Lopez-Jimenez F, Malinski M, Gutt M, Sierra-Johnson J, Wady Aude Y, Rimawi A A, Mego P A, Thomas R J, Allison T G, Kirby B, Hughes-Borst B, Somers V K
Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Int J Obes (Lond). 2005 Jan;29(1):137-41. doi: 10.1038/sj.ijo.0802831.
We investigated the documentation of obesity as a medical problem, and subsequent management recommendations, in patients after myocardial infarction (MI).
We performed a cross-sectional analysis of a randomly selected sample of 627 patients discharged after an MI, from five US teaching hospitals between 1/1/01 and 12/31/02. Information was extracted from clinical notes using standardized definitions.
Mean body mass index (BMI) was 31+/-13 kg/m2, which was documented in only 14% of patients and had to be calculated post hoc in the rest. Waist circumference and waist/hip ratio were not documented at all; 83% of patients were overweight, 55% obese, and 8% morbidly obese. In only 20% of patients with BMI> or =30 kg/m2 was the diagnosis of obesity documented either as a current medical problem, as part of past medical history or as a final diagnosis. A dietary counseling was carried out in 61% of patients with BMI> or =25 kg/m2 and in 61% of patients with BMI<25 kg/m2, P=0.96. Weight loss was described as part of the goals/plan at discharge in 7% of overweight and 9% of obese patients. There was no change in either the level of recognition of obesity (22 vs 19%, P=0.3) or in the proportion of obese patients for whom weight loss was described as part of the goals/plan at discharge (8 vs 10%, P=0.7) before (n=301) compared to after (n=326) the Call to Action in Obesity by the Surgeon General in December 2001.
Obesity is underecognized, underdiagnosed and undertreated in persons with acute MI.
我们调查了心肌梗死（MI）患者中肥胖作为一个医学问题的记录情况及其后续的管理建议。
我们对2001年1月1日至2002年12月31日期间从美国五家教学医院出院的627例心肌梗死后患者的随机样本进行了横断面分析。使用标准化定义从临床记录中提取信息。
平均体重指数（BMI）为31±13kg/m²，只有14%的患者有记录，其余患者需事后计算得出。腰围和腰臀比根本没有记录；83%的患者超重，55%肥胖，8%病态肥胖。在BMI≥30kg/m²的患者中，只有20%的患者的肥胖诊断被记录为当前的医学问题、既往病史的一部分或最终诊断。61%的BMI≥25kg/m²的患者和61%的BMI<25kg/m²的患者接受了饮食咨询，P = 0.96。7%的超重患者和9%的肥胖患者在出院时的目标/计划中提到了体重减轻。与2001年12月美国卫生局局长发出肥胖问题行动呼吁之前（n = 301）相比，之后（n = 326）肥胖的识别率（22%对19%，P = 0.3）或被描述为出院时目标/计划一部分的肥胖患者比例（8%对10%，P = 0.7）均无变化。
急性心肌梗死患者中肥胖的识别、诊断和治疗不足。
