Goel Kashish, Lopez-Jimenez Francisco, De Schutter Alban, Coutinho Thais, Lavie Carl J
Department of Internal Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Future Cardiol. 2014 Jan;10(1):81-91. doi: 10.2217/fca.13.84.
An inverse association between BMI and mortality has been reported in patients with coronary heart disease and heart failure. This 'obesity paradox' has recently been reported in other disease states, including stroke, hypertension, incident diabetes, atrial fibrillation, hemodialysis and transcatheter aortic valve replacement. Cardiorespiratory fitness influences the obesity paradox and this inverse association may be present only in individuals with low fitness levels. Intentional weight loss, exercise training and improving lean mass are important and should be advised to all patients. Recent studies have also explored the association between measures of central obesity and direct measures of body fat with mortality. This review will summarize the evidence, controversies and mechanisms associated with the puzzling obesity paradox.
在冠心病和心力衰竭患者中，已报道体重指数（BMI）与死亡率之间存在负相关。最近在其他疾病状态中也报道了这种“肥胖悖论”，包括中风、高血压、新发糖尿病、心房颤动、血液透析和经导管主动脉瓣置换术。心肺适能会影响肥胖悖论，这种负相关可能仅存在于适能水平较低的个体中。有意减肥、运动训练和增加瘦体重很重要，应建议所有患者这样做。最近的研究还探讨了中心性肥胖指标和身体脂肪直接测量值与死亡率之间的关联。本综述将总结与令人困惑的肥胖悖论相关的证据、争议和机制。
