«Парадокс ожирения» и степень его доказанности

Миклишанская С.В., Мазур Н.А., Соломасова Л.В., Чигинева В.В. «Парадокс ожирения» и степень его доказанности. Терапевтический архив. 2020; 92 (4): 84–90. DOI: 10.26442/00403660.2020.04.000421

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Miklisanskaya S.V., Mazur N.A., Solomasova L.V., Chigineva V.V. The "obesity paradox" and its degree of proof. Therapeutic Archive. 2020; 92 (4): 84–90. DOI: 10.26442/00403660.2020.04.000421

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Аннотация

В статье дана критическая оценка так называемого «парадокса ожирения». Освещены методические ошибки, которые встречаются при организации исследований, изучавших «парадокс ожирения», и формировании групп сравнения. Также приводятся примеры исчезновения «парадокса ожирения» при учете дополнительных факторов риска. Организация проспективных исследований или более тщательный учет всех известных на сегодняшний день факторов риска сердечно-сосудистых заболеваний (ССЗ) позволит существенно улучшить результаты изучения влияния избыточной массы тела и ожирения на смертность больных с ССЗ. Таким образом, несмотря на биологические возможности существования положительного влияния жировой ткани при ССЗ, наличие большого количества ошибок, выявленных при анализе работ, исследующих «парадокс ожирения», требует пересмотреть вопрос о существовании данного феномена, следует учитывать возможность того, что «парадокс ожирения» может быть следствием неправильного дизайна исследований для изучения данного явления.

Ключевые слова: «парадокс ожирения», индекс массы тела, факторы риска, сердечно-сосудистые заболевания, группы сравнения, курение.

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The article gives a critical assessment of the so-called "obesity paradox". Methodological errors that occur in the organization of studies that studied the "obesity paradox" and the formation of comparison groups are highlighted. There are also examples of the disappearance of the "obesity paradox" when taking into account additional risk factors. The organization of prospective studies or more careful consideration of all currently known risk factors for cardiovascular diseases (CVD) will significantly improve the results of the study of the effect of overweight and obesity on mortality in patients with CVD. Thus, despite the biological possibility of the existence of a positive effect of adipose tissue in CVD, the presence of a large number of errors identified in the analysis of the work of researchers "obesity paradox" require to reconsider the existence of this phenomenon, it should be taken into account the possibility that the "obesity paradox" may be a consequence of improper design studies to investigate this phenomenon.

Key words: "obesity paradox", body mass index, risk factors, cardiovascular diseases, comparison groups, smoking.

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Авторы

С.В. Миклишанская, Н.А. Мазур, Л.В. Соломасова, В.В. Чигинева

ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия

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S.V. Miklisanskaya, N.A. Mazur, L.V. Solomasova, V.V. Chigineva

Russian Medical Academy of Continuous Professional Education, Moscow, Russia

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