Kotchen J M, Cox-Ganser J, Wright C J, Kotchen T A
Department of Medicine, West Virginia University, Morgantown 26506.
Int J Obes Relat Metab Disord. 1993 Mar;17(3):145-51.
Obesity is associated with increased cardiovascular disease risk factors in some, but not all, individuals, and blood pressure responses to weight loss are also heterogeneous. The purposes of this study are: (i) to assess associations among cardiovascular disease risk factors in obese individuals and (ii) to determine clinical predictors of a hypotensive response to weight loss. The study was undertaken in 155 consecutive patients enrolled in a weight loss programme. Individuals entering the programme were predominantly women and differences were found between men and women who joined the programme. Before weight loss, obese men exhibited higher cardiovascular disease risk factors (body mass indices, waist-to-hip ratios, systolic and diastolic blood pressures, serum glucose, and lower HDL cholesterol) than did women. However, among women, but not men, cardiovascular disease risk factors clustered in individuals with higher waist-to-hip ratios. Furthermore, in contrast to men, a higher waist-to-hip ratio in women was associated with a reduction in systolic blood pressure in response to weight loss. While it is possible that selection bias may explain gender differences among programme participants, and smaller numbers of men available for study may obscure associations in men, our data document that even at high levels of obesity, waist-to-hip ratios are associated with hypertension and a clustering of cardiovascular disease risk factors in women. We conclude that body fat distribution, as reflected in waist-to-hip ratios, may be a more robust risk factor in female than in male obese patients and that this risk factor extends to those women with high levels of obesity.
肥胖在部分而非所有个体中与心血管疾病风险因素增加相关，并且体重减轻时的血压反应也存在异质性。本研究的目的是：（i）评估肥胖个体中心血管疾病风险因素之间的关联，以及（ii）确定体重减轻时出现降压反应的临床预测因素。该研究对连续纳入一个减肥项目的155名患者进行。参与该项目的个体以女性为主，且参与项目的男性和女性之间存在差异。在减肥前，肥胖男性的心血管疾病风险因素（体重指数、腰臀比、收缩压和舒张压、血糖以及较低的高密度脂蛋白胆固醇）高于女性。然而，在女性而非男性中，心血管疾病风险因素在腰臀比更高的个体中聚集。此外，与男性不同，女性较高的腰臀比与体重减轻时收缩压的降低相关。虽然选择偏倚可能解释项目参与者之间的性别差异，且可供研究的男性数量较少可能掩盖男性中的关联，但我们的数据表明，即使在肥胖程度较高时，腰臀比也与女性的高血压及心血管疾病风险因素聚集相关。我们得出结论，以腰臀比反映的体脂分布在肥胖女性中可能比在肥胖男性中是更强有力的风险因素，并且这种风险因素在肥胖程度较高的女性中也存在。
