Overview of human obesity and central mechanisms regulating energy homeostasis

Ann Clin Biochem 2008;45:245-255
© 2008 Association for Clinical Biochemistry


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Review Article

Vivion E F Crowley

Central Pathology Laboratory, Department of Biochemistry, St James’s Hospital, Dublin 8, Ireland

Email: vcrowley{at}stjames.ie

Obesity is now regarded as a global epidemic affecting bothadults and children, and is associated with significant morbidityand mortality. Thus the effective management of obesity hasbecome an important clinical focus. Therefore, an understandingof the pathways controlling appetite, satiety and food intakeis critical for gaining an insight into the pathogenesis ofobesity and also for the development of diagnostic tests andtherapeutic agents for use in the clinical management of thiscondition. Over the last decade or more research using bothmouse and human genetic models has elucidated the critical roleof the leptin-melanocortin pathway in the hypothalamus, in regulatingmammalian energy balance. In tandem with this, a clearer understandingof the regulation of gut-derived hormones and their interactionwith the central nervous system has further illuminated thecomplex interplay between central and peripheral aspects ofenergy regulation. The obesity epidemic and the expanded knowledgebase relating to its aetiopathogenesis have specific implicationsfor clinical biochemistry. In particular, an increase in workloadmay be expected due to biochemical investigation of obesityand its co-morbidities. Moreover, advice on the in-depth investigationof complex cases of obesity may be sought, including informationon newer diagnostic tests, such as serum leptin or moleculargenetic analysis. There may also be a substantive role for chemicalpathologists in establishing and running clinical obesity services.Finally, clinical biochemistry has a role in research pertainingto obesity and cardiometabolic risk.

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