AADE Conference
http://www.diabeteseducator.org/
この関係で肥満関連の話題が少々・・・
ところで、
心疾患患者では、肥満の方が予後が良いという事象が知られている。
“Obesity Paradox”→ The correlation between increasing body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and decreasing mortality,
（BMI増加ほど、死亡率減少）
後顧的な5万名弱の左室駆出率温存の患者を3.1ン3ン感の平均フォローアップ、多変量解析にて検討し、LMI(lean mass index)：（１－BF）×BMI（
BF:Jackson-Pollock equation）で体脂肪評価。
体脂肪層別群内比較での、低体重は、除脂肪体重と独立して死亡率増加し、
Body Composition and Mortality in a Large Cohort With Preserved Ejection Fraction: Untangling the Obesity Paradox
http://www.mayoclinicproceedings.org/article/S0025-6196(14)00389-9/fulltext
対象全体では、BMI高値は、死亡率の低さと、極小さく相関 (hazard ratio [HR], 0.99; P<.001)
BMI高値群は、あきらかに防御的 (HR, 0.71; P<.001)
非補正下では、体脂肪（BF)3分位は、死亡率低下と関連するが、補正化では相関消失 (HR, 0.87; P<.001 without LMI; HR, 0.97; P=.23 with LMI)
やせ患者では、低BMIは、明らかに死亡率高値と相関 (HR, 0.92; P<.001) し、LMI補正無しの場合のみ、低BF3分位は死亡率低値と相関 (HR, 0.80; P<.001 without LMI; HR, 1.01; P=.83 with LMI)
BFによる層別化低体重患者は、LMIと独立して死亡率増加 (HR, 1.91; 95% CI, 1.56-2.34)
肥満患者限定では、 BMI (HR, 1.03; P<.001)、BF (HR, 1.18; P=.003) とも、死亡率増加と相関。それは（防御的に働く要素の）LMI補正後でも同様。
体脂肪重量、除脂肪重量を考慮することで、心疾患患者群での、死亡率とBMIのJ現象の説明がうまくいく。すなわち、
体脂肪は一見予防的に見えるが、これは、LMI（除脂肪重量）補正にて解消する現象である。
要するに、心不全るいそうというのがバックグラウンドの特殊な問題？
"Lifestyle habits and metabolic risk in American overweight and obese young adults"
Cha E, et al
AADE 2014.
As described in the paper, our proposal defines 5 stages of obesity ranked according to increasing severity.
STAGE 0: Patient has no apparent obesity-related risk factors (e.g., blood pressure, serum lipids, fasting glucose, etc. within normal range), no physical symptoms, no psychopathology, no functional limitations and/or impairment of well being.
STAGE 1: Patient has obesity-related subclinical risk factor(s) (e.g., borderline hypertension, impaired fasting glucose, elevated liver enzymes, etc.), mild physical symptoms (e.g., dyspnea on moderate exertion, occasional aches and pains, fatigue, etc.), mild psychopathology, mild functional limitations and/or mild impairment of well being.
STAGE 2: Patient has established obesity-related chronic disease(s) (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.), moderate limitations in activities of daily living and/or well being.
STAGE 3: Patient has established end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitation(s) and/or impairment of well being.
STAGE 4: Patient has severe (potentially end-stage) disability/ies from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitation(s) and/or severe impairment of well being.
Given that obesity treatment requires considerable efforts and resources, we suggest a pragmatic approach to managing patients at the different stages of obesity:
For STAGE O: Identification of factors contributing to increased body weight. Counseling to prevent further weight gain through lifestyle measures including healthy eating and increased physical activity.
For STAGE 1: Investigation for other (non-weight related) contributors to risk factors. More intense lifestyle interventions, including diet and exercise to prevent further weight gain. Monitoring of risk factors and health status.
For STAGE 2: Initiation of obesity treatments including considerations of all behavioral, pharmacological and surgical treatment options. Close monitoring and management of comorbidities as indicated.
For STAGE 3: More intensive obesity treatment including consideration of all behavioral, pharmacological and surgical treatment options. Aggressive management of comorbidities as indicated.
For STAGE 4: Aggressive obesity management as deemed feasible. Palliative measures including pain management, occupational therapy and psychosocial support.
- See more at: http://www.drsharma.ca/edmonton-obesity-staging-system.html#sthash.xRrEQQSJ.dpuf
