肥胖悖论:为什么心脏手术后肥胖患者的票价比其他人好

肥胖悖论:为什么心脏手术后肥胖患者的票价比其他人好
与BMI在正常或体重不足范围内的患者相比,超重和肥胖的患者在心脏手术后的死亡率更低。
(存在Shutterstock)

世界卫生组织有 宣布肥胖为全球流行病 “威胁到发达国家和发展中国家。” However, is obesity always bad when it comes to health?但是,肥胖对健康总是有害吗?

当然,肥胖是许多慢性病发展的重要风险因素, 包括心脏病。 However, research has shown that in a number of situations, being overweight may actually be of benefit.但是,研究表明,在许多情况下,超重实际上可能是有益的。 This phenomenon has been called the “这种现象被称为“肥胖悖论设立的区域办事处外,我们在美国也开设了办事处,以便我们为当地客户提供更多的支持。“

我们小组来自皇后大学公共卫生科学,麻醉学和围手术期医学系 研究了体重指数(BMI,体重与身高的常用比率)与心脏手术后结局之间的关系。 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我们分析了一个庞大的健康记录数据库,该数据库记录了XNUMX年内安大略省近XNUMX名接受了开放性冠状动脉搭桥手术的患者 使用来自ICES的数据,这是位于安大略省的非营利性研究所。 We tracked five-year survival rates as well as complications occurring during the year after surgery.我们追踪了五年生存率以及术后一年内发生的并发症。

We found that patients in the overweight and moderately obese categories made up two-thirds of all cardiac surgery patients.我们发现,超重和中度肥胖类别的患者占所有心脏外科手术患者的三分之二。 However, these patients actually had lower death rates and complications than patients in the normal weight, underweight and morbidly obese categories.但是,与正常体重,体重不足和病态肥胖类别的患者相比,这些患者的死亡率和并发症的发生率实际上更低。


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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极端情况下,发生并发症的风险最高,这意味着体重过轻和病态肥胖的患者。 Such a relationship这样的关系 在其他患者组中也被发现 具有不同 医疗条件或程序.

BMI进行心脏手术后的死亡率。 (肥胖悖论为何肥胖患者在心脏手术后的表现比其他人更好)
BMI进行心脏手术后的死亡率。
(安娜·约翰逊), 作者提供

规模经济

除了并发症发生率的差异外,还有 经济影响 for these findings.对于这些发现。 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.我们分析了在XNUMX年期间的XNUMX多名患者中,冠状动脉搭桥术和术后一年内的医疗费用。

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,由于这些类别的患者接受心脏手术的比例过高,超重和肥胖患者占医疗保健费用的大部分,总计XNUMX亿加元(XNUMX年为加元),相比之下,超重和肥胖患者为XNUMX亿加元。其他BMI类别合并在一起。 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,超重和肥胖类别中每名患者的平均护理费用大大低于正常体重,体重不足和病态肥胖类别中的患者。

权衡体重增加

This does not necessarily mean that weight gain should be recommended to reduce these risks.这并不一定意味着应该建议增加体重以减少这些风险。 The scientific literature is consistent that科学文献一致认为 肥胖和缺乏健身与心血管疾病有关以及许多其他心脏病风险因素,例如高血压和糖尿病。

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,一旦确定需要手术,体内多余的脂肪可能会在压力和康复期间增加能量储备,这是低体重患者无法获得的。 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.在极端肥胖的情况下,该优势丧失了,在这种情况下,其他相关疾病的普遍存在和手术后活动能力降低可能会导致并发症发生率增加。

脆弱的危险

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,我们发现体重过轻与住院患者死亡率增加和医疗费用增加有关。 In fact, low BMI is more detrimental to the recovery from heart surgery than even extreme obesity.实际上,比起极端肥胖,低BMI对心脏手术的恢复更有害。 This may reflect the这可能反映了 虚弱的负面影响已显示对手术恢复有不利影响。

In addition to reduced body fat, patients in the underweight category typically have reduced muscle mass, which limits function and mobility even before surgery.除了减少体内脂肪,体重过轻的患者通常还具有减少的肌肉质量,这甚至限制了手术前的功能和活动能力。 That leaves them with little in reserve to resist the stress of major surgery and the prolonged recovery period afterwards.这使得他们几乎没有储备来抵抗大手术的压力以及随后延长的恢复期。

Even when taking advanced age and other diseases into account, low BMI was independently associated with death and other complications after heart surgery.即使考虑到高龄和其他疾病,低BMI仍独立于心脏手术后的死亡和其他并发症。 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.这表明,如果时间允许的话,如果体弱的患者在手术前得到锻炼和营养计划,可能会做得更好。

反正正常吗?

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.查看被认为是比较标准的BMI类别也很重要:所谓的“正常”体重类别的患者。 This is generally considered the optimal BMI and the target for most fitness strategies.通常,这被认为是最佳BMI以及大多数健身策略的目标。 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,在我们的研究和其他研究中,正常体重类别的患者的结局较超重和中度肥胖类别的患者差。

重要的是,这些结果并不意味着使正常体重范围内的人群增肥应成为公共卫生目标。

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,超重的患者患心脏病的风险要高得多,而一盎司(或几克)的预防方法比一磅(或几公斤)的治疗方法更为有效。 Improving the fitness of the population is one of the most important提高人口适应性是最重要的一项 减少心脏病的公共卫生策略 首先需要进行心脏手术。

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,很可能在其他情况下最佳BMI不应被认为是从手术中恢复的最佳选择,因此根据具体情况定义“正常” BMI是有意义的。 In this sense, the obesity paradox might not be a paradox at all.从这个意义上说,肥胖悖论可能根本不是悖论。

作者简介

安娜·约翰逊(Ana Johnson),公共卫生科学系教授, 安大略女王大学 和Joel Parlow,麻醉学和围手术期医学教授, 安大略女王大学

这篇文章也是由皇后大学名誉教授,麻醉学和围手术期医学教授Brian Milne共同撰写的。谈话

本文重新发表 谈话 根据知识共享许可。 阅读 原创文章.

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