problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl201460543-48problendo-7045Research ArticleСтатьиArticlesНовая парадигма ожиренияThe new paradigm of obesityСамородскаяИ ВSamorodskayaI Vsamor2000@yandex.ruФГБУ «Государственный научно-исследовательский центр профилактической медицины» Минздрава России, МоскваРоссияState Research Centre of Prophylactic Medicine, MoscowRussian Federation201415102014605ТОМ 60, №5 (2014)4348Copyright © Самородская И.В., 20142014Самородская И.В.Samorodskaya I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/7045

Несмотря на доказанную взаимосвязь между ожирением и рядом хронических заболеваний, в мире накапливается противоречивая информация о влиянии массы тела на продолжительность жизни. Значительное число публикаций посвя- щено парадоксу ожирения - лучшей выживаемости пациентов с избыточным индексом массы тела (ИМТ) и небольшим ожирением по сравнению с нормальным и сниженным ИМТ. Новая парадигма оценки ИМТ и ожирения представлена Американской ассоциацией эндокринологов. Необходим консенсус российских специалистов в отношении новой парадигмы и разработка рекомендаций для практических врачей.

Despite the well-proved relationship between obesity and a number of chronic diseases, the information about the influence of the body weight on the life expectancy is contradictory. A wealth of literature publications deal with the paradoxical relation of the survival rate to obesity that manifests itself among the patients with the elevated body mass index (BMI) and moderate obesity as opposed to the patients having the normal or lowered BMI. The American Association of Endocrinologists proposed the new paradigm of the evaluation of BMI and obesity. The consensus of the Russian specialists as regards this paradigm needs to be reached in conjunction with the development of the relevant guidelines for practicing healthcare providers.

ожирениесмертностьпродолжительность жизниobesitymortalitylife expectancyReferencesWorld Health Organization: Fact Sheet No. 311 (May 2012). www.who.int/mediacentre/factsheets/fs311/en/World Health Organization: Fact Sheet No. 311 (May 2012). www.who.int/mediacentre/factsheets/fs311/en/Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9•1 million participants. The Lancet. 2011;377(9765):557-567. doi: 10.1016/s0140-6736(10)62037-5Finucane MM, Stevens GA, Cowan MJ, Danaei G, Lin JK, Paciorek CJ, et al. National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9•1 million participants. The Lancet. 2011;377(9765):557-567. doi: 10.1016/s0140-6736(10)62037-5Дедов И.И., Мельниченко Г.А. Ожирение. Руководство для врачей. – М.: МИА; 2004. – 456 с. [Dedov II, Mel’nichenko GA. Obesity. Guidelines for physicians. Moscow: MIA; 2004. 456p. ]Дедов И.И., Мельниченко Г.А. Ожирение. Руководство для врачей. – М.: МИА; 2004. – 456 с. [Dedov II, Mel’nichenko GA. Obesity. Guidelines for physicians. Moscow: MIA; 2004. 456p. ]Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1•8 million participants. The Lancet. 2014;383(9921):970-983. doi: 10.1016/s0140-6736(13)61836-xMetabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1•8 million participants. The Lancet. 2014;383(9921):970-983. doi: 10.1016/s0140-6736(13)61836-xCalle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults. New England Journal of Medicine. 1999;341(15):1097-1105. doi: 10.1056/nejm199910073411501Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW. Body-Mass Index and Mortality in a Prospective Cohort of U.S. Adults. New England Journal of Medicine. 1999;341(15):1097-1105. doi: 10.1056/nejm199910073411501Durazo-Arvizu R, Cooper RS, Luke A, Prewitt TE, Liao Y, McGee DL. Relative weight and mortality in U.S. blacks and whites: Findings from representative national population samples. Annals of Epidemiology. 1997;7(6):383-395. doi: 10.1016/s1047-2797(97)00044-6Durazo-Arvizu R, Cooper RS, Luke A, Prewitt TE, Liao Y, McGee DL. Relative weight and mortality in U.S. blacks and whites: Findings from representative national population samples. Annals of Epidemiology. 1997;7(6):383-395. doi: 10.1016/s1047-2797(97)00044-6Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, et al. Association between Body-Mass Index and Risk of Death in More Than 1 Million Asians. New England Journal of Medicine. 2011;364(8):719-729. doi: 10.1056/NEJMoa1010679Zheng W, McLerran DF, Rolland B, Zhang X, Inoue M, Matsuo K, et al. Association between Body-Mass Index and Risk of Death in More Than 1 Million Asians. New England Journal of Medicine. 2011;364(8):719-729. doi: 10.1056/NEJMoa1010679Badheka AO, Rathod A, Kizilbash MA, Garg N, Mohamad T, Afonso L, et al. Influence of Obesity on Outcomes in Atrial Fibrillation: Yet Another Obesity Paradox. The American Journal of Medicine. 2010;123(7):646-651. doi: 10.1016/j.amjmed.2009.11.026Badheka AO, Rathod A, Kizilbash MA, Garg N, Mohamad T, Afonso L, et al. Influence of Obesity on Outcomes in Atrial Fibrillation: Yet Another Obesity Paradox. The American Journal of Medicine. 2010;123(7):646-651. doi: 10.1016/j.amjmed.2009.11.026Carnethon MR, De Chavez PJD, Biggs ML, Lewis CE, Pankow JS, Bertoni AG, et al. Association of Weight Status With Mortality in Adults With Incident Diabetes. JAMA. 2012;308(6). doi: 10.1001/jama.2012.9282Carnethon MR, De Chavez PJD, Biggs ML, Lewis CE, Pankow JS, Bertoni AG, et al. Association of Weight Status With Mortality in Adults With Incident Diabetes. JAMA. 2012;308(6). doi: 10.1001/jama.2012.9282Ma SH, Park B-Y, Yang JJ, Jung E-J, Yeo Y, Whang Y, et al. Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study. Journal of Preventive Medicine & Public Health. 2012;45(6):394-401. doi: 10.3961/jpmph.2012.45.6.394Ma SH, Park B-Y, Yang JJ, Jung E-J, Yeo Y, Whang Y, et al. Interaction of Body Mass Index and Diabetes as Modifiers of Cardiovascular Mortality in a Cohort Study. Journal of Preventive Medicine & Public Health. 2012;45(6):394-401. doi: 10.3961/jpmph.2012.45.6.394Tseng C-H. Obesity paradox: Differential effects on cancer and noncancer mortality in patients with type 2 diabetes mellitus. Atherosclerosis. 2013;226(1):186-192. doi: 10.1016/j.atherosclerosis.2012.09.004Tseng C-H. Obesity paradox: Differential effects on cancer and noncancer mortality in patients with type 2 diabetes mellitus. Atherosclerosis. 2013;226(1):186-192. doi: 10.1016/j.atherosclerosis.2012.09.004Logue J, Walker JJ, Leese G, Lindsay R, McKnight J, Morris A, et al. Association Between BMI Measured Within a Year After Diagnosis of Type 2 Diabetes and Mortality. Diabetes Care. 2012;36(4):887-893. doi: 10.2337/dc12-0944Logue J, Walker JJ, Leese G, Lindsay R, McKnight J, Morris A, et al. Association Between BMI Measured Within a Year After Diagnosis of Type 2 Diabetes and Mortality. Diabetes Care. 2012;36(4):887-893. doi: 10.2337/dc12-0944Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. European Heart Journal. 2002;23(9):706-713. doi: 10.1053/euhj.2001.2889Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. European Heart Journal. 2002;23(9):706-713. doi: 10.1053/euhj.2001.2889Coutinho T, Goel K, Corrêa de Sá D, Kragelund C, Kanaya AM, Zeller M, et al. Central Obesity and Survival in Subjects With Coronary Artery Disease. Journal of the American College of Cardiology. 2011;57(19):1877-1886. doi: 10.1016/j.jacc.2010.11.058Coutinho T, Goel K, Corrêa de Sá D, Kragelund C, Kanaya AM, Zeller M, et al. Central Obesity and Survival in Subjects With Coronary Artery Disease. Journal of the American College of Cardiology. 2011;57(19):1877-1886. doi: 10.1016/j.jacc.2010.11.058Arnlov J, Ingelsson E, Sundstrom J, Lind L. Impact of Body Mass Index and the Metabolic Syndrome on the Risk of Cardiovascular Disease and Death in Middle-Aged Men. Circulation. 2009;121(2):230-236. doi: 10.1161/circulationaha.109.887521Arnlov J, Ingelsson E, Sundstrom J, Lind L. Impact of Body Mass Index and the Metabolic Syndrome on the Risk of Cardiovascular Disease and Death in Middle-Aged Men. Circulation. 2009;121(2):230-236. doi: 10.1161/circulationaha.109.887521Thomsen M, Nordestgaard BG. Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome. JAMA Internal Medicine. 2014;174(1):15. doi: 10.1001/jamainternmed.2013.10522Thomsen M, Nordestgaard BG. Myocardial Infarction and Ischemic Heart Disease in Overweight and Obesity With and Without Metabolic Syndrome. JAMA Internal Medicine. 2014;174(1):15. doi: 10.1001/jamainternmed.2013.10522Kramer CK, Zinman B, Retnakaran R. Are Metabolically Healthy Overweight and Obesity Benign Conditions? Annals of Internal Medicine. 2013;159(11):758. doi: 10.7326/0003-4819-159-11-201312030-00008Kramer CK, Zinman B, Retnakaran R. Are Metabolically Healthy Overweight and Obesity Benign Conditions? Annals of Internal Medicine. 2013;159(11):758. doi: 10.7326/0003-4819-159-11-201312030-00008Coutinho T, Goel K, Corrêa de Sá D, Carter RE, Hodge DO, Kragelund C, et al. Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease. Journal of the American College of Cardiology. 2013;61(5):553-560. doi: 10.1016/j.jacc.2012.10.035Coutinho T, Goel K, Corrêa de Sá D, Carter RE, Hodge DO, Kragelund C, et al. Combining Body Mass Index With Measures of Central Obesity in the Assessment of Mortality in Subjects With Coronary Disease. Journal of the American College of Cardiology. 2013;61(5):553-560. doi: 10.1016/j.jacc.2012.10.035Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Heart Journal. 2012;33(13):1635-1701. doi: 10.1093/eurheartj/ehs092Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European Heart Journal. 2012;33(13):1635-1701. doi: 10.1093/eurheartj/ehs092Garvey WT, Garber AJ, Mechanick JI, Bray GA, Dagogo-Jack S, Einhorn D, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease. Endocrine Practice. 2014;20(9):977-989. doi: 10.4158/ep14280.psGarvey WT, Garber AJ, Mechanick JI, Bray GA, Dagogo-Jack S, Einhorn D, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease. Endocrine Practice. 2014;20(9):977-989. doi: 10.4158/ep14280.ps

The authors declare that there are no conflicts of interest present.