张 蕊,曾湘晖

肥胖不仅是严重的社会、健康问题，而且对于生殖来说更是独立危险因素。目前对于肥胖的诊断，多以身体质量指数为主。但身体质量指数无法准确描述人体脂肪含量，更可能因肌肉型个体体质量较重而引起误诊。评估人体的脂肪分布，例如：体脂百分比、腰臀比、腰围身高比等，将更客观的判断患者的肥胖程度。本文将从体脂分布对于女性生殖、男性生殖及辅助生殖技术的影响三个方面进行论述。

体脂分布；肥胖；女性生殖；男性生殖；辅助生殖技术

[1] Catalano P M,Shankar K.Obesity and pregnancy:mechanisms of short term and long term adverse consequences for mother and child[J].Bmj,2017,356. [2] Chew N W S,Ng C H,Tan D J H,et al.The global burden of metabolic disease:Data from 2000 to 2019[J].Cell Metabolism,2023,35(3):414-428.e3. [3] Leisegang K,Henkel R,Agarwal A.Obesity and metabolic syndrome associated with systemic inflammation and the impact on the male reproductive system[J].American journal of reproductive immunology,2019,82(5):e13178. [4] Niño O M S,da Costa C S,Torres K M,et al.High‐refined carbohydrate diet leads to polycystic ovary syndrome-like features and reduced ovarian reserve in female rats[J].Toxicology Letters,2020,332:42-55. [5] Kim J,Juneau C,Patounakis G,et al.The appraisal of body content(ABC)trial:obesity does not significantly impact gamete production in infertile men and women[J].Journal of Assisted Reproduction and Genetics,2020,37:2733-2742. [6] Moslehi N,Shab-Bidar S,Tehrani F R,et al.Is ovarian reserve associated with body mass index and obesity in reproductive aged women?A meta-analysis[J].Menopause,2018,25(9):1046-1055. [7] Kuchenbecker W K H,Groen H,Zijlstra T M,et al.The subcutaneous abdominal fat and not the intraabdominal fat compartment is associated with anovulation in women with obesity and infertility[J].The Journal of Clinical Endocrinology&Metabolism, 2010, 95(5): 2107-2112. [8] Jaswa E G,Rios J S,Cedars M I,et al.Increased body mass index is associated with a nondilutional reduction in antimüllerian hormone[J]. The Journal of Clinical Endocrinology&Metabolism,2020,105(10):3234-3242. [9] Luke B,Brown M B,Stern J E,et al.Female obesity adversely affects assisted reproductive technology(ART)pregnancy and live birth rates[J].Human Reproduction,2011,26(1):245-252. [10] Meulders B,Marei W F A,Xhonneux I,et al.Preconception diet interventions in obese outbred mice and the impact on female offspring metabolic health and oocyte quality[J].International journal of molecular sciences,2024,25(4):2236. [11] Yao Y,Liu W,Zhang X,et al.Normal weight obesity is associated with lower AFC and adverse IVF outcomes[J].Frontiers in Endocrinology,2024,15:1332995. [12] Rhee J S,Saben J L,Mayer A L,et al.Diet-induced obesity impairs endometrial stromal cell decidualization:a potential role for impaired autophagy[J].Human reproduction,2016,31(6):1315-1326. [13] Palomba S,De Wilde M A,Falbo A,et al.Pregnancy complications in women with polycystic ovary syndrome[J].Human reproduction update,2015,21(5):575-592. [14] 应瑛,刘见桥.肥胖合并不孕症的诊治[J].中国实用妇科与产科杂志,2024,40(06):618-623. [15] Lauby-Secretan B,Scoccianti C,Loomis D,et al.Body fatness and cancer—viewpoint of the IARC Working Group[J].New England journal of medicine,2016,375(8):794-798. [16] Argenta P,Svendsen C,Elishaev E,et al.Hormone receptor expression patterns in the endometrium of asymptomatic morbidly obese women before and after bariatric surgery[J].Gynecologic oncology,2014,133(1):78-82. [17] Comstock I A,Diaz-Gimeno P,Cabanillas S,et al.Does an increased body mass index affect endometrial gene expression patterns in infertile patients?A functional genomics analysis[J].Fertility and sterility,2017,107(3):740-748.e2. [18] Katib A.Mechanisms linking obesity to male infertility[J].Central European journal of urology,2015,68(1):79. [19] Sermondade N,Faure C,Fezeu L,et al.Obesity and increased risk for oligozoospermia and azoospermia[J].Archives of internal medicine,2012,172(5):440-442. [20] Ellulu M S,Patimah I,Khaza’ai H,et al.Obesity and inflammation:the linking mechanism and the complications[J].Archives of medical science,2017,13(4):851-863. [21] Leisegang K,Sengupta P,Agarwal A,et al.Obesity and male infertility:Mechanisms and management[J].Andrologia,2021,53(1):e13617. [22] Sallmén M,Sandler D P,Hoppin J A,et al.Reduced fertility among overweight and obese men[J].Epidemiology,2006,17(5):520-523. [23] Ramlau-Hansen C H,Thulstrup A M,Nohr E A,et al.Subfecundity in overweight and obese couples[J].Human reproduction, 2007, 22(6):1634-1637. [24] Nguyen R H N,Wilcox A J,Skjærven R,et al.Men's body mass index and infertility[J].Human Reproduction,2007,22(9):2488-2493. [25] Kawwass J F,Summer R,Kallen C B.Direct effects of leptin and adiponectin on peripheral reproductive tissues:a critical review[J]. Molecular Human Reproduction,2015,21(8):617-632. [26] Carrageta D F,Oliveira P F,Alves M G,et al.Obesity and male hypogonadism:Tales of a vicious cycle[J].Obesity Reviews, 2019, 20(8):1148-1158. [27] Barbagallo F,La Vignera S,Cannarella R,et al.Obesity and male reproduction:do sirtuins play a role?[J].International journal of molecular sciences,2022,23(2):973. [28] Martins A D,Majzoub A,Agawal A.Metabolic syndrome and male fertility[J].The world journal of men's health,2019,37(2):113-127. [29] Lu J C,**g J,Dai J Y,et al.Body mass index,waist‐to‐hip ratio,waist circumference and waist‐to‐height ratio cannot predict male semen quality:a report of 1231 subfertile Chinese men[J]. Andrologia,2015,47(9):1047-1054. [30] Keszthelyi M,Gyarmathy V A,Kaposi A,et al.The potential role of central obesity in male infertility:body mass index versus waist to hip ratio as they relate to selected semen parameters[J]. BMC public health,2020,20:1-10. [31] Niederberger C.Re:The Relationship between Male BMI and Waist Circumference on Semen Quality:Data from the LIFE Study[J]. The Journal of Urology,2014,192(3):883-883. [32] Xiong Y,Zhang F,Zhang Y,et al.Insights into modifiable risk factors of erectile dysfunction,a wide-angled Mendelian Randomization study[J].Journal of Advanced Research,2024,58:149-161. [33] Christofolini J,Maria Christofolini D,Zaia V,et al.Body fat distribution influences ART outcomes[J].Gynecological Endocrinology, 2020,36(1):40-43. [34] Li M C,Mínguez-Alarcón L,Arvizu M,et al.Waist circumference in relation to outcomes of infertility treatment with assisted reproductive technologies[J].American journal of obstetrics and gynecology,2019,220(6):578.e1-578.e13. [35] Setti A,Halpern G,Braga D,et al.Association between parental anthropometric measures and the outcomes of intracytoplasmic sperm injection cycles[J].Journal of Assisted Reproduction and Genetics,2019,36:461-471. [36] Hunter E,Avenell A,Maheshwari A,et al.The effectiveness of weight‐loss lifestyle interventions for improving fertility in women and men with overweight or obesity and infertility:a systematic review update of evidence from randomized controlled trials[J].Obesity reviews, 2021,22(12):e13325.

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