Dorner T E, Rieder A
Institut für Sozialmedizin und Epidemiologie, Medizinische Universität Graz, Graz.
Dtsch Med Wochenschr. 2010 Mar;135(9):413-8. doi: 10.1055/s-0030-1249178. Epub 2010 Feb 23.
Overweight and obesity are independent risk factors for the development of disease and death in the general population. However, in people with various conditions (old age, wasting diseases, heart diseases or renal dialysis) overweight and obesity are associated with a higher survival rate. The terms "reverse epidemiology" or "obesity paradox" have been suggested to describe this finding. However, it still remains uncertain, whether this phenomenon is attributable to a real protective effect of high body fat mass. Methodological problems in studies suggesting an obesity paradox such as survivor bias, selection bias, lead time bias or, in meta analyses, publication bias and confounders have been discussed. These cannot, however, entirely explain the observed phenomenon. Biological models, examining possible explanations for the protective effect of high body mass, for instance, in wasting diseases and elderly patients, have also been produced. In particular high inflammation markers combined with malnutrition predict a high mortality rate among patients with various medical conditions: overweight and obesity could counter these effects. Possible implications for clinical and public health recommendations regarding weight management and nutrition are issues for future research. In elderly subjects and patients with a poor prognosis the impact of weight management on quality of life should also be taken into account.
超重和肥胖是普通人群发病和死亡的独立危险因素。然而，在患有各种疾病（老年、消耗性疾病、心脏病或肾透析）的人群中，超重和肥胖与较高的生存率相关。有人提出用“反向流行病学”或“肥胖悖论”来描述这一发现。然而，这种现象是否归因于高体脂量的真正保护作用仍不确定。有人讨论了表明存在肥胖悖论的研究中的方法学问题，如幸存者偏差、选择偏差、领先时间偏差，或在荟萃分析中的发表偏差和混杂因素。然而，这些都不能完全解释所观察到的现象。也有人构建了生物学模型，研究高体重产生保护作用的可能原因，例如在消耗性疾病患者和老年患者中。特别是高炎症标志物与营养不良相结合预示着各种疾病患者的高死亡率：超重和肥胖可能抵消这些影响。关于体重管理和营养的临床及公共卫生建议的可能影响是未来研究的课题。在老年受试者和预后较差的患者中，体重管理对生活质量的影响也应予以考虑。
