犬肥胖症的病因分类及诊断

目录摘要 摘要宠物犬营养摄入过剩或运动不足引起肥胖症日趋严重，影响了犬的生存质量。能量控制是控制犬体重、促进犬脂肪动用的重要手段。然而由于犬身体健康状态及病症严重程度不同，常需要配合药物进行治疗。目前已使用的几种药物主要通过控制能量摄入和调节脂肪代谢两个机制来治疗犬肥胖症，展现出较好的治疗效果。此外，在其他动物上，一些膳食添加剂的研究结果显示其在防治犬肥胖症上可能具有极大的潜力。关键词：犬肥胖症能量控制药物治疗前言哺乳动物肥胖症与脂肪代谢随着生活水平的提高，肥胖（obesity）越来越常见。2013年，美国约有3422亿用于治疗肥胖引起的相关疾病，占个人卫生保健综合的28.2%ADDINCSL_CITATION{"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11606-016-3968-8","ISSN":"15251497","author":[{"dropping-particle":"","family":"Biener","given":"Adam","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cawley","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Meyerhoefer","given":"Chad","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JournalofGeneralInternalMedicine","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2017","4","1"]]},"page":"6-8","publisher":"SpringerNewYorkLLC","title":"TheHighandRisingCostsofObesitytotheUSHealthCareSystem","type":"article-journal","volume":"32"},"uris":["/documents/?uuid=7572ca36-208a-3b11-9528-9ca1adbf5310"]}],"mendeley":{"formattedCitation":"^[1]","plainTextFormattedCitation":"[1]","previouslyFormattedCitation":"^[1]"},"properties":{"noteIndex":0},"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[1]。同年，美国医学协会（AmericanMedicalAssociation）将肥胖定义为一种疾病ADDINCSL_CITATION{"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ecl.2016.04.004","ISSN":"15584410","abstract":"In2013,theAmericanMedicalAssociationrecognizedobesityasacomplex,chronicdiseaserequiringmedicalattention.Definingobesityasadiseaseisaverypublicprocess,largelydrivenbyexpectationofcostsandbenefits.Althoughthepublichasbeenslowtoembracethisdefinition,evidenceisemergingforbroaderawarenessofinfluencingfactorsbeyondpersonalchoice.Thisdecisionseemstobeworkingwithotherfactorstobringmoreaccesstocare,lessblameforpeoplewiththecondition,andmorefavorableconditionsforresearchtoidentifyeffectivestrategiesforpreventionandclinicalcaretoreducetheimpact.","author":[{"dropping-particle":"","family":"Kyle","given":"TheodoreK.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dhurandhar","given":"EmilyJ.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Allison","given":"DavidB.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"EndocrinologyandMetabolismClinicsofNorthAmerica","id":"ITEM-1","issue":"3","issued":{"date-parts":[["2016","9","1"]]},"page":"511-520","publisher":"W.B.Saunders","title":"RegardingObesityasaDisease:EvolvingPoliciesandTheirImplications","type":"article","volume":"45"},"uris":["/documents/?uuid=48bf229f-8855-3d71-8fab-dfe85eb76d94"]}],"mendeley":{"formattedCitation":"^[2]","plainTextFormattedCitation":"[2]","previouslyFormattedCitation":"^[2]"},"properties":{"noteIndex":0},"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[2]，2015年名古屋宣言（NagoyaDeclaration）将肥胖疾病（obesitydisease）定义为由肥胖引起的一种疾病状态并需要临床医疗干预ADDINCSL_CITATION{"citationItems":[{"id":"ITEM-1","itemData":{"URL":"http://www.jasso.or.jp/data/data/pdf/nagoya2015.pdf","accessed":{"date-parts":[["2020","2","17"]]},"id":"ITEM-1","issued":{"date-parts":[["0"]]},"title":"(NoTitle)","type":"webpage"},"uris":["/documents/?uuid=68a5f5c7-c133-330f-9610-268a02dfc1b5"]}],"mendeley":{"formattedCitation":"^[3]","plainTextFormattedCitation":"[3]","previouslyFormattedCitation":"^[3]"},"properties":{"noteIndex":0},"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[3]。由此可见，肥胖症已经成为一个世界性的医学难题。BMI（BodyMassindex）是常见的肥胖评判标准，一般将BMI30kg/m2的人定义为肥胖人群。肥胖能够引起多种疾病，包括血脂紊乱、冠心病、高血压、睡眠呼吸暂停症、全身性炎症、胰岛素抵抗以及交感神经系统过度活跃等ADDINCSL_CITATION{"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11892-017-0859-2","ISSN":"1534-4827","abstract":"PurposeofReview:Thisreviewprovidesanoverviewofthecurrentstateofdrugtherapyforobesity,withafocusonfournewdrugtherapies—lorcaserin,phentermine/topiramate,naltrexone/bupropion,andliraglutide3.0

mg—whichhavebeenapprovedbytheUSFoodandDrugAdministration(FDA)forlong-termmanagementofobesitysince2012.Topicsdiscussedinthispaperincluderationaleforpharmacotherapy,historyofantiobesitydrugs,andefficacyandsafetydatafromrandomizedcontrolledtrialswithimplicationsforclinicalpractice.RecentFindings:Weightlossachievedbycurrentlyapproveddrugsrangesfromapproximately3to9%,aboveandbeyondweightlosswithlifestylecounselingalone,afterayear.Responseandattritionratesinclinicaltrialsindicatethatthebenefitsofpharmacotherapyrangefromsubstantialforsomepatients,modestforothers,andnobenefitsforothersstill.Summary:Decisionsregardingselectionofasuitabledrugfromtheavailablepharmacotherapyoptionsanddurationoftreatmentshouldbebasedontheexpectedandobservedbenefit-to-riskbalanceandtailoredtotheneedsofeachindividualpatientusingtheprinciplesofshareddecision-making.","author":[{"dropping-particle":"","family":"Gadde","given":"KishoreM.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"PrithamRaj","given":"Y.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"CurrentDiabetesReports","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2017","5","4"]]},"page":"34","publisher":"CurrentMedicineGroupLLC1","title":"PharmacotherapyofObesity:ClinicalTrialstoClinicalPractice","type":"article-journal","volume":"17"},"uris":["/documents/?uuid=538af538-4e07-3b63-bee8-328fa879d3dd"]}],"mendeley":{"formattedCitation":"^[4]","plainTextFormattedCitation":"[4]","previouslyFormattedCitation":"^[4]"},"properties":{"noteIndex":0},"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[4]。与人肥胖症趋势相同的是，犬、猫等伴侣动物也面临相同的问题。通常将犬的超重（Overweight）和肥胖分别定义为超过标准体重的15%和30%ADDINCSL_CITATION{"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/jn/136.7.1940s","ISSN":"0022-3166","PMID":"16772464","abstract":"Obesityisdefinedasanaccumulationofexcessiveamountsofadiposetissueinthebody,andisthemostcommonnutritionaldisorderincompanionanimals.Obesityisusuallytheresultofeitherexcessivedietaryintakeorinadequateenergyutilization,whichcausesastateofpositiveenergybalance.Numerousfactorsmaypredisposeanindividualtoobesityincludinggenetics,theamountofphysicalactivity,andtheenergycontentofthediet.Themainmedicalconcernofobesityrelatestothemanydiseaseassociationsthataccompanytheadiposity.Numerousstudiesdemonstratedthatobesitycanhavedetrimentaleffectsonthehealthandlongevityofdogsandcats.Theproblemstowhichobesecompanionanimalsmaybepredisposedincludeorthopedicdisease,diabetesmellitus,abnormalitiesincirculatinglipidprofiles,cardiorespiratorydisease,urinarydisorders,reproductivedisorders,neoplasia(mammarytumors,transitionalcellcarcinoma),dermatologicaldiseases,andanestheticcomplications.Themaintherapeuticoptionsforobesityincompanionanimalsincludedietarymanagementandincreasingphysicalactivity.Althoughnopharmaceuticalcompoundsareyetlicensedforweightlossindogsandcats,itisenvisagedthatsuchagentswillbeavailableinthefuture.Dietarytherapyformsthecornerstoneofweightmanagementindogsandcats,butincreasingexerciseandbehavioralmanagementformusefuladjuncts.Thereisaneedtoincreasetheawarenessofcompanionanimalobesityasaseriousmedicalconcernwithintheveterinaryprofession.","author":[{"dropping-particle":"","family":"German","given":"AlexanderJ.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"TheJournalofNutrition","id":"ITEM-1","issue":"7","issued":{"date-parts":[["2006","7","1"]]},"page":"1940S-1946S","publisher":"OxfordUniversityPress(OUP)","title":"TheGrowingProblemofObesityinDogsandCats","type":"article-journal","volume":"136"},"uris":["/documents/?uuid=b72c2bb5-0b75-3a19-b973-3a826f8147b8"]}],"mendeley":{"formattedCitation":"^[5]","plainTextFormattedCitation":"[5]","previouslyFormattedCitation":"^[5]"},"properties":{"noteIndex":0},"schema":"/citation-style-language/schema/raw/master/csl-citation.json"}[5]。现有临床报告显示，34-59%的犬属于超重，5-20%属于肥胖ADDINCSL_CITATION{"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1136/vr.156.22.695","ISSN":"00424900","PMID":"15923551","abstract":"AstudywasundertakentodeterminetheprevalenceofobesityindogsexaminedbyveterinarypracticesacrossAustralia,andtodeterminetheriskfactorsinvolved;1700practiceswereaskedtocompleteaveterinarianopinionsurvey,andofthe428practicesthatresponded,178wereselectedtocompleteanRSPCAAustraliaPetObesityQuestionnaire,togetherwithadditionalpracticesselectedbyAustralianStateandTerritoryRSPCAsocieties.Thisquestionnairewassenttoatotalof209practiceswhichwereaskedtorecorddetailsofeligibledogs,andthereasonwhytheyhadbeenexaminedduringthepreviousmonth.Fifty-two(24.9percent)ofthepracticesrespondedandprovideddataon2661dogs,ofwhich892(33.5percent)wereoverweightand201(7.6percent)wereobese.Afurther112dogs(4.2percent)wereclassifiedasthinorverythin,butthesewereexcludedfromsubsequentanalysesoftheremaining2549dogs,approximatelyhalfwerefemaleand1905(74.7percent)wereneutered.Thedogs'weightcategorywasinfluencedbyseveralfactors.Breedinfluencedtheimportanceofsexandneuteringasriskfactors.Theprevalenceofoverweightandobesedogscombinedwas41percent;theprevalenceincreasedwithageuptoabout10yearsold,andthendeclined.Ruralandsemiruraldogsweremoreatriskofobesitythanurbanandsuburbandogs.","author":[{"dropping-particle":"","family":"McGreevy","given":"P.D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thomson","given":"P.C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pride","given":"C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fawcett","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Grassi","given":"T.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jones","given":"B.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"VeterinaryRecord","id":"ITEM-1","issue":"22","issued":{"date-parts":[["2005","5","28"]]},"page":"695-702","publisher":"BritishVeterinaryAssociation","title":"PrevalenceofobesityindogsexaminedbyAustralianveterinarypracticesandtheriskfactorsinvolved","type":"article-journal","volume":"156"},"uris":["/documents/?uuid=e656c7c0-649e-3826-bb3c-2b0fff5f8876"]},{"id":"ITEM-2","itemData":{"DOI":"10.1111/j.1748-5827.2010.00933.x","ISSN":"00224510","abstract":"Objectives:Toassesstherelationshipsbetweensocioeconomicandotherenvironmentalfactorswithcanineobesity.Methods:Thiswasacross-sectionalquestionnairestudyofdogownersattendingfiveprimaryveterinarypracticesintheUK.Ownerswereaskedaboutdogage,neuterstatus,feedinghabits,dogexercise,householdincomeandownerage.Thebodyconditionscoreofthedogswasalsoassessed.Factorshypothesisedtobeassociatedwithobesitywereinvestigated.Results:Intotal,datafrom696questionnaireswereevaluated.Outofthosedataevaluated,35·3%ofdogs(n=246)wereclassedasanidealbodyshape,38·9%(n=271)wereoverweight,20·4%(n=142)wereobeseand5·3%(n=37)wereunderweight.Identifiedriskfactorsassociatedwithobesityincludedownerage,hoursofweeklyexercise,frequencyofsnacks/treatsandpersonalincome.ClinicalSignificance:Environmentalriskfactorsassociatedwithcanineobesityaremultifactorialandincludepersonalincome,ownerage,frequencyofsnacks/treatsandamountofexercisethedogreceives.Awarenessabouthealthrisksassociatedwithobesityindogsissignificantlylessinpeopleinlowerincomebrackets.Thisphenomenonisrecognisedinhumanobesity.©2010BritishSmallAnimalVeterinaryAssociation.","author":[{"dropping-particle":"","family":"Courcier","given":"E.A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thomson","given":"R.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mellor","given":"D.J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yam","given":"P.S.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JournalofSmallAnimalPractice","id":"ITEM-2","issue":"7","issued":{"date-parts":[["2010","7"]]},"page":"362-367","title":"Anepidemiologicalstudyofenvironmentalfactorsassociatedwithcanineobesity","type":"article-journal","volume":"51"},"uris":["/documents/?uuid=e64e3b30-2c9a-3590-9108-c8c052abe1f2"]},{"id":"ITEM-3","itemData":{"DOI":"10.1093/jn/136.7.1951s","ISSN":"0022-3166","abstract":"Therehasbeenarapidriseintheincidenceofobesity,primarilyasaresultofchangesinlifestyle(dietandactivitylevels).Obesityhasprovidedconsiderableimpetusfortheinvestigationofthefundamentalmechanismsinvolvedintheregulationofenergybalance.Importantdevelopmentsincludetheidentificationofnovelfactorsinvolvedinthecontrolofappetite,suchasghrelin,orexinA,andtheendogenouscannabinoids,andtheemergenceoftheconceptof\"nonexerciseactivitythermogenesis\"(NEAT)providednewperspectivesonenergyexpenditure.Studiesonwhiteadiposetissuehaveledtotherecognitionthatitisanimportantendocrineorgan,communicatingwiththebrainandperipheraltissuesthroughthesecretionofleptinandotheradipokines.Thereisarapidlyexpandinglistofproteinfactorsreleasedbywhiteadiposetissue,includingthekeyhormone,adiponectin.Ofparticularnoteistherangeofcytokines,chemokines,andotherinflammation-relatedproteinssecretedbywhitefatastissuemassrises;indeed,obesityischaracterizedbychronicmildinflammation.Theadipokinesprovideanextensivenetworkofcommunicationbothwithinadiposetissueandwithotherorgans,andsomeareimplicateddirectlyinthepathologiesassociatedwithobesity,particularlythemetabolicsyndrome.Althoughthefocusremainsverymuchonobesityinhumans,thedisorderanditssequelaearealsoagrowingconcernincompanionanimals.","author":[{"dropping-particle":"","family":"Colliard","given":"Laurence","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ancel","given":"Julie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Benet","given":"Jean-Jacques","non-dropping-particle":"","parse-name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