Singh, R.B. and De Meester, F. and Wilczynska, A. and Wilson, D.W. and Hungin, A.P.S. (2012) 'The liver-pancreas and the brain connection in the pathogenesis of obesity and metabolic syndrome.', Acta cardiologica., 2 (4). pp. 213-225.
Background. Obesity and type 2 diabetes mellitus have become major health problems in both developing and developed countries. The exact pathogenesis of obesity and type 2 diabetes mellitus that are components of metabolic syndrome is not known. Method. Perspectives, rather than formal review, were derived from a structured literature search essentially based on selected key words, vide infra, using Medline, PubMed and other personal bibliographies. Results. Physical inactivity and increased intake of energy in association with gene expression are common predisposing factors for obesity and metabolic syndrome. Apart from these factors, brain-related mechanisms concerned with the hypothalamus and vagus nerve have been implicated in such pathogenesis. The role of liver and beta cells of the pancreas and their interactions with the hypothalamus and vagus nerve are important mechanisms to explain the behavioural factors in the pathogenesis of metabolic syndrome. It seems that a neuronal pathway consisting of the afferent vagus from the liver and efferent sympathetic nerves to adipose tissues appear to be involved in the regulation of energy expenditure, systemic insulin sensitivity, glucose metabolism, and fat distribution between the liver and the peripheral tissues. Therefore, it is likely that the liver conveys information regarding energy balance to the brain via the afferent vagus, whereas leptin could be a humoral signal to the brain from the adipocytes. It is possible that the brain receives information from several tissues and organs via both humoral and neuronal pathways, which it integrates to produce an appropriate response; sympathetic nervous system activation and or parasympathetic modulation to maintain energy homeostasis. In this connection, the role of w-6/w-3 fatty acids ratio on liver-pancreas and brain function in relation to the Tsim Tsoum concept appears to be very interesting because it places emphasis on mind-body connection/interactions in the pathogenesis of obesity and diabetes. Omega-3 fatty acids can also improve neuronal efficiency causing improvement in attention, cognitive performance, mood-state and in the electroencephalographic alpha and theta oscillations which are indicators of memory function. Treatment of type 2 diabetes mellitus and coronary atherosclerosis with an ω-3 fatty acid rich Mediterranean diet may be protective by their direct effect as well as by their influence on the hypothalamic and vagal connections. Conclusions. It is possible that liver and pancreas via vagus nerve and hypothalamic connections as well as via humoral mechanisms can influence energy metabolism and food intake to maintain energy homeostasis which may have an independent effect on the development of obesity, type 2 diabetes and metabolic syndrome.ω-3 fatty acids may also have an independent effect on liver-pancreatic beta cells and brain connections.
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