Obesity paradox: new facts as an example of reverse epidemiology
R.A. Fursov, O.B. Ospanov
Medical University of Astana, Kazakhstan
Obesity is associated with most health problems, including some cancers. The combination of obesity with metabolic disorders, cardiovascular diseases, diabetes and other pathologies increases the risk of death. However, in recent years, there have been publications showing that people with obesity are more likely to survive than people with normal and underweight. This phenomenon has been called the «obesity paradox».
This article presents materials from the world medical literature on the obesity paradox. Information resources accumulated in traditional libraries and automated library information systems were used to select scientific sources and analyze materials. The search was carried out through the databases of international organizations that are engaged in compiling scientific reviews of medicine (Cochrane Library, MEDLINE, EMBASE, HealthStar, CrossRef and others).
According to recent studies, it is not the presence of obesity and high body mass index itself that is important, but the distribution of fat deposits, structure and volume of visceral fat. The shape and dynamics of the waist size increase (the so-called body shape trajectory) can be predictors of complications and sudden death in obese patients. Moreover, the paradox of obesity consists in higher survival rates among patients with obesity and cardiovascular complications who have undergone cardiac surgery in hospital. It has been suggested that a group of obese people have a higher metabolic reserve, which can serve as protection for chronic conditions such as coronary heart disease, etc.
Many scientists are sceptical of the paradoxical results associated with obesity, as these results are contrary to generally accepted concepts and views, and therefore raise some doubts.
Keywords: obesity, body mass index, obesity paradox, morbidity, mortality risk, reverse epidemiology.
For citation: Fursov R.A., Ospanov O.B. Obesity paradox: new facts as an example of reverse epidemiology. RMJ. Medical Review. 2019;1(I):16–20.
References
1. World Health Organization — WHO (2017) Obesity and overweight. Controlling the global obesity epidemic. (Electronic resource). URL: http://www.who.int/nutrition/topics/obesity/en (access date: 12.10.2017).
2. Fursov R., Ospanov O., Fursov A. Prevalence of obesity in Kazakhstan. AMJ 2017;10(11):916–920. DOI: 10.21767/AMJ.2017.3169.
3. NIDDK/NIH (National Institute of Diabetes and Digestive and Kidney Diseases). (Electronic resource). URL: https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity (access date: 12.10.2017).
4. NIDDK/NIH (National Institute of Diabetes and Digestive and Kidney Diseases). (Electronic resource). URL: https://www.niddk.nih.gov/health-information/weight-management/adult–overweight-obesity#foot1 (access date: 17.12.2017).
5. Leddy М.А., Power M.L., Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008;1(4):170–178.
6. Kitahara C.M., Flint A.J., Berrington de Gonzalez A. et al. Association between class III obesity (BMI of 40–59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7): e1001673. DOI: 10.1371/journal.pmed.1001673.
7. Reeves G.K., Pirie К., Beral V. et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007;335:1134. DOI: 10.1136/bmj.39367.495995.AE.
8. Eliassen A.H., Colditz G.A., Rosner B. et al. Adult weight change and risk of postmenopausal breast cancer. JAMA. 2006;296:193–201.
9. Lauby-Secretan B., Scoccianti C., Loomis D. et al. International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer-viewpoint of the IARC Working Group. N Engl J Med. 2016;375:794–798.
10. Manson J.E., Willett W.C., Stampfer M.J. et al. Body weight and mortality among women. N Engl J Med. 1995;333:677–685.
11. Calle E.E., Rodriguez C., Walker-Thurmond K., Thun M.J. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–1638.
12. Fitzgerald К. Even A Few Extra Pounds Can Be Dangerous to Your Heart. Medical News Today. (Electronic resource). URL: https://www.medicalnewstoday.com/articles/262542.php?sr (access date: 01.02.2019).
13. McNamee D. Extreme obesity linked to substantially higher death rates. Medical News Today. (Electronic resource). URL: https://www.medicalnewstoday.com/articles/279337.php (access date: 01.02.2019).
14. Lee S.H., Tak Y.J., Yi Y.H. et al. Correlations between obesity indices and cardiometabolic risk factors in obese subgroups in women with severe obesity: A multicenter, cross-sectional study. Obesity Research and Clinical Practice (ORCP). 2017;11(2):167–176.
15. Padwal R.S., Pajewski N.M., Allison D.B., Sharma A.M. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ. 2011;15:110387.
16. Song M., Hu F.B., Wu K., Must A. et al. Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies. BMJ. 2016:353. DOI: 10.1136/bmj.i2195.
17. Wise J. Waist measurement, not BMI, is stronger predictor of death risk, study finds. BMJ. 2017:357. DOI: 10.1136/ bmj.j2033.
18. Doornweerd S., IJzerman R.G., van der Eijk L. et al. Physical activity and dietary intake in BMI discordant identical twins. Obesity (Sliver Spring). 2016;24:1349–1355.
19. Kim S.G., Ko K.D., Hwang I.C. et al. Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: The Fourth and Fifth Korea National Health and Nutrition Examination Survey. Obes Res Clin Pract. 2015;9(5):487¬–98. DOI: 10.1016/j.orcp.2014.11.002.
20. Batsis J.A., Mackenzie T.A., Emeny R.T. et al. Low Lean Mass With and Without Obesity, and Mortality: Results From the 1999–2004 National Health and Nutrition Examination Survey. J Gerontol a Biol Sci Med Sci. 2017;72(10):1445–1451. DOI: 10.1093/gerona/glx002.
21. Ma С., Avenell А., Bolland М. et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017;359: j4849. DOI: 10.1136/bmj.j4849.
22. Sahakyan K.R., Somers V.K., Rodriguez-Escudero J.P. et al. Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality. Ann. Intern. Med 2015;163(11):827–835.
23. Medina-Inojosa J., Somers V., Jenkins S. et al. Validation of a White-light 3D Body Volume Scanner to Assess Body Composition. Obes Open Access. 2017;3(1). DOI: 10.16966/2380-5528.127.
24. Ladabaum U., Mannalithara A., Myer P.A., Singh G. Obesity, abdominal obesity, physical activity, and caloric intake in US adults: 1988–2010. Am J Med. 2014;127(8):717–727.e12. DOI: 10.1016/j.amjmed.2014.02.026.
25. Mosterd A. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001;22(15):1318–1327.
26. Kalantar-Zadeh К. InCites: An Interview with Dr. Kamyar Kalantar-Zadeh. (Electronic resource). URL: http://in-cites.com/scientists/KamyarKalantar-Zadeh.html. (access date: 01.07.2017).
27. Kalantar-Zadeh K., Block G., Humphreys M.H., Kopple J.D. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int. 2003;63:793–808.
28. Kalantar-Zadeh K., Kovesdy C.P., Derose S.F. et al. Racial and survival paradoxes in chronic kidney disease.Nat Clin Pract Nephrol. 2007;3:493–506.
29. Sharma A., Vallakati A., Einstein A.J. et al. Relationship of Body Mass Index with Total Mortality, Cardiovascular Mortality, and Myocardial Infarction After Coronary Revascularization: Evidence from a Meta-analysis. Mayo Clin Proc. 2014;89(8) 1080–1100. DOI: 10.1016/j.mayocp. 2014.04.020.
30. De Schutter А., Lavie C.J., Kachur S. et al. Body Composition and Mortality in a Large Cohort with Preserved Ejection Fraction: Untangling the Obesity Paradox. Mayo Clin Proc. 2014;89(8):1072–1079. DOI: 10.1016/j.mayocp.2014.04.025.
31. Lavie C.J., De Schutter A., Patel D. et al. Body Composition and Coronary Heart Disease Mortality — An Obesity or a Lean Paradox? Mayo Clin Proc. 2011;86(9):857–864. DOI: 10.4065/mcp.2011. 0092.
32. Barth S., Zacher М., Reinecke Н. et al. Decreasing incidence of coronary heart disease in extreme obesity (BMI ? 40) — A single centre experience. Obes Res Clin Pract. 2017;11(4):435–444. DOI: 10.1016/j.orcp.2016.08.007.
33. Kalantar-Zadeh К., Rhee С.М., Alpesh N. Amin To Legitimize the Contentious Obesity Paradox. Mayo Clin Proc. 2014;89(8):1033–1035. DOI: 10.1016/j.mayocp.2014.06.015.
34. Stokes А., Ni Y., Samuel H. Preston Prevalence and Trends in Lifetime Obesity in the U.S., 1988–2014. Am J Prev Med. 2017;53(5):567–575. DOI: 10.1016/j.amepre.2017.06.008.
35. Arnold M., Jiang L., Stefanick M.L. et al. Duration of adulthood overweight, obesity, and cancer risk in the Women’s Health Initiative: a longitudinal study from the United States. PLoS Med. 2016;13: e1002081. DOI: 10.1371/journal.pmed.1002081.
36. Hirko K.A., Kantor E.D., Cohen S.S. et al. Body mass index in young adulthood, obesity trajectory, and premature mortality. Am J Epidemiol. 2015;182:441–450. DOI: 10.1093/aje/kwv084.
37. Reis J.P., Allen N., Gibbs B.B. et al. Association of the degree of adiposity and duration of obesity with measures of cardiac structure and function: the CARDIA study. Obesity (Silver Spring). 2014;22:2434–2440. DOI: 10.1002/oby.20865.
38. Reis J.P., Hankinson A.L., Loria C.M. et al. Duration of abdominal obesity beginning in young adulthood and incident diabetes through middle age: the CARDIA study. Diab Care. 2013;36:1241–1247. DOI: 10.2337/dc12-1714.
39. Wong E., Tanamas S.K., Wolfe R. et al. The role of obesity duration on the association between obesity and risk of physical disability. Obesity (Silver Spring). 2015;23:443–447. DOI: 10.1002/oby.20936.
40. Batsis J.A., Mackenzie T.A., Lopez-Jimenez F., Bartels S.J. Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999–2004. Nutr Res. 2015;35:1031–1039. DOI: 10.1016/j.nutres.2015.09.003.
41. Kohara K. Sarcopenic obesity in aging population: current status and future directions for research. Endocrine. 2014;45:15–25. DOI: 10.1007/s12020-013-9992-0.
42. Visser M., Harris T.B. Body composition and aging. In: A.B. Newman, J.A. Cauley (Eds.) The Epidemiology of Aging. Springer, New York; 2012:275–292. DOI: 10.1007/978-94-007-5061-6.
43. Wannamethee S.G., Atkins J.L. Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc. 2015;74:405–412. DOI: 10.1017/S002966511500169X.
44. Albanese E., Strand B.H., Guralnik J.M. et al. Weight loss and premature death: the 1946 British birth cohort study. PLoS One. 2014;9: e86282. DOI: 10.1371/journal.pone.0086282.
45. Carslake D., Jeffreys M., Davey Smith G. Being overweight in early adulthood is associated with increased mortality in middle age. Sci Rep. 2016;6:36046. DOI: 10.1038/srep36046.
46. Stokes A., Preston S.H. How dangerous is obesity? Issues in measurement and interpretation. Popul Dev Rev. 2016;42:595–614. DOI: 10.1111/padr.12015.
47. Johnson E., Simpson A., Harvey J. et al. Trends in bariatric surgery, 2002–2012: do changes parallel the obesity trend? Surg Obes Relat Dis. 2016;12:398–404. DOI: 10.1016/j.soard.2015.07.009.
48. Habbu A., Lakkis N.M., Dokainish H. The Obesity Paradox: Fact or Fiction? Am J Cardiol. 2004;98:944–948.
49. Шпагина О.В., Бондаренко Ш.З. «Парадокс ожирения» — еще один взгляд на проблему сердечно-сосудистых заболеваний. Ожирение и метаболизм. 2013;10:3–9 [Shpagina O.V., Bondarenko Sh.Z. The obesity paradox — another look at the problem of cardiovascular diseases. Obesity and Metabolism. 2013;10:3–9 (in Russ.)].
50. Кологривова И.В., Винницкая И.В., Кошельская О.А., Суслова Т.Е. Висцеральное ожирение и кардиометаболический риск: особенности гормональной и иммунной регуляции. Ожирение и метаболизм. 2017;14(3):3–10 [Kologrivova I.V., Vinnitskaya I.V., Koshelskaya O.A., Suslova T.E. Visceral obesity and cardiometabolic risk: features of hormonal and immune regulation. Obesity and Metabolism. 2017;14(3):3–10 (in Russ.)]. DOI: 10.14341/OMET201733-10.
51. Бородкина Д.А., Груздева О.В., Квиткова Л.В., Барбараш О.Л. Распределение жировых отложений: разгадка кажущегося парадокса ожирения в кардиологии? Ожирение и метаболизм. 2017;14(2):3–8 [Borodkina D.A., Gruzdeva O.V., Kvitkova L.V., Barbarash O.L. Distribution of body fat: a solution to the apparent paradox of obesity in cardiology? Obesity and Metabolism. 2017;14(2):3–8 (in Russ.)]. DOI: 10.14341/OMET201723-8.
52. Romero-Corral A., Somers V.K., Sierra-Johnson J. et al. Diagnostic performance of body mass index to detect obesity in patients with coronary artery disease. European Heart Journal. 2007;28:2087–2093.
53. Самородская И.В. Индекс массы тела и парадокс ожирения. РМЖ. Кардиология. 2014;2:170 [Samorodskaya I.V. Body mass index and obesity paradox. RMJ. Kardiologiya. 2014;2:170 (in Russ.)].
2. Fursov R., Ospanov O., Fursov A. Prevalence of obesity in Kazakhstan. AMJ 2017;10(11):916–920. DOI: 10.21767/AMJ.2017.3169.
3. NIDDK/NIH (National Institute of Diabetes and Digestive and Kidney Diseases). (Electronic resource). URL: https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity (access date: 12.10.2017).
4. NIDDK/NIH (National Institute of Diabetes and Digestive and Kidney Diseases). (Electronic resource). URL: https://www.niddk.nih.gov/health-information/weight-management/adult–overweight-obesity#foot1 (access date: 17.12.2017).
5. Leddy М.А., Power M.L., Schulkin J. The impact of maternal obesity on maternal and fetal health. Rev Obstet Gynecol. 2008;1(4):170–178.
6. Kitahara C.M., Flint A.J., Berrington de Gonzalez A. et al. Association between class III obesity (BMI of 40–59 kg/m2) and mortality: a pooled analysis of 20 prospective studies. PLoS Med. 2014;11(7): e1001673. DOI: 10.1371/journal.pmed.1001673.
7. Reeves G.K., Pirie К., Beral V. et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ. 2007;335:1134. DOI: 10.1136/bmj.39367.495995.AE.
8. Eliassen A.H., Colditz G.A., Rosner B. et al. Adult weight change and risk of postmenopausal breast cancer. JAMA. 2006;296:193–201.
9. Lauby-Secretan B., Scoccianti C., Loomis D. et al. International Agency for Research on Cancer Handbook Working Group. Body fatness and cancer-viewpoint of the IARC Working Group. N Engl J Med. 2016;375:794–798.
10. Manson J.E., Willett W.C., Stampfer M.J. et al. Body weight and mortality among women. N Engl J Med. 1995;333:677–685.
11. Calle E.E., Rodriguez C., Walker-Thurmond K., Thun M.J. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625–1638.
12. Fitzgerald К. Even A Few Extra Pounds Can Be Dangerous to Your Heart. Medical News Today. (Electronic resource). URL: https://www.medicalnewstoday.com/articles/262542.php?sr (access date: 01.02.2019).
13. McNamee D. Extreme obesity linked to substantially higher death rates. Medical News Today. (Electronic resource). URL: https://www.medicalnewstoday.com/articles/279337.php (access date: 01.02.2019).
14. Lee S.H., Tak Y.J., Yi Y.H. et al. Correlations between obesity indices and cardiometabolic risk factors in obese subgroups in women with severe obesity: A multicenter, cross-sectional study. Obesity Research and Clinical Practice (ORCP). 2017;11(2):167–176.
15. Padwal R.S., Pajewski N.M., Allison D.B., Sharma A.M. Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ. 2011;15:110387.
16. Song M., Hu F.B., Wu K., Must A. et al. Trajectory of body shape in early and middle life and all cause and cause specific mortality: results from two prospective US cohort studies. BMJ. 2016:353. DOI: 10.1136/bmj.i2195.
17. Wise J. Waist measurement, not BMI, is stronger predictor of death risk, study finds. BMJ. 2017:357. DOI: 10.1136/ bmj.j2033.
18. Doornweerd S., IJzerman R.G., van der Eijk L. et al. Physical activity and dietary intake in BMI discordant identical twins. Obesity (Sliver Spring). 2016;24:1349–1355.
19. Kim S.G., Ko K.D., Hwang I.C. et al. Relationship between indices of obesity obtained by anthropometry and dual-energy X-ray absorptiometry: The Fourth and Fifth Korea National Health and Nutrition Examination Survey. Obes Res Clin Pract. 2015;9(5):487¬–98. DOI: 10.1016/j.orcp.2014.11.002.
20. Batsis J.A., Mackenzie T.A., Emeny R.T. et al. Low Lean Mass With and Without Obesity, and Mortality: Results From the 1999–2004 National Health and Nutrition Examination Survey. J Gerontol a Biol Sci Med Sci. 2017;72(10):1445–1451. DOI: 10.1093/gerona/glx002.
21. Ma С., Avenell А., Bolland М. et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017;359: j4849. DOI: 10.1136/bmj.j4849.
22. Sahakyan K.R., Somers V.K., Rodriguez-Escudero J.P. et al. Normal-Weight Central Obesity: Implications for Total and Cardiovascular Mortality. Ann. Intern. Med 2015;163(11):827–835.
23. Medina-Inojosa J., Somers V., Jenkins S. et al. Validation of a White-light 3D Body Volume Scanner to Assess Body Composition. Obes Open Access. 2017;3(1). DOI: 10.16966/2380-5528.127.
24. Ladabaum U., Mannalithara A., Myer P.A., Singh G. Obesity, abdominal obesity, physical activity, and caloric intake in US adults: 1988–2010. Am J Med. 2014;127(8):717–727.e12. DOI: 10.1016/j.amjmed.2014.02.026.
25. Mosterd A. The prognosis of heart failure in the general population: The Rotterdam Study. Eur Heart J. 2001;22(15):1318–1327.
26. Kalantar-Zadeh К. InCites: An Interview with Dr. Kamyar Kalantar-Zadeh. (Electronic resource). URL: http://in-cites.com/scientists/KamyarKalantar-Zadeh.html. (access date: 01.07.2017).
27. Kalantar-Zadeh K., Block G., Humphreys M.H., Kopple J.D. Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int. 2003;63:793–808.
28. Kalantar-Zadeh K., Kovesdy C.P., Derose S.F. et al. Racial and survival paradoxes in chronic kidney disease.Nat Clin Pract Nephrol. 2007;3:493–506.
29. Sharma A., Vallakati A., Einstein A.J. et al. Relationship of Body Mass Index with Total Mortality, Cardiovascular Mortality, and Myocardial Infarction After Coronary Revascularization: Evidence from a Meta-analysis. Mayo Clin Proc. 2014;89(8) 1080–1100. DOI: 10.1016/j.mayocp. 2014.04.020.
30. De Schutter А., Lavie C.J., Kachur S. et al. Body Composition and Mortality in a Large Cohort with Preserved Ejection Fraction: Untangling the Obesity Paradox. Mayo Clin Proc. 2014;89(8):1072–1079. DOI: 10.1016/j.mayocp.2014.04.025.
31. Lavie C.J., De Schutter A., Patel D. et al. Body Composition and Coronary Heart Disease Mortality — An Obesity or a Lean Paradox? Mayo Clin Proc. 2011;86(9):857–864. DOI: 10.4065/mcp.2011. 0092.
32. Barth S., Zacher М., Reinecke Н. et al. Decreasing incidence of coronary heart disease in extreme obesity (BMI ? 40) — A single centre experience. Obes Res Clin Pract. 2017;11(4):435–444. DOI: 10.1016/j.orcp.2016.08.007.
33. Kalantar-Zadeh К., Rhee С.М., Alpesh N. Amin To Legitimize the Contentious Obesity Paradox. Mayo Clin Proc. 2014;89(8):1033–1035. DOI: 10.1016/j.mayocp.2014.06.015.
34. Stokes А., Ni Y., Samuel H. Preston Prevalence and Trends in Lifetime Obesity in the U.S., 1988–2014. Am J Prev Med. 2017;53(5):567–575. DOI: 10.1016/j.amepre.2017.06.008.
35. Arnold M., Jiang L., Stefanick M.L. et al. Duration of adulthood overweight, obesity, and cancer risk in the Women’s Health Initiative: a longitudinal study from the United States. PLoS Med. 2016;13: e1002081. DOI: 10.1371/journal.pmed.1002081.
36. Hirko K.A., Kantor E.D., Cohen S.S. et al. Body mass index in young adulthood, obesity trajectory, and premature mortality. Am J Epidemiol. 2015;182:441–450. DOI: 10.1093/aje/kwv084.
37. Reis J.P., Allen N., Gibbs B.B. et al. Association of the degree of adiposity and duration of obesity with measures of cardiac structure and function: the CARDIA study. Obesity (Silver Spring). 2014;22:2434–2440. DOI: 10.1002/oby.20865.
38. Reis J.P., Hankinson A.L., Loria C.M. et al. Duration of abdominal obesity beginning in young adulthood and incident diabetes through middle age: the CARDIA study. Diab Care. 2013;36:1241–1247. DOI: 10.2337/dc12-1714.
39. Wong E., Tanamas S.K., Wolfe R. et al. The role of obesity duration on the association between obesity and risk of physical disability. Obesity (Silver Spring). 2015;23:443–447. DOI: 10.1002/oby.20936.
40. Batsis J.A., Mackenzie T.A., Lopez-Jimenez F., Bartels S.J. Sarcopenia, sarcopenic obesity, and functional impairments in older adults: National Health and Nutrition Examination Surveys 1999–2004. Nutr Res. 2015;35:1031–1039. DOI: 10.1016/j.nutres.2015.09.003.
41. Kohara K. Sarcopenic obesity in aging population: current status and future directions for research. Endocrine. 2014;45:15–25. DOI: 10.1007/s12020-013-9992-0.
42. Visser M., Harris T.B. Body composition and aging. In: A.B. Newman, J.A. Cauley (Eds.) The Epidemiology of Aging. Springer, New York; 2012:275–292. DOI: 10.1007/978-94-007-5061-6.
43. Wannamethee S.G., Atkins J.L. Muscle loss and obesity: the health implications of sarcopenia and sarcopenic obesity. Proc Nutr Soc. 2015;74:405–412. DOI: 10.1017/S002966511500169X.
44. Albanese E., Strand B.H., Guralnik J.M. et al. Weight loss and premature death: the 1946 British birth cohort study. PLoS One. 2014;9: e86282. DOI: 10.1371/journal.pone.0086282.
45. Carslake D., Jeffreys M., Davey Smith G. Being overweight in early adulthood is associated with increased mortality in middle age. Sci Rep. 2016;6:36046. DOI: 10.1038/srep36046.
46. Stokes A., Preston S.H. How dangerous is obesity? Issues in measurement and interpretation. Popul Dev Rev. 2016;42:595–614. DOI: 10.1111/padr.12015.
47. Johnson E., Simpson A., Harvey J. et al. Trends in bariatric surgery, 2002–2012: do changes parallel the obesity trend? Surg Obes Relat Dis. 2016;12:398–404. DOI: 10.1016/j.soard.2015.07.009.
48. Habbu A., Lakkis N.M., Dokainish H. The Obesity Paradox: Fact or Fiction? Am J Cardiol. 2004;98:944–948.
49. Шпагина О.В., Бондаренко Ш.З. «Парадокс ожирения» — еще один взгляд на проблему сердечно-сосудистых заболеваний. Ожирение и метаболизм. 2013;10:3–9 [Shpagina O.V., Bondarenko Sh.Z. The obesity paradox — another look at the problem of cardiovascular diseases. Obesity and Metabolism. 2013;10:3–9 (in Russ.)].
50. Кологривова И.В., Винницкая И.В., Кошельская О.А., Суслова Т.Е. Висцеральное ожирение и кардиометаболический риск: особенности гормональной и иммунной регуляции. Ожирение и метаболизм. 2017;14(3):3–10 [Kologrivova I.V., Vinnitskaya I.V., Koshelskaya O.A., Suslova T.E. Visceral obesity and cardiometabolic risk: features of hormonal and immune regulation. Obesity and Metabolism. 2017;14(3):3–10 (in Russ.)]. DOI: 10.14341/OMET201733-10.
51. Бородкина Д.А., Груздева О.В., Квиткова Л.В., Барбараш О.Л. Распределение жировых отложений: разгадка кажущегося парадокса ожирения в кардиологии? Ожирение и метаболизм. 2017;14(2):3–8 [Borodkina D.A., Gruzdeva O.V., Kvitkova L.V., Barbarash O.L. Distribution of body fat: a solution to the apparent paradox of obesity in cardiology? Obesity and Metabolism. 2017;14(2):3–8 (in Russ.)]. DOI: 10.14341/OMET201723-8.
52. Romero-Corral A., Somers V.K., Sierra-Johnson J. et al. Diagnostic performance of body mass index to detect obesity in patients with coronary artery disease. European Heart Journal. 2007;28:2087–2093.
53. Самородская И.В. Индекс массы тела и парадокс ожирения. РМЖ. Кардиология. 2014;2:170 [Samorodskaya I.V. Body mass index and obesity paradox. RMJ. Kardiologiya. 2014;2:170 (in Russ.)].
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