Institut für Humanernährung und Lebensmittelkunde, Christian-Albrechts-Universität zu Kiel, Kiel, Germany.
Obes Rev. 2021 Mar;22 Suppl 2:e13190. doi: 10.1111/obr.13190. Epub 2021 Jan 21.
Traditional diagnosis and understanding of the pathophysiology of obesity are based on excessive fat storage due to a chronically positive energy balance characterized by body mass index (BMI). Quantitative and qualitative analysis of lean and adipose tissue compartments by body composition analysis reveals that characterization of obesity as "overfat" does not facilitate a comprehensive understanding of obesity-associated health risk. Instead of being related to fat mass, body composition characteristics underlying BMI-associated prognosis may depend (i) on accelerated growth by a gain in lean mass or fat-free mass (FFM) in children with early BMI rebound or adolescents with early puberty; (ii) on a low muscle mass in aging, associated chronic disease, or severe illness; and (iii) on impaired adipose tissue expandability with respect to cardiometabolic risk. It is therefore time to call the adipocentric paradigm of obesity into question and to avoid the use of BMI and body fat percentage. By contrast, obesity should be seen in face of a limited FFM/muscle mass together with a limited capacity of fat storage.
传统的肥胖病理生理学的诊断和理解是基于由于长期的能量正平衡而导致的脂肪过度储存，其特征是体重指数 (BMI)。通过身体成分分析对瘦组织和脂肪组织进行定量和定性分析，表明将肥胖描述为“脂肪过多”并不能促进对肥胖相关健康风险的全面理解。与脂肪量相关的 BMI 相关预后的身体成分特征可能取决于（i）儿童早期 BMI 反弹或青少年早期青春期时通过增加瘦组织或去脂体重（FFM）而加速生长；（ii）老年人、伴发慢性疾病或严重疾病时的肌肉量低；以及（iii）脂肪组织扩张能力受损与心血管代谢风险有关。因此，现在是时候对肥胖的以脂肪为中心的范式提出质疑，并避免使用 BMI 和体脂百分比。相比之下，应该将肥胖视为有限的 FFM/肌肉质量与有限的脂肪储存能力一起出现。
