世界衛生組織有 宣布肥胖為全球流行病 “威脅到發達國家和發展中國家。” However, is obesity always bad when it comes to health?但是,肥胖對健康總是有害嗎?

當然,肥胖是許多慢性疾病發展的重要風險因素, 包括心髒病。 However, research has shown that in a number of situations, being overweight may actually be of benefit.但是,研究表明,在許多情況下,超重實際上可能是有益的。 This phenomenon has been called the “這種現像被稱為“肥胖悖論

我們小組來自皇后大學公共衛生科學,麻醉學和圍手術期醫學系 研究了體重指數(BMI,體重與身高的常用比率)與心臟手術後結局之間的關係。 We analyzed a large database of health records of almost 80,000 patients having open coronary bypass surgery in Ontario over a 13-year period我們分析了一個龐大的健康記錄數據庫,該數據庫在XNUMX年的時間裡對安大略省近XNUMX名接受了開放性冠狀動脈搭橋手術的患者進行了研究 使用來自ICES的數據,這是位於安大略省的非營利性研究所。 We tracked five-year survival rates as well as complications occurring during the year after surgery.我們追踪了五年生存率以及術後一年內發生的並發症。

We found that patients in the overweight and moderately obese categories made up two-thirds of all cardiac surgery patients.我們發現,超重和中度肥胖類別的患者佔所有心臟外科手術患者的三分之二。 However, these patients actually had lower death rates and complications than patients in the normal weight, underweight and morbidly obese categories.但是,與正常體重,體重不足和病態肥胖類別的患者相比,這些患者的死亡率和並發症的發生率實際上更低。


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The highest risk of complications was seen at the extremes of BMI, meaning patients in the underweight and the morbidly obese categories.在BMI極端情況下,發生並發症的風險最高,這意味著體重過輕和病態肥胖的患者。 Such a relationship這樣的關係 在其他患者組中也被發現 不同 醫療條件或程序.

BMI進行心臟手術後的死亡率。 (肥胖悖論為什麼肥胖患者在心臟手術後表現會比其他人更好)
(安娜·約翰遜), 作者提供


除了並發症發生率的差異外,還有 經濟影響 for these findings.對於這些發現。 We analyzed the financial costs of coronary bypass surgery and the medical care during the year following surgery in a group of over 53,000 patients over a 10-year period.我們分析了XNUMX年期間一組XNUMX多名患者的冠脈搭橋手術和術後一年的醫療費用。

Not surprisingly, due to the disproportionate number of patients in these categories having heart surgery, overweight and obese patients accounted for the overall majority of health-care costs, a total of $1.4 billion (in 2014 Canadian dollars), compared to $788 million for the other BMI categories combined.毫不奇怪,由於這些類別的患者接受心臟手術的比例過高,超重和肥胖患者佔醫療保健費用的大部分,總計XNUMX億加元(XNUMX年為加元),相比之下,超重和肥胖患者為XNUMX億加元。其他BMI類別合併在一起。 However, the average cost of care per patient in the overweight and obese categories was substantially lower than in the normal weight, underweight and morbidly obese categories.但是,超重和肥胖類別中每位患者的平均護理費用大大低於正常體重,體重不足和病態肥胖類別中的患者。


This does not necessarily mean that weight gain should be recommended to reduce these risks.這並不一定意味著應該建議增加體重以減少這些風險。 The scientific literature is consistent that科學文獻一致認為 肥胖和缺乏健身與心血管疾病有關以及許多其他心髒病風險因素,例如高血壓和糖尿病。

However, once the need for surgery is determined, having excess body fat may provide increased energy reserves during a period of stress and healing that are not available to lower-weight patients.但是,一旦確定需要手術,體內多餘的脂肪可能會在壓力和康復期間增加能量儲備,這是低體重患者無法獲得的。 This advantage is lost in the case of extreme obesity, where the common presence of other related diseases and reduced mobility after surgery likely contribute to the increased complication rate.在極端肥胖的情況下,該優勢喪失了,在這種情況下,其他相關疾病的普遍存在和手術後活動能力降低可能會導致並發症發生率增加。


On the other hand, we found that being underweight is associated with increased mortality in hospital patients and increased health costs.另一方面,我們發現體重過輕與住院患者死亡率增加和醫療費用增加有關。 In fact, low BMI is more detrimental to the recovery from heart surgery than even extreme obesity.實際上,低BMI比極端肥胖更不利於心臟手術的恢復。 This may reflect the這可能反映了 虛弱的負面影響已顯示對手術恢復有不利影響。

In addition to reduced body fat, patients in the underweight category typically have reduced muscle mass, which limits function and mobility even before surgery.除了減少體內脂肪,體重過輕的患者通常還具有減少的肌肉質量,這甚至限制了手術前的功能和活動能力。 That leaves them with little in reserve to resist the stress of major surgery and the prolonged recovery period afterwards.這使得他們幾乎沒有儲備來抵抗大手術的壓力以及隨後延長的恢復期。

Even when taking advanced age and other diseases into account, low BMI was independently associated with death and other complications after heart surgery.即使考慮到高齡和其他疾病,低BMI仍獨立於心臟手術後的死亡和其他並發症。 This suggests that patients who are frail might do better after surgery if — time permitting — they were offered an exercise and nutrition program before surgery.這表明,如果時間允許的話,如果體弱的患者在手術前得到鍛煉和營養計劃,可能會做得更好。


It's also important to look at the BMI category that was considered to be the standard for comparison: patients in the so-called “normal” weight category.查看被認為是比較標準的BMI類別也很重要:所謂的“正常”體重類別的患者。 This is generally considered the optimal BMI and the target for most fitness strategies.通常認為這是最佳BMI以及大多數適應策略的目標。 However, in our study and others, patients in the normal weight category had worse outcomes than patients in the overweight and moderately obese categories.但是,在我們的研究和其他研究中,正常體重類別的患者的結局比超重和中度肥胖類別的患者差。


First, as mentioned, patients who are overweight have a far higher risk of developing heart disease in the first place, and an ounce (or gram) of prevention is a much more effective health strategy than a pound (or kilogram) of cure.首先,如前所述,超重的患者患心髒病的風險要高得多,而一盎司(或幾克)的預防方法比一磅(或幾公斤)的治療方法更為有效。 Improving the fitness of the population is one of the most important提高人口適應性是最重要的一項 減少心髒病的公共衛生策略 首先需要進行心臟手術。

Second, it may well be that what is an optimal BMI in other situations should not be considered optimal for recovery from surgery, and so it would make sense to define a “normal” BMI according to the specific situation.其次,很可能不應將在其他情況下的最佳BMI視為從手術中恢復的最佳選擇,因此根據特定情況定義“正常” BMI是有意義的。 In this sense, the obesity paradox might not be a paradox at all.從這個意義上說,肥胖悖論可能根本不是悖論。


安娜·約翰遜(Ana Johnson),公共衛生科學系教授, 安大略省女王大學 和Joel Parlow,麻醉學和圍手術期醫學教授, 安大略省女王大學

這篇文章也是由皇后大學名譽教授,麻醉學和圍手術期醫學教授Brian Milne共同撰寫的。談話

本文重新發表 談話 根據知識共享許可。 閱讀 原創文章.




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