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营养不良包括：营养不足、营养过剩（肥胖）。 2016年12月14日，美国《内分泌实践》在线发表美国临床内分泌科医师协会（AACE）和美国内分泌学会（ACE）的联合声明，建议将“肥胖”改为“肥胖所致慢性疾病”（ABCD）。 根据AACE/ACE肥胖委员会，最新术语的应用旨在帮助医生及患者将关注重点由体重超标转变为肥胖共病，更好地强调肥胖的病理生理学和分子靶向疗法，以改善患者的疾病诊疗。 新术语有两大优点：首先，ABCD强调了肥胖相关不良影响而非仅仅是体重增加（即ABCD还包括分布和功能异常）；第二，ABCD避免了肥胖多重含义的困惑。 肥胖这一术语经常造成公众和医疗卫生专业人士的混淆，因为其诊断完全根据人体测量。该术语本身传达与之相关的信息很少，仅通过体重指数（BMI）估计肥胖，对预测疾病和指导临床实践的表现并不理想。 ABCD的概念并不改变肥胖本身，但为医生和患者传达了更多健康相关信息，并涉及降低异常脂肪质量、分布和（或）功能不良影响及风险的初级预防和降低肥胖并发症不良影响及风险的二级或三级预防。 根据美国疾病预防控制中心，2008年美国有超过三分之一的成年人为肥胖患者。通过专业人员（如内分泌医师）参与，肥胖相关疾病（如糖尿病、心脏病、卒中和癌症）可以得到预防。引入这一术语后，AACE/ACE下一步将倾听各方的评论和批评，细化完善管理框架（不仅仅以BMI为中心而是以并发症为中心），并逐步在患者及整个人群中验证此举带来的获益性。 Endocr Pract. 2016 Dec 14. [Epub ahead of print] Adiposity-Based Chronic Disease as a new diagnostic term: American Association of Clinical Endocrinologists and The American College Of Endocrinology Position Statement. Mechanick JI, Hurley DL, Garvey WT. The American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) have created a chronic care model, advanced diagnostic framework, clinical practice guidelines, and clinical practice algorithm for the comprehensive management of obesity. This coordinated effort is not solely based on body mass index as in previous models, but emphasizes a complications-centric approach that primarily determines therapeutic decisions and desired outcomes. Adiposity-Based Chronic Disease (ABCD) is a new diagnostic term for obesity that explicitly identifies a chronic disease, alludes to a precise pathophysiological basis, and avoids the stigmata and confusion related to the differential use and multiple meanings of the term “obesity”. Key elements to further the care of patients using this new ABCD term are: (1) positioning lifestyle medicine in the promotion of overall health, not only as the first algorithmic step, but as the central, pervasive action, (2) standardizing protocols that comprehensively and durably address weight loss and management of adiposity-based complications, (3) approaching patient care through contextualization (e.g., primordial prevention to decrease obesogenic environmental risk factors and transculturalization to adapt evidence-based recommendations for different ethnicities, cultures, and socio-economics), and lastly, (4) developing evidence-based strategies for successful implementation, monitoring, and optimization of patient care over time. This AACE/ACE blueprint extends current work and aspires to meaningfully improve both individual and population health by presenting a new ABCD term for medical diagnostic purposes, use in a complications-centric management and staging strategy, and precise reference to the obesity chronic disease state, divested from counterproductive stigmata and ambiguities found in the general public sphere. KEYWORDS: adiposity; body imaging; chronic disease; insulin resistance; lifestyle medicine; metabolic syndrome; obesity; prediabetes; type-2 diabetes PMID: 27967229 DOI: 10.4158/EP161688.PS
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