cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2015-4-103-110cardiovascular-254Research ArticleОБЗОРЫREVIEWSАКТУАЛЬНЫЕ ВОПРОСЫ КЛАССИФИКАЦИИ ОЖИРЕНИЯCURRENT ISSUES OF OBESITY CLASSIFICATIONСамородскаяИ. В.SamorodskayaI. V.

д. м.н., профессор, руководитель лаборатории

БолотоваЕ. В.BolotovaE. V.

д. м.н., профессор кафедры терапии №1 ФПК и ППС

bolotova_e@mail.ruБойцовС. А.BoytsovS. A.

д. м.н., профессор, директор

ФГБУ "Государственный научно-исследовательский центр профилактической медицины" Министерства здравоохранения Российской Федерации. Москва, РоссияFSBI "State Scientific-Prevention Center of the Prevention Medicine" of the Healthcare Ministry. Moscow, RussiaГБОУ ВПО "Кубанский государственный медицинский университет" Министерства здравоохранения Российской Федерации. Краснодар, РоссияSBEI HPE "Kubanskiy State Medical University" of the Healthcare Ministry. Krasnodar, Russia201520082015144103110Copyright © Самородская И.В., Болотова Е.В., Бойцов С.А., 20152015Самородская И.В., Болотова Е.В., Бойцов С.А.Samorodskaya I.V., Bolotova E.V., Boytsov S.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/254

Целью настоящего обзора является анализ современных класси­фикаций ожирения, рассматриваемых с точки зрения стратифика­ции риска сердечно-сосудистых (ССЗ) и метаболических заболе­ваний, оценки влияния на риск осложнений и отдаленный прогноз (смертность). Новая классификация ожирения AACE/ACE (2014) позволяет сконцентрировать внимание и начать многофакторную коррекцию веса именно у лиц с наибольшим риском развития осложнений и ухудшения состояния здоровья. Вместе с тем, в условиях дефицита времени, отведенного врачу первичного звена на осмотр пациента, а также необходимости проведения дополнительных к программе диспансеризации исследований, использование данной классификации проблематично. К настоя­щему времени не получено убедительных доказательств того, что ИМТ 25-35 кг/м2 без учета метаболических изменений, окружно­сти талии (ОТ), соотношения жира и мышечной ткани является фактором риска (ФР) более высокой сердечно-сосудистой смерт­ности (по сравнению с нормальным ИМТ) в долгосрочной пер­спективе. В настоящее время существует целый ряд определений метаболически здорового ожирения (МЗО), в которых использу­ются различные критерии оценки здорового метаболизма. Соответственно, будущие исследования должны сосредоточиться на разработке единого определения МЗО и выделения континген- тов, наиболее подверженных высокому риску развития ССЗ и метаболических заболеваний.

 

The main aim of the review is analysis of recent obesity classifications, taken from the viewpoint of cardiovascular diseases (CVD) risk stratification and metabolic diseases, evaluation of the complication risk and long-term prognosis (mortality). Novel obesity classification of AACE/ACE (2014) concentrates the attention on and makes it to begin multifactorial weight correction for the persons with the highest risk of complication development and worsening of the health state. However, in time deficiency conditions of the primary healthcare physician's practice, and necessity of additions for the screening programmes, usage of the classification is problematic. Recently there is no convincing evidence for that BMI 25-35 kg/m2 without mention of metabolic changes, waist circumference (WC), fat-muscle ration, is itself a risk factor (FR) of higher cardiovascular mortality (comparing to normal BMI) in long-term prognosis. Recently there is a row of metabolically healthy obesity (MHO) definitions which use different criteria for the evaluation of healthy metabolism. Hence further studies shall focus on the development of unified MHO definition and selection of groups that are at the most risk of CVD and metabolic diseases.

ожирениеклассификацияметаболически здо­ровое ожирениеobesityclassificationmetabolically healthy obesityReferencesZheng W, McLerran D, Rolland B, et al. Association between body-massindex and risk of death in more than 1 million Asians. N Engl J Med 2011; 364: 719-29.Zheng W, McLerran D, Rolland B, et al. Association between body-massindex and risk of death in more than 1 million Asians. N Engl J Med 2011; 364: 719-29.Frühbeck G, Toplak H, Yumuk EWV, et al. Obesity: The Gateway to ill Health — an EASO Position Statement on a Rising Public Health, Clinical and Scientific Challenge in Europe. Obes Facts 2013; 6(2): 117-120.Frühbeck G, Toplak H, Yumuk EWV, et al. Obesity: The Gateway to ill Health — an EASO Position Statement on a Rising Public Health, Clinical and Scientific Challenge in Europe. Obes Facts 2013; 6(2): 117-120.Jill J. Obesity and the Heart. JAMA 2013; 310(19): 2113.Jill J. Obesity and the Heart. JAMA 2013; 310(19): 2113.Badkeha A, Rathod A, Kizilbash M, et al. Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox. Am J Med 2010; 123(7): 646-51.Badkeha A, Rathod A, Kizilbash M, et al. Influence of obesity on outcomes in atrial fibrillation: yet another obesity paradox. Am J Med 2010; 123(7): 646-51.Carnethon M, De Chavez P, Biggs M, et al. Association of weight status with mortality in adults with incident diabetes. JAMA 2012; 308(6): 581-90.Carnethon M, De Chavez P, Biggs M, et al. Association of weight status with mortality in adults with incident diabetes. JAMA 2012; 308(6): 581-90.Ma S, Park B, Yang J, et al. Interaction of body mass index and diabetes as modifiers of cardiovascular mortality in a cohort study. J Prev Med Public 2012; 45(6): 394-401.Ma S, Park B, Yang J, et al. Interaction of body mass index and diabetes as modifiers of cardiovascular mortality in a cohort study. J Prev Med Public 2012; 45(6): 394-401.Kit B, Orpana H, Graubard BI. Association of all-cause mortality with Health. — Overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309(1): 71-82.Kit B, Orpana H, Graubard BI. Association of all-cause mortality with Health. — Overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309(1): 71-82.Arnlov J, Sundstrom J, Ingelsson E, Lind L. Impact of BMI and the metabolic syndrome on the risk of diabetes in middle-aged men. Diabetes Care 2011; 34: 61-5.Arnlov J, Sundstrom J, Ingelsson E, Lind L. Impact of BMI and the metabolic syndrome on the risk of diabetes in middle-aged men. Diabetes Care 2011; 34: 61-5.Phillips CM. Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord 2013; 14: 219-27.Phillips CM. Metabolically healthy obesity: definitions, determinants and clinical implications. Rev Endocr Metab Disord 2013; 14: 219-27.Samocha-Bonet D, Dixit VD, Kahn CR, et al. Metabolically healthy and unhealthy obese: the 2013 Stock Conference report. Obes Rev 2014; 15: 697-708.Samocha-Bonet D, Dixit VD, Kahn CR, et al. Metabolically healthy and unhealthy obese: the 2013 Stock Conference report. Obes Rev 2014; 15: 697-708.Seo MH, Rhee EJ. Metabolic and cardiovascular implications of a metabolically healthy obesity phenotype. Endocrinol Metab 2014; 29(4): 427-34.Seo MH, Rhee EJ. Metabolic and cardiovascular implications of a metabolically healthy obesity phenotype. Endocrinol Metab 2014; 29(4): 427-34.http://www.who.int/http://www.who.int/Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. JACC 2014; 63(25 Pt B): 2985-3023.Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. JACC 2014; 63(25 Pt B): 2985-3023.Management of Overweight and Obesity Working Group. VA/DoD clinical practice guideline for screening and management of overweight and obesity. Washington (DC): Department of Veterans Affairs, Department of Defense; 2014. p. 178.Management of Overweight and Obesity Working Group. VA/DoD clinical practice guideline for screening and management of overweight and obesity. Washington (DC): Department of Veterans Affairs, Department of Defense; 2014. p. 178.National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne (Australia): National Health and Medical Research Council; 2013. p. 202.National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne (Australia): National Health and Medical Research Council; 2013. p. 202.Academy of Nutrition and Dietetics. Adult weight management evidence-based nutrition practice guideline. Chicago (IL): Academy of Nutrition and Dietetics; 2014.Academy of Nutrition and Dietetics. Adult weight management evidence-based nutrition practice guideline. Chicago (IL): Academy of Nutrition and Dietetics; 2014.Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015: 100(2); 342-62.Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2015: 100(2); 342-62.De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis 2014; 56(4): 401-8.De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis 2014; 56(4): 401-8.Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309(1): 71-82.Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA 2013; 309(1): 71-82.Lavie CJ, Schutter AD, Archer E, et al. Obesity and prognosis in chronic diseases — impact of cardiorespiratory fitness in the obesity paradox. Curr Sports Med Rep 2014; 13(4): 240-5.Lavie CJ, Schutter AD, Archer E, et al. Obesity and prognosis in chronic diseases — impact of cardiorespiratory fitness in the obesity paradox. Curr Sports Med Rep 2014; 13(4): 240-5.Bastien M, Poirier P, Lemieux I, Després JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis 2014; 56(4): 369-81.Bastien M, Poirier P, Lemieux I, Després JP. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis 2014; 56(4): 369-81.Banack HR, Kaufman JS. The obesity paradox: understanding the effect of obesity on mortality among individuals with cardiovascular disease. Prev Med May 2014; 62: 96-102.Banack HR, Kaufman JS. The obesity paradox: understanding the effect of obesity on mortality among individuals with cardiovascular disease. Prev Med May 2014; 62: 96-102.Singh P. N., Clark R. W., Herring P. et al. Obesity and Life Expectancy Among LongLived Black Adults. J Gerontol A Biol Sci Med Sci 2014; 69(1): 63-72.Singh P. N., Clark R. W., Herring P. et al. Obesity and Life Expectancy Among LongLived Black Adults. J Gerontol A Biol Sci Med Sci 2014; 69(1): 63-72.Fitch A, Everling L, Fox C, et al. Prevention and management of obesity for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 May. p. 99.Fitch A, Everling L, Fox C, et al. Prevention and management of obesity for adults. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 May. p. 99.European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 2012; 33: 1635-701.European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal 2012; 33: 1635-701.Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults: Partial Update of CG43. National Clinical Guideline Centre (UK). London: National Institute for Health and Care Excellence (UK); 2014 Nov.Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults: Partial Update of CG43. National Clinical Guideline Centre (UK). London: National Institute for Health and Care Excellence (UK); 2014 Nov.World Gastroenterology Organisation (WGO). World Gastroenterology Organisation global guideline: obesity. Milwaukee (WI): World Gastroenterology Organisation 2011.World Gastroenterology Organisation (WGO). World Gastroenterology Organisation global guideline: obesity. Milwaukee (WI): World Gastroenterology Organisation 2011.Bays H, Abate N, Chandalia M. Adiposopathy: sick fat causes high blood sugar, high blood pressure and dyslipidemia. Futur Cardiol 2005; 1: 39-59.Bays H, Abate N, Chandalia M. Adiposopathy: sick fat causes high blood sugar, high blood pressure and dyslipidemia. Futur Cardiol 2005; 1: 39-59.Ruderman NB, Schneider SH, Berchtold P. The “metabolically-obese,” normalweight individual. Am J Clin Nutr 1981; 34: 1617-21.Ruderman NB, Schneider SH, Berchtold P. The “metabolically-obese,” normalweight individual. Am J Clin Nutr 1981; 34: 1617-21.Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001; 50: 1499-504.Sims EA. Are there persons who are obese, but metabolically healthy? Metabolism. 2001; 50: 1499-504.Primeau V, Coderre L, Karelis AD, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes 2011; 35: 971-81.Primeau V, Coderre L, Karelis AD, et al. Characterizing the profile of obese patients who are metabolically healthy. Int J Obes 2011; 35: 971-81.Samocha-Bonet D, Chisholm DJ, Tonks K, et al. Insulin-sensitive obesity in humans: a ‘favorable fat’ phenotype? Trends Endocrinol Metab 2012; 23: 116-24.Samocha-Bonet D, Chisholm DJ, Tonks K, et al. Insulin-sensitive obesity in humans: a ‘favorable fat’ phenotype? Trends Endocrinol Metab 2012; 23: 116-24.Stefan N, Haring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol 2013; 1: 152-62.Stefan N, Haring HU, Hu FB, Schulze MB. Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. Lancet Diabetes Endocrinol 2013; 1: 152-62.Bluher M. The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol 2010; 21: 38-43.Bluher M. The distinction of metabolically ‘healthy’ from ‘unhealthy’ obese individuals. Curr Opin Lipidol 2010; 21: 38-43.Naukkarinen J, Heinonen S, Hakkarainen A, et al. Characterising metabolically healthy obesity in weight-discordant monozygotic twins. Diabetologia 2014; 57: 167-76.Naukkarinen J, Heinonen S, Hakkarainen A, et al. Characterising metabolically healthy obesity in weight-discordant monozygotic twins. Diabetologia 2014; 57: 167-76.Kloting N, Fasshauer M, Dietrich A, et al. Insulin-sensitive obesity. Am J Physiol Endocrinol Metab 2010; 299: E506-15.Kloting N, Fasshauer M, Dietrich A, et al. Insulin-sensitive obesity. Am J Physiol Endocrinol Metab 2010; 299: E506-15.Tran TT, Yamamoto Y, Gesta S, Kahn CR. Beneficial effects of subcutaneous fat transplantation on metabolism. Cell Metab 2008; 7: 410-20.Tran TT, Yamamoto Y, Gesta S, Kahn CR. Beneficial effects of subcutaneous fat transplantation on metabolism. Cell Metab 2008; 7: 410-20.Koster A, Stenholm S, Alley DE, et al. Health ABC Study. Body fat distribution and inflammation among obese older adults with and without metabolic syndrome. Obesity 2010; 18: 2354-61.Koster A, Stenholm S, Alley DE, et al. Health ABC Study. Body fat distribution and inflammation among obese older adults with and without metabolic syndrome. Obesity 2010; 18: 2354-61.Bays HE, González-Campoy JM, Bray GA, et al. Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity. Expert Rev Cardiovasc Ther 2008; 6(3): 343-68.Bays HE, González-Campoy JM, Bray GA, et al. Pathogenic potential of adipose tissue and metabolic consequences of adipocyte hypertrophy and increased visceral adiposity. Expert Rev Cardiovasc Ther 2008; 6(3): 343-68.Badoud F, Perreault M, Zulyniak MA, Mutch DM. Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals. FASEB J 2015; 29(3): 748-58.Badoud F, Perreault M, Zulyniak MA, Mutch DM. Molecular insights into the role of white adipose tissue in metabolically unhealthy normal weight and metabolically healthy obese individuals. FASEB J 2015; 29(3): 748-58.Rice T, Perusse L, Bouchard C, Rao DC. Familial clustering of abdominal visceral fat and total fat mass: the Quebec Family Study. Obes Res 1996; 4: 253-61.Rice T, Perusse L, Bouchard C, Rao DC. Familial clustering of abdominal visceral fat and total fat mass: the Quebec Family Study. Obes Res 1996; 4: 253-61.Arner P. Regional differences in protein production by human adipose tissue. Biochem Soc Trans 2001; 29(Pt 2): 72-5.Arner P. Regional differences in protein production by human adipose tissue. Biochem Soc Trans 2001; 29(Pt 2): 72-5.Kim JY, van de Wall E, Laplante M, et al. Obesity-associated improvements in metabolic profile through expansion of adipose tissue. J Clin Invest 2007; 117: 2621-37.Kim JY, van de Wall E, Laplante M, et al. Obesity-associated improvements in metabolic profile through expansion of adipose tissue. J Clin Invest 2007; 117: 2621-37.Kanneganti TD, Dixit VD. Immunological complications of obesity. Nat Immunol 2012; 13: 707-12.Kanneganti TD, Dixit VD. Immunological complications of obesity. Nat Immunol 2012; 13: 707-12.Navarro E, Funtikova AN, Fito M, Schröder H. Can metabolically healthy obesity be explained by diet, genetics, and inflammation? Mol Nutr Food Res 2015; 59(1): 75-93.Navarro E, Funtikova AN, Fito M, Schröder H. Can metabolically healthy obesity be explained by diet, genetics, and inflammation? Mol Nutr Food Res 2015; 59(1): 75-93.Advanced framework for a new diagnosis of obesity as a chronic disease. The American Association of Clinical Endocrinologists and the American College of Endocrinology; 2014.Advanced framework for a new diagnosis of obesity as a chronic disease. The American Association of Clinical Endocrinologists and the American College of Endocrinology; 2014.

The authors declare that there are no conflicts of interest present.