肥胖症进程中脂肪与肌骨代谢相互作用机制及营养诊疗新进展

高雪峰; 张苑; 朱翠凤

doi:10.16689/j.cnki.cn11-9349/r.2026.01.007

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肿瘤代谢与营养电子杂志 ›› 2026, Vol. 13 ›› Issue (1) : 38-51. DOI: 10.16689/j.cnki.cn11-9349/r.2026.01.007

专家论坛

肥胖症进程中脂肪与肌骨代谢相互作用机制及营养诊疗新进展

¹高雪峰, ²张苑, ¹朱翠凤

作者信息 +

Crosstalk mechanisms between adipose and musculoskeletal metabolism in obesity and recent advances in nutritional diagnosis and treatment

¹Gao Xuefeng, ²Zhang Yuan, ¹Zhu Cuifeng

Author information +

文章历史 +

摘要

肥胖症作为全球公共卫生的难题,其病理机制远超传统能量平衡观念,核心在于脂肪组织与肌骨系统间复杂的代谢相互作用网络。本文系统综述了肥胖状态下脂肪组织功能障碍的核心机制,包括脂肪细胞扩张受限、炎症与纤维化加剧、棕色脂肪产热调控异常,以及脂肪因子与外泌体介导的器官间通讯紊乱。同时,骨骼肌代谢紊乱表现为肌纤维类型转化、线粒体功能受损及胰岛素信号通路抑制,而骨骼通过骨钙素等因子参与全身能量调节。脂肪-肌骨轴通过炎症循环、代谢信号通路交叉对话及脂肪因子-肌因子双向调控,形成恶性循环,推动代谢综合征进展。营养干预策略已从单纯热量限制转向多靶点精准调控:限时饮食、地中海饮食,及功能营养元素补充(如ω-3多不饱和脂肪酸)可协同改善体成分与代谢健康;抗炎饮食与特定营养素靶向调节炎症与线粒体功能;时间营养学通过同步生物钟优化代谢节律。然而,临床转化仍需解决个体异质性、多组学生物标志物开发及药物-营养协同等问题。未来需整合精准营养、数字健康技术及多学科管理,以突破肥胖及其并发症的防治瓶颈。

Abstract

Obesity, a critical global public health challenge, transcends the traditional paradigm of energy imbalance, with its core lying in the intricate metabolic crosstalk network between adipose tissue and the musculoskeletal system. This review systematically delineates the fundamental mechanisms underlying adipose tissue dysfunction in obesity, encompassing impaired adipocyte expansion, exacerbated inflammation and fibrosis, dysregulated thermogenesis in brown adipose tissue, and disrupted inter-organ communication mediated by adipokines and exosomes. Concurrently, metabolic disturbances in skeletal muscle manifest as fiber-type switching, mitochondrial dysfunction, and suppression of the insulin signaling pathway, while bone participates in systemic energy regulation through factors such as osteocalcin. The adipose-musculoskeletal axis drives the progression of metabolic syndrome by forming a vicious cycle, orchestrated via inflammatory cascades, crosstalk among metabolic signaling pathways, and bidirectional regulation between adipokines and myokines. Nutritional intervention strategies have evolved from mere caloric restriction to multi-targeted precision regulation: time-restricted feeding, the Mediterranean diet, and supplementation with functional nutrients (e.g., ω-3 polyunsaturated fatty acids) synergistically improve body composition and metabolic health; anti-inflammatory diets and specific nutrients target inflammation and mitochondrial function; chrononutrition optimizes metabolic rhythms by synchronizing the circadian clock. Nevertheless, clinical translation still faces challenges, including addressing individual heterogeneity, developing multi-omics biomarkers, and optimizing drug-nutrition synergy. Future efforts should integrate precision nutrition, digital health technologies, and multidisciplinary management to overcome the bottlenecks in the prevention and treatment of obesity and its complications.

导出引用

高雪峰, 张苑, 朱翠凤. 肥胖症进程中脂肪与肌骨代谢相互作用机制及营养诊疗新进展[J]. 肿瘤代谢与营养电子杂志. 2026, 13(1): 38-51 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.01.007

Gao Xuefeng, Zhang Yuan, Zhu Cuifeng. Crosstalk mechanisms between adipose and musculoskeletal metabolism in obesity and recent advances in nutritional diagnosis and treatment[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(1): 38-51 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.01.007

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