重温肥胖悖论:内脏脂肪分布在预测死亡率和心脏代谢风险方面优于BMI
Mingjian Zhao1, Huimin Chen2, Qi Zhang3
1Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
International journal of surgery (London, England)
|February 3, 2026
概括
内脏脂肪积累和不利的脂肪分布显著增加死亡风险,挑战肥胖悖论. 评估BMI以外的脂肪分布和代谢健康对于准确的风险分层至关重要.
科学领域:
- 心脏病学 心脏病学
- 代谢健康 代谢健康
- 肥胖问题研究研究
背景情况:
- 肥胖悖论,即更高的BMI与在某些条件下更好的生存相关,使风险评估复杂化.
- 身体质量指数 (BMI) 无法区分脂肪与瘦肉或内脏脂肪与皮下脂肪.
- 这种限制可能解释了在心脏代谢条件下观察到的肥胖悖论.
研究的目的:
- 确定腹部脂肪分布和代谢健康的直接测量是否比单独的BMI更好地预测心脏代谢发病率和死亡率.
- 调查这些措施是否可以澄清肥胖悖论.
主要方法:
- 横截面分析与前性死亡率的随访.
- 包括来自国家健康和营养检查调查 (NHANES) (2011-2018) 的15925名美国成年人.
- 分析了脂肪分布指数 (内脏脂肪指数 (VFI),皮下脂肪指数 (SFI)),代谢健康,BMI和死亡率之间的关联.
主要成果:
- 较高的VFI和VFI/SFI比率与所有原因和心脏代谢死亡率的增加有关.
- 更高的SFI显示出一种保护作用.
- 与正常体重相比,超重和肥胖I类与较低的全因死亡风险有关,但当考虑脂肪分布和代谢健康时,这种影响会减少.
- 内脏脂肪积累强烈预测了45岁及以上成年人心脏代谢疾病发病率.
- 代谢不健康状态是显著的死亡风险因素,特别是在女性中.
结论:
- 内脏脂肪积累和不利的脂肪分布是比BMI更强大的死亡率和心脏代谢疾病风险预测因素.
- 当考虑脂肪分布和代谢健康时,高BMI的明显生存益处会减少.
- 临床风险评估应包括超出BMI的脂肪分布和代谢表型的测量.
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