作者：宠物医师网编委会
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摘要
全球猫群中超重和肥胖（overweight and obesity，O&O）的患病率已经显著上升，成为宠物健康的主要隐患。更为严重的是，O&O不仅仅是体重问题，它还可能为其他疾病的发生提供“温床”，无论是通过增加猫咪的易感性，还是直接促使现有健康问题加重或新病症的出现。
这些相关疾病包括肌肉骨骼变化、胰岛素抵抗、2型糖尿病、皮肤病，甚至肾脏和尿路问题等。因此，本综述将探讨与家猫O&O的相关疾病，以期为改善猫咪健康提供有益见解。
关键词：营养病理；超重；肥胖；糖尿病；健康
一、MHO vs MUO
1.1 什么是代谢健康肥胖（MHO）？
定义：MHO指的是猫咪虽然体重超标，但尚未出现明显的健康问题，如糖尿病、高血脂或心血管疾病。
研究背景：这一概念最早源于人类医学，20世纪50年代的研究发现，部分肥胖人群尽管体重超标，却较少出现代谢性疾病。
猫咪中的MHO：目前，关于猫咪MHO的研究较少，但已有研究发现，部分肥胖猫咪（BCS >7/9）的甘油三酯（TGs）和肝酶活性正常，但脂联素和血清淀粉样蛋白A（SAA）水平异常。
1.2 什么是代谢不健康肥胖（MUO）？
定义：MUO指的是肥胖猫咪伴随有相关的健康问题，如胰岛素抵抗、2型糖尿病、脂肪肝等。
诊断标准：如果猫咪满足以下两个或更多条件，则可能被诊断为MUO：血清脂联素浓度低于3 μg/ml。高脂血症（TGs > 165 mg/dl）。SAA水平较高（> 200 ng/ml）。
健康风险：MUO猫咪的内脏脂肪堆积更多，容易引发脂肪毒性和代谢并发症。
二、超重和肥胖相关疾病
研究表明，家猫的超重和肥胖（O&O）与多种疾病相关，包括眼科疾病、非过敏性皮肤病、消化系统紊乱、跛行、肝脂肪变、心脏病、胰岛素抵抗、2型糖尿病（T2D）以及泌尿系统疾病等8,10,14,24,34,57,58。然而，值得注意的是，这些病症可能具有共同的病因或潜在因素，并不一定与超重和肥胖猫的代谢不健康肥胖（MUO）直接相关。
接下来，我们将详细介绍与家猫O&O相关的一些主要疾病。
2.1 泌尿系统疾病
尿石症：肥胖猫咪更容易患上尿石症，尤其是磷酸铵镁尿石。
饮水不足：室内猫和绝育猫饮水较少，尿液浓缩，增加了尿石形成的风险。
绝育的影响：绝育猫患尿石症的风险是未绝育猫的8.3倍。
2.2 皮肤病
皮肤屏障受损：肥胖可能导致皮肤水分流失，破坏上皮屏障功能，引发慢性炎症。
清洁困难：肥胖猫咪难以清洁身体某些部位，增加了皮肤病风险。
治疗副作用：某些皮肤病的治疗药物（如皮质类固醇）可能增加食欲，导致肥胖加重。
2.3 骨关节炎
关节负担加重：肥胖猫咪的关节承受更大压力，容易引发骨关节炎和退行性关节病。
炎症介质：脂肪细胞分泌的炎症介质（如TNF-α、IL-1）可能加剧关节炎症。
2.4 心脏和呼吸系统疾病
心脏负担：肥胖猫咪的心脏需要承受更大负荷，可能增加心脏病风险。
肺功能下降：肥胖可能导致猫咪的肺功能受限，表现为潮气量和通气量降低。
2.5 胰岛素抵抗与糖尿病
胰岛素敏感性下降：每增加1公斤体重，猫咪的胰岛素敏感性下降30%。
2型糖尿病：肥胖猫咪患糖尿病的风险是正常体重猫咪的2至4倍。
葡萄糖代谢异常：肥胖猫咪的胰岛素抵抗可能导致葡萄糖利用效率下降，进而诱发糖尿病。
三、结论
肥胖猫咪更容易罹患一系列健康问题，尤其是胰岛素抵抗、2型糖尿病、尿路疾病，以及皮肤、关节和肾脏疾病。
相关研究表明，使用CT评估的MUO猫咪，其腹部脂肪积聚更加明显，这与脂肪毒性以及各种病理事件的发生密切相关。因此，未来的研究不仅应关注肥胖猫咪的体况，还应探讨脂肪分布的影响，从而发展出更为精确的肥胖评估技术，应用于临床实践。
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Technical Documentation, 2025.
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