本文由HelaineE.Resnick博士編輯

    在最新的一期《糖尿病護理》雜志上綜述文章總結(jié)了肥胖者自身腸道微生物與肥胖特征間的聯(lián)系，包括葡萄糖代謝異常。

    在正常條件下，腸細(xì)菌和宿主是共生關(guān)系。然而，一些嚙齒類動物和人類研究表明，腸道菌群的組成在瘦者和肥胖者中存在差異，持續(xù)觀察表明腸道微生物可能在能量平衡中發(fā)揮重要作用。據(jù)推測，肥胖者的腸道微生物或可特別有效地從飲食中獲取能量，這可能是最終導(dǎo)致肥胖和肥胖相關(guān)疾病如糖尿病的根本原因。

    為研究肥胖和消瘦者的腸道微生物如何影響各種生理特性，糞便菌群移植（FMT）已在嚙齒類動物和人類展開了研究。最新FMT研究表明，對于存在胰島素抵抗人群，瘦者FMT后可改善外周胰島素敏感性和對受試者的腸道菌群多樣性。

    這一研究表明的潛在的重要內(nèi)容是腸道微生物多樣性的增加，包括丁酸產(chǎn)生菌增加。丁酸、乙酸和丙酸等短鏈脂肪酸在能量代謝中起重要作用。在小鼠研究表明，口服丁酸可通過增加增加線粒體功能增加胰島素敏感性和能量消耗。雖然這些結(jié)果可能說明腸道微生物與肥胖者特定情況間的潛在聯(lián)系，但是特定菌群、短鏈脂肪酸和代謝功能間的因果關(guān)系尚未確定。

    未來的研究需要集中于短鏈脂肪酸補充或FMT的創(chuàng)新研究，以便利用腸道微生物可以解決肥胖和糖尿病的頑固問題。

    原文：

    “Obese” and “Lean” Bacteria: Growing Interest in the Gut MicrobiomeA review in this issue of Diabetes Care （p. 159） summarizes an increasing body of evidence linking features of the gut microbiome to a number of obesity-related conditions, including abnormalities of glucose metabolism. Under normal conditions, there is a symbiotic relationship between bacteria that inhabit the gut and the humans who host them. However, studies in both rodents and humans have shown that the composition of gut microbiota differs between lean and obese subjects—a persistent observation suggesting that the gut microbiome may play a meaningful role in energy balance. It has been postulated that an “obese microbiome” may be particularly efficient at deriving energy from the diet, and this efficiency may ultimately lead to obesity and obesity-related conditions such as diabetes. Fecal microbiota transplantation （FMT） has been used in both rodents and humans to begin to understand how lean and obese microbiota may influence various physiological characteristics. Recent FMT studies in insulin-resistant humans have shown that FMT from lean donors resulted in improvements in pe**heral insulin sensitivity and increases in the diversity of subjects' intestinal microbiota. A potentially important aspect of this observation was that the increased diversity of the gut microbiome included an increase in butyrate-producing bacteria. This is significant because butyrate and acetate and propionate are short-chain fatty acids （SCFAs） that are known to be important in energy metabolism. Studies in mice have shown that oral butyrate increases insulin sensitivity and energy expenditure by increasing mitochondrial function. Although these observations may offer a potential connection between specific features of the gut microbiome and mechanisms that underpin human obesity, a causal link between specific intestinal bacteria, SCFA, and metabolic function has not been established. Moving this line of investigation forward will require innovative studies that focus on SCFA supplementation or FMT from various donors to understand how manipulation of the gut microbiome may be harnessed to address the stubborn problems of obesity and diabetes. — Helaine E. Resnick, PhD, MPH