Дисбіоз кишечника, ожиріння і метаболічний синдром: як вибратися із підступного трикутника?
DOI:
https://doi.org/10.30978/MG-2019-4-45Ключові слова:
мікробіота, дисбіоз кишечника, сидром надлишкового бактеріального росту, ожиріння, метаболічний синдром, патогенез, лікуванняАнотація
Проаналізовано дані світової літератури та результати доказових експериментальних і клінічних досліджень про взаємозв’язок особливостей харчування і мікробіоти кишечника. Особливу увагу приділено участі дисбіозу кишечника та синдрому надлишкового бактеріального росту в тонкій кишці в патогенезі ожиріння і метаболічного синдрому. Наведено аргументи на користь двох основних гіпотез: метаболічної ендотоксемії та «зберігання». Перша розглядає механізми впливу ліпополісахариду грамнегативної кишкової флори, підвищення проникності кишкової стінки, ендоканабіноїдної системи і кишкової лужної фосфатази. Гіпотеза «зберігання» враховує особливості ферментації харчових полісахаридів, абсорбцію моносахаридів і роль кишкової мікробіоти та метаболітів її життєдіяльності (зокрема коротколанцюгових жирних кислот) у регуляції ліпідного обміну. Особливу увагу приділено лікуванню: зміні харчового раціону, використанню про- і пребіотиків, фекальній трансплантації. Проаналізовано вплив компонентів їжі на кишкову мікробіоту, зокрема харчових волокон, таких як резистентний крохмаль та інулін, а також жиру і білків. Показано, що склад кишкової мікробіоти відображує харчові звички та склад раціону. Дієта з високим вмістом жирів різко збільшує кишкову проникність завдяки механізму, пов’язаному зі зниженою експресією білків епітеліального щільного з’єднання, зокрема зонуліну та оклюдину. Обґрунтовано гіпотезу про те, що кишковий мікробіом, пов’язаний з ожирінням, має підвищену здатність до отримання енергії з раціону («ефект накопичення»). Проаналізовано переваги антибіотика з низькою кишковою абсорбцією — рифаксиміну. Наведено результати досліджень, які доводять еубіотичні властивості рифаксиміну та його ефективність при дисбіозі кишечника.
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