Goyal Akankasha, Nimmakayala Kameswara Rao, Zonszein Joel
From the *Department of Medicine, Division of Endocrinology and Metabolism, Montefiore Medical Center, Bronx, NY; and †Department of Internal Medicine, Mount Vernon Hospital Center, Mount Vernon, NY.
Cardiol Rev. 2014 Jul-Aug;22(4):163-70. doi: 10.1097/CRD.0000000000000004.
In an industrialized society, the increase in obesity incidence has led to an increase in premature morbidity and mortality rates. There is a relationship between body mass index (BMI) and the increased incidence of hypertension, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease, an increase in mortality. However, obese individuals with these conditions may have better outcomes than their lean counterparts, thus the term "obesity paradox." Most studies supporting this paradox are cross-sectional and do not take into account the quantity or type of adiposity, the disease severity, and comorbidities. Although BMI is an indicator of the amount of body fat, it does not differentiate between adiposity types. Adipocytes that are highly functional have good fuel storage capacity are different from adipocytes found in visceral obesity, which are poorly functioning, laden with macrophages, and causing low-grade inflammation. Individuals with high BMI may be physically fit and have a lower mortality risk when compared with individuals with a lower BMI and poorly functioning adiposity. We review the complexity of adipose tissue and its location, function, metabolic implications, and role in cardiovascular morbidity and mortality. The terminology "obesity paradox" may reflect a lack of understanding of the complex pathophysiology of obesity and the association between adiposity and cardiovascular disease.
在工业化社会中，肥胖发生率的增加导致过早发病和死亡率上升。体重指数（BMI）与高血压、血脂异常、2型糖尿病和心血管疾病的发病率增加以及死亡率上升之间存在关联。然而，患有这些疾病的肥胖个体可能比瘦人有更好的预后，因此出现了“肥胖悖论”这一术语。大多数支持这一悖论的研究是横断面研究，没有考虑肥胖的数量或类型、疾病严重程度和合并症。虽然BMI是身体脂肪量的一个指标，但它并不能区分肥胖类型。具有高功能且有良好燃料储存能力的脂肪细胞不同于内脏肥胖中发现的脂肪细胞，后者功能不佳，充满巨噬细胞，并导致低度炎症。与BMI较低且脂肪功能不佳的个体相比，BMI较高的个体可能身体健康且死亡风险较低。我们综述了脂肪组织的复杂性及其位置、功能、代谢影响以及在心血管发病和死亡中的作用。“肥胖悖论”这一术语可能反映了对肥胖复杂病理生理学以及肥胖与心血管疾病之间关联的理解不足。
