Kortelainen Marja-Leena, Porvari Katja
Department of Forensic Medicine, Institute of Diagnostics, University of Oulu, Finland.
Am J Forensic Med Pathol. 2011 Dec;32(4):372-7. doi: 10.1097/PAF.0b013e318219cd89.
Extreme obesity is a strong predictor of premature death, but the prevalence of cardiovascular disease in morbidly obese populations is largely unknown. The aim of the present study was to find out whether there has been an increase in extreme obesity with body mass index 40.0 kg/m(2) or greater in medicolegal autopsy material in a known geographical area in Finland during a period of 3 decades and to examine the prevalence and time trends of associated cardiovascular disease in this obesity category. Autopsy reports of 235 cases examined in 1975 to 2006 were analyzed. The number of extremely obese individuals increased from 0.6% of the yearly amount of autopsies in the 1970s and 1980s to 2.8% and 2.5% in 2005 and 2006, respectively. The most frequent cause of death was cardiomyopathy or cardiomegaly (28.9%), followed by coronary heart disease (24.3%). Either coronary arteries were lesion-free, or only fatty streaks had been observed in 46.8% of the women and in 43.1% of the men. No significant changes in the average body mass index or severity of coronary atherosclerosis were observed. Younger individuals younger than 40 years began to appear more often after 1995. An increased trend of extreme obesity in a region where autopsy frequency is high may refer to a general increase of this obesity category. A large number of extremely obese people are resistant to coronary atherosclerosis, but cardiac hypertrophy may be accompanied by several mechanisms leading to sudden death even among the youngest extremely obese individuals.
极度肥胖是过早死亡的有力预测因素，但病态肥胖人群中心血管疾病的患病率在很大程度上尚不清楚。本研究的目的是查明在芬兰一个已知地理区域内，在30年的时间里，法医尸检材料中体重指数达到40.0kg/m²或更高的极度肥胖情况是否有所增加，并研究这一肥胖类别中相关心血管疾病的患病率和时间趋势。对1975年至2006年检查的235例尸检报告进行了分析。极度肥胖个体的数量从20世纪70年代和80年代每年尸检数量的0.6%分别增加到2005年的2.8%和2006年的2.5%。最常见的死亡原因是心肌病或心脏肥大（28.9%），其次是冠心病（24.3%）。在46.8%的女性和43.1%的男性中，冠状动脉要么无病变，要么仅观察到脂肪条纹。未观察到平均体重指数或冠状动脉粥样硬化严重程度的显著变化。1995年后，40岁以下的年轻人开始更频繁地出现。在尸检频率较高的地区，极度肥胖呈上升趋势可能意味着这一肥胖类别的普遍增加。大量极度肥胖的人对冠状动脉粥样硬化具有抗性，但即使在最年轻的极度肥胖个体中，心脏肥大也可能伴有多种导致猝死的机制。
