Obesity and Diabetes
http://www.100md.com
《新英格兰医药杂志》
During the past two decades, diabetes has become one of the most important public health problems — a consequence of increasing awareness and a dramatic increase in the number of people who receive a diagnosis of type 2 diabetes. It is not simply excessive body fat but also the distribution of fat that influences glucose metabolism through independent, yet additive, mechanisms. As upper-body obesity increases, so does insulin resistance, which results in increases in plasma levels of glucose and insulin. What is meant by "naturally fat" is uncertain. There is a continuing debate about the effect of genes and the environment on obesity and type 2 diabetes — "nature or nurture."
Evolution suggests the inevitability of the passage of "thrifty genes" from generation to generation, providing protection during times of famine but predisposing the carriers of these genes to obesity and type 2 diabetes in times of plenty. Intriguingly, a contrasting theory suggests that undernutrition of the developing fetus, independent of genetic inheritance, determines the later onset of obesity, hypertension, and type 2 diabetes. The close relationship of obesity and type 2 diabetes with a cluster of cardiovascular risk factors has produced the terms "diabesity" and "metabolic syndrome." The many questions about the biologic basis of the metabolic syndrome underscore the importance of an integrated approach to prevention and treatment.
The clinical management of obesity and type 2 diabetes is often disjointed, with clinicians failing to appreciate the importance of aggressively treating associated cardiovascular risk factors as well as diabetes and obesity. Clearly, a textbook that addresses both diabetes and obesity is timely.
In Obesity and Diabetes, editor Christos S. Mantzoros brings together a group of American and European experts, many of whom are from Harvard Medical School, and gives them carte blanche to discuss and illustrate problems relevant to obesity and diabetes. The chapters are organized into four parts: history and epidemiology; genetics and pathophysiology; diagnosis, clinical manifestations, and complications; and treatment. The book is both a textbook on diabetes and a textbook on obesity rather than a single work focused on integrating the two disciplines. There is also an occasional discussion of type 1 diabetes, which serves only to confuse. In the section on genetics and pathophysiology (part 2), the earlier chapters succeed in interweaving the discussion of obesity and diabetes, but this thread is lost later in part 4, which covers treatment. As a result, there is inevitable repetition and duplication rather than integration. Still, the discussion of the evidence that an adipocyte is an endocrine organ in its own right, associated with a chronic inflammatory state invoking cytokines in obesity, is both important and readable. In the end, it is disappointing that the medical complications that so intimately entwine obesity and diabetes are not addressed in greater detail. The book lacks an integrated approach to the management of the two conditions; it has not presented an evidence base for treating complications linked to obesity and type 2 diabetes.
Too often, clinicians focus on diabetes to the detriment of obesity or are unadvisedly persuaded that weight reduction will provide the total solution, ignoring the benefits to be had from aggressively managing hypertension and dyslipidemia. An example from this book is the interesting chapter on obesity and renal disease, which is useful but nonetheless overlooks the thornier question of diabetic renal impairment superimposed on obesity-induced glomerulosclerosis. Similarly, the chapter on infections in diabetes includes considerable practical advice but neglects the increasingly common clinical challenge of infection in a patient who both has diabetes and is morbidly obese. The chapter on highly active antiretroviral therapy, although interesting, fails to pursue the fascinating scientific insights that have contributed to knowledge about the mechanisms of lipohypertrophy and insulin resistance that are relevant to obesity and diabetes.
There is undoubtedly much still to learn about diabetes and obesity. This book provides a compendium of information, but it disappoints in its lack of an integrative viewpoint. The authors are to be commended for bringing the two conditions together, but readers are cautioned that the story is only partly told — diabesity is a challenging condition that requires an integrated understanding of both diabetes and obesity, as well as a coherent management plan that will drive forward effective measures for both prevention and intervention.
Peter Kopelman, M.D.
University of East Anglia
Norwich NR4 7TJ, United Kingdom
p.kopelman@uea.ac.uk((Contemporary Diabetes.) )
Evolution suggests the inevitability of the passage of "thrifty genes" from generation to generation, providing protection during times of famine but predisposing the carriers of these genes to obesity and type 2 diabetes in times of plenty. Intriguingly, a contrasting theory suggests that undernutrition of the developing fetus, independent of genetic inheritance, determines the later onset of obesity, hypertension, and type 2 diabetes. The close relationship of obesity and type 2 diabetes with a cluster of cardiovascular risk factors has produced the terms "diabesity" and "metabolic syndrome." The many questions about the biologic basis of the metabolic syndrome underscore the importance of an integrated approach to prevention and treatment.
The clinical management of obesity and type 2 diabetes is often disjointed, with clinicians failing to appreciate the importance of aggressively treating associated cardiovascular risk factors as well as diabetes and obesity. Clearly, a textbook that addresses both diabetes and obesity is timely.
In Obesity and Diabetes, editor Christos S. Mantzoros brings together a group of American and European experts, many of whom are from Harvard Medical School, and gives them carte blanche to discuss and illustrate problems relevant to obesity and diabetes. The chapters are organized into four parts: history and epidemiology; genetics and pathophysiology; diagnosis, clinical manifestations, and complications; and treatment. The book is both a textbook on diabetes and a textbook on obesity rather than a single work focused on integrating the two disciplines. There is also an occasional discussion of type 1 diabetes, which serves only to confuse. In the section on genetics and pathophysiology (part 2), the earlier chapters succeed in interweaving the discussion of obesity and diabetes, but this thread is lost later in part 4, which covers treatment. As a result, there is inevitable repetition and duplication rather than integration. Still, the discussion of the evidence that an adipocyte is an endocrine organ in its own right, associated with a chronic inflammatory state invoking cytokines in obesity, is both important and readable. In the end, it is disappointing that the medical complications that so intimately entwine obesity and diabetes are not addressed in greater detail. The book lacks an integrated approach to the management of the two conditions; it has not presented an evidence base for treating complications linked to obesity and type 2 diabetes.
Too often, clinicians focus on diabetes to the detriment of obesity or are unadvisedly persuaded that weight reduction will provide the total solution, ignoring the benefits to be had from aggressively managing hypertension and dyslipidemia. An example from this book is the interesting chapter on obesity and renal disease, which is useful but nonetheless overlooks the thornier question of diabetic renal impairment superimposed on obesity-induced glomerulosclerosis. Similarly, the chapter on infections in diabetes includes considerable practical advice but neglects the increasingly common clinical challenge of infection in a patient who both has diabetes and is morbidly obese. The chapter on highly active antiretroviral therapy, although interesting, fails to pursue the fascinating scientific insights that have contributed to knowledge about the mechanisms of lipohypertrophy and insulin resistance that are relevant to obesity and diabetes.
There is undoubtedly much still to learn about diabetes and obesity. This book provides a compendium of information, but it disappoints in its lack of an integrative viewpoint. The authors are to be commended for bringing the two conditions together, but readers are cautioned that the story is only partly told — diabesity is a challenging condition that requires an integrated understanding of both diabetes and obesity, as well as a coherent management plan that will drive forward effective measures for both prevention and intervention.
Peter Kopelman, M.D.
University of East Anglia
Norwich NR4 7TJ, United Kingdom
p.kopelman@uea.ac.uk((Contemporary Diabetes.) )