心与脑：肥胖相关炎症、心血管疾病与认知功能的关联

文献信息

中文摘要

心脏与大脑相互关联，影响心脏的危险因素可对大脑和认知产生负面影响。促成大脑健康不佳和心脏健康不佳的潜在特征包括肥胖、糖尿病、缺乏体力活动和睡眠质量差。肥胖和2型糖尿病与认知障碍和痴呆的可能性增加相关。此外，肥胖是阻塞性睡眠呼吸暂停的致病因素，导致间歇性低氧血症、神经炎症和认知功能障碍。伴有脑血流减少的脑血管疾病可引起卒中并升高痴呆风险。与心血管疾病一样，脑血管疾病在肥胖状态下也会加速，可能通过相同的机制，即高血压、血脂异常和炎症导致的内皮功能障碍以及大血管和微血管损伤。肥胖被认为是复发性卒中的危险因素。过度肥胖所致的炎症标志物长期低度慢性升高会导致氧化应激，并促进内皮功能障碍和促血栓状态。与年轻肥胖成人相比，中年和老年肥胖成人已记录到更大的脑体积损失。肥胖对全世界个体的心脑血管健康和福祉构成威胁。不幸的是，以减少热量摄入为目标的治疗效果有限。本综述将聚焦于过量脂肪组织与心脏和大脑健康之间联系的最新研究，并关注可能保护血管和大脑完整性与功能的饮食和生活方式干预。

英文摘要

The heart and brain are interconnected, and risk factors that impact the heart can negatively affect the brain and cognition. Among the underlying features that foster both poor brain health and poor heart health are obesity, diabetes, physical inactivity and low sleep quality. Obesity and type 2 diabetes are associated with an increased likelihood of cognitive impairment and dementia. Further, obesity is a causal factor in obstructive sleep apnea, leading to intermittent hypoxemia, neuroinflammation and cognitive dysfunction. Cerebrovascular disease with reduced cerebral blood flow brings on stroke and elevates dementia risk. Like cardiovascular disease, cerebrovascular disease is also accelerated in the setting of obesity, likely through the same mechanisms involving endothelial dysfunction and damage to macrovasculature and microvasculature from hypertension, dyslipidemia and inflammation. Obesity is considered a risk factor for recurrent stroke. The protracted low-grade chronic elevation of inflammatory markers found with excess adiposity leads to oxidative stress and promotes both endothelial dysfunction and a pro-thrombotic state. Greater loss of brain volume has been documented in middle-aged and older adults with obesity compared with young adults with obesity. Obesity poses a threat to the cardiovascular and cerebrovascular health and well-being of individuals worldwide. Unfortunately, treatments directed at reducing caloric intake are of limited effectiveness. This review will focus on the latest research into the link between excess adipose tissue and cardiac and brain health, with attention to dietary and lifestyle interventions that may be protective of the integrity and function of the vasculature and brain.