Obesity Paradoxのレビュー

Obesity Paradoxのレビュー論文（Editorial）を紹介します。

Mitja Lainscak, Stephan von Haehling, Wolfram Doehner and Stefan D. Anker: The obesity paradox in chronic disease: facts and numbers. Journal of Cachexia, Sarcopenia and Muscle, Volume 3, Number 1, 1-4. doi: 10.1007/s13539-012-0059-5

下記のHPで全文見ることができます。

http://www.springerlink.com/content/504h421l33317812/fulltext.pdf

Obesity Paradoxは、心不全（急性、慢性）、冠動脈疾患（PCI、CABG後含め）、脳卒中、ICU領域、COPD（急性増悪、安定期）、CKD、DM＋心疾患で報告されています。悪液質の原因疾患が多いですが、その他でも報告されつつあります。

健常者での最適なBMIと、特に慢性炎症性疾患の患者での最適なBMIは、異なる可能性があります。一次予防では肥満の場合、栄養療法と運動療法で体重減少をすすめるべきです。しかし、二次予防、三次予防では肥満の場合の対応をよく考えなければいけません。

Abstract
Body size, particularly large, is a matter of concern among the lay public. Whether this is justified depends upon the state of health and should be judged individually. For patients with established chronic disease, there is sufficient evidence to support the benefits of large body size, i.e., the obesity paradox. This uniform finding is shared over a variety of cardiovascular, pulmonary, and renal diseases and is counterintuitive to the current concepts on ideal body weight. The scientific community has to increase the awareness about differences for optimal body size in health and disease. Simultaneously, clinicians have to be aware about body weight dynamics implications and should interpret the changes in the context of an underlying disease in order to implement the best available management.