2022+UEG意见书：肥胖和消化健康（英文版）.pdf

DOI:10.1002/ueg2.12334NEWSUEG position paper:Obesity and digestive healthTHE SCALE OF THE ISSUEThe obesity epidemic is one of the most significant public healthchallenges in Europe today.Obesity rates have more than doubled inthe last 40 yearsover half of the EUs adult population and nearlyone in three children in the World Health Organisation Europeanregion are overweight or obese.OBESITY AND CHRONIC DIGESTIVE DISEASESObesity is a major risk factor for chronic digestive diseases,placing asubstantial strain on European health systems.Childhood obesity Childhood obesity is a significant risk factor for digestive andmetabolic diseases later in life1 Nonalcoholic fatty liver disease(NAFLD)is a consequence ofadolescent obesity,with the risk of developing liver cirrhosis2,3Obesity and functional digestive disorders Four in 10 adults suffer from one or more disorders of gutbraininteraction(DGBI),4and people with obesity are even morelikely to suffer DGBI symptoms5 There is a strong association between obesity and gastroesopha-geal reflux disease6Obesity and inflammatory bowel disease Twenty percent of paediatric7and 40%of adult8patients with IBDare overweight or obese A westerntype diet is thought to contribute to obesity and IBD9 Obesity and/or visceral adiposity may increase the risk for devel-oping surgical complications,hospitalisation and postoperativerecurrence in patients with IBD1014Obesity and liver disease NAFLD is common in people who are obese or morbidly obese(prevalence of 70%95%)15 NAFLD is a leading cause of liverrelated mortality in Europe,predicted to become the leading cause of endstage liver diseaseunless urgent action is taken16,17Obesity and digestive cancers Obesity is an established risk factor for multiple types ofcancer,18including pancreatic,19,20liver,21,22and colorectal23cancer In 2019,4.6%of all cancer deaths were attributable to obesity24PREVENTION AND TREATMENTThe increase in people who are overweight and obese across Europeis alarming and has been exacerbated by the COVID19 pandemic.25There is an urgent need for preventive and therapeutic strategies atboth individual and public health levels.Lifestylerelated prevention Promoting healthy lifestyle choices,such as following a Mediter-ranean diet and reducing alcohol consumption Tackling the overconsumption of ultraprocessed foods,oftenhigh in calories,salt,sugar,and saturated fats Promoting physical activity to improve overall health and maintaina healthy body weightPharmacological therapies Despite the high prevalence of NAFLD in Europe,no effectivepharmacological treatment is currently approved for use Existing therapies mainly focus on metabolic disorders associatedwith NAFLD26,27Endoscopic and metabolic therapies Patients with obesity who receive intragastric balloons or endo-scopic sleeve gastroplasty and lifestyle intervention show a highermean total bodyweight loss compared to those who receive life-style intervention only28,29The role of bariatric surgery Bariatric surgery should be considered in patients with morbidobesity Bariatric surgery is associated with greater and faster weight lossand,in most cases,with improved longterm results comparedwith conventional therapy.This has the potential to reduceallcausemortalityandthedevelopmentofobesityrelatedThis is an open access article under the terms of the Creative Commons AttributionNonCommercialNoDerivs License,which permits use and distribution in anymedium,provided the original work is properly cited,the use is noncommercial and no modifications or adaptations are made.2022 The Authors.United European Gastroenterology Journal published by Wiley Periodicals LLC.on behalf of United European Gastroenterology.United European Gastroenterol J.2022;1-1diseases.30Additionally,this decreases the incidence of obesityrelated cancer and cancerrelated mortality31,32 Itisimportantthatbariatricsurgerybeaccompaniedbystructuredbehaviouraltherapies,nutritionalprogrammesand lifestyle changes to reduce calorie intake and increaseexerciseUEG RECOMMENDATIONSIn accordance with World Health Organisation guidelines,UEG rec-ommends the following policy interventions:1.Effective prevention strategies targeting foodincluding foodreformulation,mandatory EUwide frontofpack nutrition label-ling,food marketing restrictions(especially to protect children),taxation of unhealthy food high in fats,sugar and salt,increasedavailability and affordability of healthy foods to influence con-sumer choices.2.CoherentactionthroughoutEUandmemberstatesandinvolvement of all relevant sectors to create environments forpeople and communities that are conducive to limiting the pro-duction and consumption of unhealthy foods.3.Population prevention effortsmust targetallage groupsthroughout the life course,with a particular focus on children asearly life interventions can have a substantial impact.4.Mass media awareness campaigns and educational programmesin schools,with a focus on improving overall health outcomesrather than on weight loss alone and the inclusion of healthyschool meals and integration of food science into the schoolcurriculum.5.Consistent uptake of clinical practice guidelines for healthcareto deliver effective,evidenceinformed obesity care and improvethe quality of healthcare and patient outcomes.6.Research and development investment to provide innovativeprevention and treatment options.Patrizia Burra1Marianna Arvanitakis2,3Jorge Amil Dias4Michael Bretthauer5,6Ana Dugic7,8Daniel Hartmann9Patrick Michl10Thomas Seufferlein11Joana Torres12,13Hans Trnblom14Monique E.van Leerdam15Shira ZelberSagi16,17Andreea Botos181Multivisceral Transplant Unit,Department of Surgery,Oncologyand Gastroenterology,Padua University Hospital,Padua,Italy2Department of Gastroenterology,Hepatopancreatology and GIOncology,Erasme University Hospital,Universit Libre deBruxelles,Brussels,Belgium3Nutrition Team,Erasme University Hospital,Universit Libre deBruxelles,Brussels,Belgium4Department of Pediatrics,Hospital S.JooPorto,Portugal5Department of Transplantation Medicine,Clinical EffectivenessResearch Group,Oslo University Hospital,Oslo,Norway6Clinical Effectiveness Research Group,Institute of Health andSociety,University of Oslo,Oslo,Norway7Department of Gastroenterology,FriedrichAlexanderUniversittErlangenNrnberg(FAU),Medizincampus Oberfranken,Bayreuth,Germany8Department of Medicine,Karolinska Institutet,Stockholm,Sweden9Department of Surgery,Klinikum rechts der Isar TechnischeUniversitt Munich,Munich,Germany10Department of Internal Medicine I,MartinLuther UniversityHalleWittenberg,Halle,Germany11Department of Internal Medicine I,Ulm University Hospital,Ulm,Germany12Division of Gastroenterology,Hospital Beatriz ngelo,Loures,Portugal13Faculdade de Medicina,Universidade de Lisboa,Lisboa,Portugal14Department of Molecular and Clinical Medicine,Institute ofMedicine,Sahlgrenska Academy,University of Gothenburg,Gothenburg,Sweden15Department of Gastroenterology,Netherlands Cancer Institute,Amsterdam,The Netherlands16School of Public Health,Faculty of Social Welfare and HealthSciences,University of Haifa,Haifa,Israel17Department of Gastroenterology,Tel Aviv Medical Center,TelAviv,Israel18United European Gastroenterology(UEG),Vienna,AustriaCorrespondencePatrizia Burra,Multivisceral Transplant Unit,Department of Surgery,Oncology and Gastroenterology,Padua University Hospital,Padua,Italy.Email:burraunipd.itORCIDPatrizia Burrahttps:/orcid.org/0000-0002-8791-191XHans Trnblomhttps:/orcid.org/0000-00032117-9874REFERENCES1.Barton M.Childhood obesity:a lifelong health risk.Acta PharmacolSin.2012;33(2):18993.https:/doi.org/10.1038/aps.2011.2042.Kumar S,Kelly AS.Review of childhood obesity:from epidemiology,etiology,and comorbidities to clinical assessment and treatment.MayoClinProc.2017;92(2):25165https:/doi.org/10.1016/j.mayocp.2016.09.0173.Shaunak M,Byrne CD,Davis N,Afolabi P,Faust SN,Davies JH.Nonalcoholic fatty liver disease and childhood obesity.Arch Dis 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