Bagheri M, Speakman J R, Shabbidar S, Kazemi F, Djafarian K
Department of Community Nutrition, School of Nutritional Sciences and Dietetic, Tehran University of Medical Sciences, Tehran, Iran.
Obes Rev. 2015 May;16(5):416-23. doi: 10.1111/obr.12272. Epub 2015 Mar 5.
The obesity paradox is often attributed to fat acting as a buffer to protect individuals in fragile metabolic states. If this was the case, one would predict that the reverse epidemiology would be apparent across all causes of mortality including that of the particular disease state. We performed a dose-response meta-analysis to assess the impact of body mass index (BMI) on all-cause and stroke-specific mortality among stroke patients. Data from relevant studies were identified by systematically searching PubMed, OVID and Scopus databases and were analysed using a random-effects dose-response model. Eight cohort studies on all-cause mortality (with 20,807 deaths of 95,651 stroke patients) and nine studies of mortality exclusively because of stroke (with 8,087 deaths of 28,6270 patients) were evaluated in the meta-analysis. Non-linear associations of BMI with all-cause mortality (P < 0.0001) and mortality by stroke (P = 0.05) were observed. Among overweight and obese stroke patients, the risk of all-cause mortality increased, while the risk of mortality by stroke declined, with an increase in BMI. Increasing BMI had opposite effects on all-cause mortality and stroke-specific mortality in stroke patients. Further investigations are needed to examine how mortality by stroke is influenced by a more accurate indicator of obesity than BMI.
肥胖悖论通常归因于脂肪起到缓冲作用，保护处于脆弱代谢状态的个体。如果真是如此，那么可以预测，在所有死因中，包括特定疾病状态的死因，反向流行病学都将很明显。我们进行了一项剂量反应荟萃分析，以评估体重指数（BMI）对中风患者全因死亡率和中风特异性死亡率的影响。通过系统检索PubMed、OVID和Scopus数据库确定相关研究的数据，并使用随机效应剂量反应模型进行分析。荟萃分析评估了八项关于全因死亡率的队列研究（95,651名中风患者中有20,807例死亡）和九项仅因中风导致的死亡率研究（286,270名患者中有8,087例死亡）。观察到BMI与全因死亡率（P < 0.0001）和中风死亡率（P = 0.05）之间存在非线性关联。在超重和肥胖的中风患者中，随着BMI的增加，全因死亡风险增加，而中风死亡风险下降。BMI增加对中风患者的全因死亡率和中风特异性死亡率有相反的影响。需要进一步研究，以探讨比BMI更准确的肥胖指标如何影响中风死亡率。
