relationship between adipocyte number and obesity, and how obesogenic chemicals may interfere with the highly efficient homeostatic mechanisms regulating adipocyte number and energy balance.