Nutr J. 2015; 15: 5.
Idasindikizidwa pa intaneti 2016 Jan 13. do: 10.1186/s12937-016-0124-6
PMCID: PMC4711027
Jose Manuel Lerma-Cabrera, Francisca Carvajalndipo Patricia Lopez-Legarrea
Kuyamba. Kunenepa kwambiri masiku ano
Kunenepa kwambiri kwakhala nkhawa yayikulu yaboma padziko lonse lapansi chifukwa champhamvu yachuma ndi zachuma zomwe zimachokera ku ma comorbidities ake okhudzana nawo [1]. Kulemera kwakukulu kwa thupi akuti akuti ndi amene amachititsa 16% ya matenda opatsirana padziko lonse lapansi [2] ndipo malinga ndi kuyerekezera kwa World Health Organisation, anthu opitilira 600 miliyoni ndi onenepa kwambiri padziko lonse lapansi Akufotokozedwa ngati vuto la etiology yambiri ndipo zinthu zingapo zikuwoneka kuti zikukhudzana ndi chiyambi ndi chitukuko [1]. Ngakhale kuti kupita patsogolo kwa matenda a kunenepa kwambiri, kuchuluka kwa matenda akupitiliza kuchuluka, ndikuwonetsa kuti zina zowonjezera ziyenera kutenga nawo mbali pa pathogenesis yamatendawa. Kuphatikiza apo, ngakhale mapulogalamu othandizira kuchepetsa thupi amathandizanso, kuchepetsa kulemera kumapitilizabe kukhala kovuta kuthana nako [3]. Munkhani iyi, ziphunzitso zatsopano zikubwera pankhani yokhudza chakudya. Kumvetsetsa kunenepa ngati chizolowezi cha chakudya ndi njira yatsopano yomwe yathandizira chidwi. Kafukufuku wina wasonyeza kuyanjana pakati pa kusintha kwa zakudya ndi njira yonse yazakudya kuphatikiza zakudya zina [4]. Kafukufuku waposachedwa akuwonetsanso kuti chakudya chabwino komanso chopatsa mphamvu cha kalori chitha kukhala champhamvu kwambiri. Omwe amadyedwa nthawi zambiri amadya zakudya zazikuluzikulu kuposa zomwe zimafunikira kuti mukhale athanzi, zomwe zimawonetsa kulephera kudziletsa pakakhalidwe ka chakudya [5]. Kuphatikiza apo, kuchuluka kwa anthu 40% okonda kudya kwakhala kukuwonetsedwa mwa anthu onenepa omwe akufuna kuchitidwa opaleshoni ya bariatric [6]. Zotsatira zonsezi zikuwonetsa kuti pakhoza kukhala ubale womwe ungakhalepo pakati pa chikhalidwe ndi kuwonda.
Malingaliro atsopano okhudzana ndi kunenepa kwambiri: kunenepa kwambiri monga chizolowezi cha chakudya
M'zaka zaposachedwa, pakhala pakuwonjezereka kwa umboni wa sayansi womwe ukuwonetsa ubale ndi mitsempha yaubongo pakati pa mankhwala ndi zakudya. Kafukufuku woyamba pogwiritsa ntchito mitundu ya zinyama ndi anthu awonetsa kuti zakudya zina, makamaka zopatsa thanzi kwambiri, zimakhala ndi mankhwala osokoneza bongo. Kuphatikiza apo, kuwonetsedwa kwa chakudya ndi mankhwala osokoneza bongo kwawonetsa kuyankha komweko mu dopaminergic ndi opioid system. Kufanana kumene pakati pa chakudya ndi mankhwala kwapangitsa kuti pakhale chidwi chofuna kusiya kudya.
Zakudya zamagetsi komanso magawo a mphotho yaubongo
Dopaminergic system imakhudzidwa pamakhalidwe ambiri kuphatikizapo kukonza mphotho ndi machitidwe olimbikitsidwa. Chifukwa chake, mankhwala onse ozunza amawonjezera kuchuluka kwa dopamine (DA) mu striatum ndi zigawo za mesolimbic [7]. Gulu la a Di Chiara lawonetsa kwambiri kuti mankhwala osokoneza bongo (mwachitsanzo amphetamine ndi cocaine) amawonjezera akunja kwa DA mu nucleus accumbens (NAc), malo oyambira amakhalidwe olimbikitsidwa [7]. Momwemonso, ma micodialysis awonetsa kuti kukhudzana ndi chakudya chopindulitsa kumalimbikitsa kufalitsa kwa dopaminergic mu NAc [8].
Komanso, maphunziro a neuroimaging akuwonetsa kuti kuyankha kwa ubongo wathu ndikofanana pamaso pa chakudya ndi kugwiritsa ntchito mankhwala osokoneza bongo: kuchuluka kwa maselo ku NAc, malo osangalatsa a ubongo [9-11]. Kafukufuku wopatsa chidwi mwa anthu awonetsanso kufanana pakati pa kunenepa kwambiri komanso kuzolowera. Mwachitsanzo, kunenepa kwambiri komanso kuzolowera zimagwirizanitsidwa ndi ochepa a D2 dopamine receptors mu ubongo [12, 13], kutanthauza kuti samvera kwenikweni mphotho zoyambitsa ndipo amakhala pachiwopsezo cha chakudya kapena mankhwala osokoneza bongo. Chifukwa chake, mwachitsanzo, anthu omwe ali ndi index yayikulu kwambiri ya thupi (BMI) anali ndi zotsika kwambiri za D2 [13].
Makamaka, kuchepetsedwa kwa kusungunuka kwa D2 kachulukidwe komwe kumachepetsa kagayidwe ka magazi m'malo a ubongo (pre mbeleal and orbitofrontal cortex) komwe kumapereka mphamvu yolamulira pakumwa [12]. Chifukwa chake, maphunziro onenepa kwambiri akuwonetsa gawo lalikulu la mphotho komanso magawo omwe anthu amawaganizira kuposa momwe zinthu zambirimbiri zolemetsa zimayankhira chifukwa cha zithunzi zabwino za chakudya pofanizira ndi zithunzi zoyang'anira [14, 15]. Izi zikuwonetsa kuti kuchepa pakubweza mphotho ndi gawo lofunikira pachiwopsezo chamakhalidwe oyenera ndi okakamiza omwe akuwonetsedwa ndi anthu onenepa kwambiri. Kutengedwa palimodzi, izi zitha kufotokozera chifukwa chake kunenepa kwambiri komanso kugwiritsa ntchito mankhwala osokoneza bongo zizolowezi zomangika zimapitilirabe ngakhale zotsatirapo zoipa zaumoyo, thanzi komanso zachuma. Zambiri zamitsempha izi zikuonetsa kuti kunenepa kwambiri komanso kugwiritsa ntchito mankhwala osokoneza bongo kumatha kugawana mayankho ofanana ndi aubongo pazomwe zimachitika.
Udindo wa zakudya za neuropeptides pakukonda
Lingaliro loti ma neuropeptides okhudzana ndi malamulo a metabolic amathandizidwanso pakusintha mayankho a neurobiological ku mankhwala ozunza alandila chidwi chachikulu m'mabuku aposachedwa [16, 17]. Kafukufuku angapo adawonetsa kuti kudziwika ndi mankhwala osokoneza bongo kumasintha kwambiri magwiridwe antchito amachitidwe ambiri a ma neuropeptides. Kumbali inayi, makina omwe amalimbana ndi ma neuropeptides awa amagwira ntchito yofunika kwambiri pakusintha mayankho a neurobiological ku mankhwala ozunza. Mwachitsanzo, melanocortins (MC) ndi orexins system, yomwe imagwira ntchito yofunika pakudya, imaphatikizidwanso pakugwiritsa ntchito mankhwala osokoneza bongo. Kuphatikiza apo, mafotokozedwe aubongo awa a neuropeptides amasinthika pambuyo pakumwa mankhwala osokoneza bongo [18-20] kapena zinthu zothandiza (caloric and non-caloric) [21]. Central management of Agouti-peptide-peptide, MC okonda, activate midbrain dopamine neurons ndikuyambitsa kudya mafuta olemera zakudya [22]. Kuphatikizidwa pamodzi, idathayi ikhoza kufotokozera chifukwa chake mitundu ina ya chakudya imakhazikitsidwa nthawi zambiri.
Njira zoyendetsera zakudya zomwe timadya zimatha kukhala zofunikira zapakhomo - komanso kufunika kwa hedonic [23]. Lingaliro ili limathandizidwa ndikuti anthu amapitilizabe kudya ngakhale mphamvu za magetsi zikwaniritsidwa. Komabe, ndikwabwino kuti makina awa (hedonic motsutsana homeostatic) sikuti amakhala osiyana, koma adzakhala ndi zolumikizana zingapo [24]. Homeostatic okhazikika a njala ndi satiety, monga ghrelin, leptin ndi insulin, amatha kuyanjana pakati pa homeostatic ndi hedonic magawo a chakudya omwe amachititsa kuti dopaminergic dongosolo [25, 26]. Leptin mwina ndiye chinthu chodziwika bwino kwambiri kwachilengedwe pokhudzana ndi kayendedwe kazakudya. Ngakhale zimabisidwa ndi minofu ya adipose, ma leptin receptors amafotokozedwa pa midbrain dopamine neurons [27]. Leptin kulowetsedwa mu gawo la gawo lozungulira, gawo la ubongo wamaubwino, kumachepetsa kudya ndikulepheretsa ntchito ya dopamine neurons [28]. Chifukwa chake, umboni waposachedwa ukusonyeza kuti njira za mesolimbic dopamine zimatha kuyambitsa zotsatira za leptin pakudya.
Chifukwa chake, malingaliro a "zakudya zosokoneza bongo" akuwonetsa kuti zakudya zina zomwe zimapangidwa kwambiri zimatha kukhala ndi vuto lalikulu ndipo zitha kuchititsa ena kunenepa kwambiri komanso vuto la kudya [29, 30]. Posachedwa, zawonetsedwa kuti maphunziro omwe akuwonetsa kudya mopatsa mphamvu mphamvu zambiri zama macronutrients (mafuta ndi mapuloteni) poyerekeza ndi zomwe sizipezeka pazakudya [31, 32]. Kukhazikitsidwa bwino kuti hyperphagia yoyambitsidwa ndi kudya kwamafuta opatsa thanzi komanso shuga woyengeka imayendetsedwa ndi mesolimbic ndi nigrostriatal dopaminergic zolowetsa. Mwachitsanzo, kumwa zakudya zabwino kwambiri, makamaka shuga, kumakhudzanso kutulutsidwa kwa mankhwala opioid mu NAc [33, 34] ndikuyambitsa dongosolo la mphotho ya dopaminergic [35]. Kuphatikiza apo, makoswe omwe adatulukira pakanthawi kena njira yothetsera shuga akuwonetsa zina zomwe zimapangitsa kuti pakhale kuchuluka kwa shuga tsiku ndi tsiku, zizindikiro zochotsa, kulakalaka komanso chidwi chambiri kuti amphetamine ndi mowa [36]. Izi zimawerengera kuti zakudya zina zimakhala ndi zopindulitsa ndipo zimatha kuyambitsa machitidwe achizolowezi mu nyama zanyumba ndi anthu.
Momwe mungawerengere zamankhwala osokoneza bongo
Monga tanenera kale, kunenepa kwambiri ndi matenda osokoneza bongo omwe amayamba chifukwa cha zinthu zingapo. Ndemanga iyi yawonetsa momwe njira zomwe zingathandizire kuti kudya kwambiri komanso kunenepa kwambiri. Chifukwa chake, kugwiritsa ntchito mankhwala osokoneza bongo kungakhale chifukwa chothandizira kudya kwambiri komanso kunenepa kwambiri. Komabe, kwa asayansi lingaliro lamavuto azakudya akadali nkhani yotsutsana [5, 37, 38]. Imodzi mwamafunso okayikira kuvomerezedwa kwa zakudya zosokoneza bongo ndikuti ngakhale kafukufuku wamatsenga adazindikira njira zomwe amagawana za chakudya ndi mankhwala, pali kusiyana kwakukulu nawonso [37]. Komanso, kayendedwe ka ubongo ka anthu onenepa kwambiri ndi omwe amadya kwambiri poyerekeza ndi kuwongolera sikugwirizana [38]. Pomaliza, ndemanga zina zovuta zimati maphunziro ambiri omwe amathandizira kukhalapo kwa kukhudzidwa kwa zakudya amaletsedwa pazithunzithunzi za nyama [5]. Pokumbukira kutsutsa kumeneku, kafukufuku wamtsogolo amafunikira kuti aphunzire mozama zowonjezereka za kuvomerezeka kwa zakudya mwa anthu. Chifukwa chake, kuwunikira motere wa "mankhwala osokoneza bongo" ndi momwe amathandizira pakudya yamavuto kumakhala kofunikira kukhala ndi zida zodalirika komanso zodalirika zogwiritsira ntchito zizolowezi zakudya.
Chida chodziwitsa anthu omwe akuwonetsa “kudalira” zakudya zina apangidwa posachedwapa. Gearhardt ndi magulu. inafotokozedwa bwino mu 2009 The Yale Food Addiction Scale (YFAS) [39]. Mulingo uwu wagwiritsidwa ntchito pakupanga zambiri zokhudzana ndi lingaliro lazakumwa zakudya ndipo zidamasuliridwa m'zilankhulo zingapo, monga, French, Germany, Italy, Spain kapena Dutch. Chida chija ndi funso la 25-cholembedwa m'magulu omwe amafanana ndi zizindikiro za kudalira kwa zinthu monga momwe zalembedwera mu Diagnostic and Statistical Manual of Mental Disorder IV. Mulingowo umaphatikizapo zinthu zomwe zimawunikira njira zina, monga kuchepetsa kuwongolera kumwa, chilimbikitso chopitilira kapena kuyesayesa mobwerezabwereza kuti musiye, kugwiritsabe ntchito ngakhale mutakhala ndi mavuto akuthupi ndi malingaliro, komanso kusokonezeka kwakukulu pakukhumudwa. Zizindikiro zofala kwambiri pakukhudzidwa kwa chakudya ndi kulephera kudziletsa pakumwa kumwa, kupitiliza kugwiritsidwa ntchito ngakhale mutakhala ndi zotsatirapo zoipa, komanso kulephera kudula ngakhale mukufuna kuchita izi [40].
Kafukufuku wogwiritsa ntchito YFAS apeza kuti odwala omwe akuwakwera kwambiri amawonetsa kwambiri zomwe zimachitika pakudya kawiri kawiri [22, 41, 42]. Momwemonso, kuchuluka kwa anthu omwe amakonda kugwiritsa ntchito mankhwala osokoneza bongo omwe amapezeka kuti akugwiritsa ntchito YFAS anali 5.4% mwa anthu onse [31]. Komabe, kuledzera kumawonjezeka chifukwa cha kunenepa kwambiri pakati pa 40% ndi 70% mwa anthu omwe ali ndi vuto la kudya kwambiri42], okonda kwambiri [43] kapena bulimia amanosa [6]. Kuphatikiza apo, anthu omwe ali ndi zakudya zambiri zosokoneza bongo amapezeka kuti ali ndi mayankho ofanana ndikamaona zithunzi monga chakudya monga anthu omwe amadalira mankhwala osokoneza bongo. Anawonetsa kukwezedwa kofunikira mu gawo la mphotho (anterior cingrate cortex, dorsolateral prefrontal cortex ndi amygdala) poyankha zokonda zazakudya ndikuchepetsedwa kwa magawo omwe ali ndi malire (medial orbitofrontal cortex) poyankha kudya [29].
Chosangalatsa ndichakuti kufalikira kwa mankhwala osokoneza bongo kudali kokhudzana ndi kuchuluka kwa zakudya (mwachitsanzo mafuta amthupi, BMI) [31, 44]. Izi zimawonetsa kuti kusuta kwa zakudya ndizofunikira kwambiri pakukula kwa kunenepa kwambiri kwa anthu komanso kuti zimakhudzana ndi kuopsa kwa kunenepa kwambiri kuyambira kwa anthu wamba mpaka onenepa. M'malo mwake, anthu onenepa kwambiri akuwonetsa kuyipa kwambiri pakuchepetsa chithandizo [41] ndi kuchuluka kwambiri pambuyo pochita opaleshoni yoyamwa [45] pezani zambiri zapamwamba za YFAS. Chifukwa chake, chithandizo chamankhwala ochepetsa thupi chiyenera kulingalira za gawo lomwe lingakhalepo pakankhwala osokoneza bongo ngati chinthu chofunikira kwambiri pakulimbikitsa kunenepa.
Kumbali inayi, mikhalidwe ina, monga kuphatikizika, yakhala ikuphatikizidwa ndi mowa komanso kugwiritsa ntchito mankhwala osokoneza bongo [46]. Potengera zakumwa zomwe zawonongeka, kafukufuku waposachedwa wasonyeza kuti anthu onenepa omwe akuwonekera kwambiri ku YFAS anali okakamiza komanso akuwonetsa kutaya mtima kwambiri kuposa zoyeserera zonenepa.22]. Zotsatira izi zikuwonetsa kuti chizolowezi chomangirira zakudya chimawonetsa mawonekedwe amisala yofanana ndi zovuta zamankhwala wamba.
Komabe, ngakhale zakudya zosokoneza bongo zilipo, ndizokayikitsa kwambiri kuti zakudya zonse zitha kukhala zowonjezera. Ogulitsa mafakitale adapanga zakudya zakonzedwa ndikuwonjezera shuga, mchere, kapena mafuta, zomwe zimatha kukulitsa mphamvu zolimbikitsira zakudya zacikhalidwe (zipatso, masamba). Kukonda kwambiri (phindu la hedonic) komwe zakudya zamtunduwu zimapereka, kumalimbikitsa omvera kudya zambiri. Chifukwa chake, zakudya zina zopukutidwa zitha kukhala ndizovuta kwambiri ndipo zimayambitsa mavuto ena akudya monga kunenepa kwambiri [30, 40]. Ngakhale pali umboni wochepa mwa anthu, mitundu ya nyama imati zakudya zomwe zimakonzedwa zimayenderana ndi zakudya zomwe zimakonda. Mwachitsanzo, Avena ndi ma col. adawonetsa kuti kudya kwambiri shuga kumayambitsa matenda a neurochemical (kutulutsa kochulukirapo kwa dopamine ndi acetylcholine ku NAc) komanso zamakhalidwe (kuchuluka kwambiri kwa shuga pambuyo pa nthawi yodziletsa komanso kusamala kwa mankhwala osokoneza bongo) Zizindikiro zodalira [47]. Zotsatira izi zikuwonetsa kuti kugwiritsidwa ntchito mopitirira muyeso wa chakudya chosakonzedwa bwino, koma osati muyezo wowoneka bwino, kumakhala ndi mawonekedwe owoneka ngati osokoneza. Komanso, zikuwonetsedwa kuti kugwiritsidwa ntchito mopitirira muyeso kwa chakudya chosasangalatsa kumayambitsa kutsika kwa malamulo a striatal D2 receptors monga momwe amachitira mankhwala [48], zomwe zikusonyeza kuti kunenepa kwambiri komanso kugwiritsa ntchito mankhwala osokoneza bongo zitha kugawana gawo limodzi la hedonic, monga tanena pamwambapa.
Ngakhale zili choncho, sikuti aliyense amene ali ndi chakudya chokwanira amakhala ndi kunenepa. Kudziwa zolinga za kubereka komanso / kapena zomwe zimapangitsa kuti anthu azidya zakudya zabwino kwambiri zitha kuthandiza kufotokozera za kunenepa kapena kulimba mtima pokhudzana ndi kunenepa kwambiri. Chifukwa chake, podziwitsa chifukwa chake anthu ayamba kudya zakudya zamtunduwu ndizotheka kupanga njira zoyenera "zopangidwa ndi anthu" kuti athane ndi kunenepa kwambiri. Palatable Motives Eating Scale (PEMS) ndiwotsimikizika komanso wokhazikika kuti azindikire zomwe zimakulimbikitsani kudya zakudya zabwino kwambiri [49]. Sikeloyo imalola kuzindikira zolinga za kudya zakudya zabwino: mwachitsanzo, chifukwa anzanu kapena abale akufuna kuti mudye kapena kumwa izi kapena zakumwa izi. Komanso, PEMS ili ndi chitsimikizo chabwino chogwirizana ndi zambiri za YFAS. Zimapangitsa kuyesa mitundu yosiyanasiyana ya zakudya zophatikiza. Ngakhale YFAS imaganizira zotsatira za kudya zakudya zabwino kwambiri, a PEMS amafufuza zolinga zomwe amamwa.
Zitsanzo ziwiri pamiyeso (YFAS ndi PEMS) zowunikira zakudya zomwe zidawonetsedwa.
Kutsiliza
Monga tafotokozera pamwambapa, kunenepa kwambiri kwakhala vuto lalikulu lathanzi labwino padziko lonse lapansi. Chifukwa chake, kupeza njira zoyenera zolimbana ndi matendawa kumayimira vuto lalikulu kwa asayansi apadziko lonse lapansi. Kuwerenga momwe anthu angakhalire ndi vuto la kudya ngati chinthu chofunikira kwambiri pakudya kwambiri kumapangitsa chidwi. Zowonjezera, poganizira zotsatira zosangalatsa ndi nyama. Amadziwika kuti nthawi zina zakudya zamagulu ambiri sizimayenderana ndi zosowa zathupi koma gawo lazikhalidwe zomwe zimayenera kuzindikirika. Kupeza chinthu ichi kungalolere kuphatikizidwa kwa njira zochiritsira pakati pa ngodya zamankhwala othandizira kunenepa, motero kukwaniritsa njira zamitundu yambiri molingana ndi magwero a kunenepa kwambiri. Kuzindikira kumene kotheka kumatha kuloleza kugwiritsa ntchito mankhwalawa moyenera, osangoleketsa kwambiri, komanso mwayi wabwino wonenepa. Zida za YFAS ndi PEMS zimapereka njira yokhazikika yodziwira ngati njira yodabwitsayo imathandizira pamavuto ena akudya, monga kunenepa kwambiri komanso kudya kwambiri. Komabe, kafukufuku wowonjezereka amafunikira kuti athe kuwunika kukhudzidwa kwa zakudya ndi momwe zimagwirizanirana ndi zovuta zakudya. Ndikofunikira kuti muphunzire zamomwe mungagwiritsire ntchito zamagetsi. Mulimonsemo, zakudya zina (zamafuta, shuga ndi zamchere) zawonetsa kuti zili ndi kuthekera kosokoneza, zomwe zikutanthauza mwayi wopewa komanso kuchiza kunenepa kwambiri.
Zothokoza
Ntchito yomwe idalipo idachitika chifukwa cha Universidad Autonoma de Chile (DPI 62 / 2015).
achidule
| DA | dopamine |
| NAc | nucleus accumbens |
| BMI | thupi misa index |
| MC | melanocortins |
| YFAS | Yale Food Addiction Scale |
| PEMS | Zoyenera Kuchita Zabwino Kudya |
Mawu a M'munsi
Zosangalatsa zovuta
Olemba amanena kuti alibe zopikisana.
Zopereka za olemba
Kusaka zolembedwa kunachitika ndi olemba onse, komanso kuphatikiza deta, kusanthula, ndi kaphatikizidwe. PLL inakonza zoyambirira zolembedwa pamanja. Kusagwirizana kunathetsedwa pakugwirizana, olemba onse amawerenga ndi kuvomereza zolemba zomaliza
Zowonjezera Zowonjezera
Jose Manuel Lerma-Cabrera, Imelo: [imelo ndiotetezedwa].
Francisca Carvajal, Imelo: [imelo ndiotetezedwa].
Patricia Lopez-Legarrea, Foni: + 56 2 23036664, Imelo: [imelo ndiotetezedwa].
Zothandizira