Der Internist

, Volume 52, Issue 4, pp 352–361

Adipositas

Valider Prädiktor für das kardiometabolische Risiko?
Schwerpunkt

Zusammenfassung

Nach gängiger Ansicht korrelieren Übergewicht und Adipositas direkt mit dem kardiometabolischen Risiko. Eine Reihe aktueller Studien stellt diese Auffassung in Frage. Das klassische Maß für Adipositas, der Body Mass Index, scheint wenig geeignet, eine erhöhte Körperfettmasse korrekt anzuzeigen, noch weniger gar potenziell ungünstige Verteilungsstörungen. Zudem sind depot- und altersabhängige Schwankungen der Fettzellmenge (einschließlich ihrem Anstieg) über die gesamte Lebensspanne physiologisch und nicht notwendig assoziiert mit einem erhöhten Diabetes- oder kardiovaskulären Risiko. Solche Schwankungen können ganz im Gegenteil mit Multisystemanpassungen im Zusammenhang stehen, denen eine Schutzfunktion z. B. für die kardiovaskuläre und Knochengesundheit zukommt und die eine Erklärung für die zuletzt sog. „benigne Adipositas“ darstellen können. Endokrine und thermogenetische Fettzellfunktionen scheinen entscheidend für die zu Grunde liegende Biologie zu sein. In diesem Artikel beleuchten wir jüngste epidemiologische und biologische Erkenntnisse, die gegen die Annahme sprechen, dass Übergewicht ein einfaches Maß für Erkrankung ist. Abschließend zeigen wir anhand von klinischen Fallbeispielen die Schwäche einer „gewichtsfokussierten“ Herangehensweise auf und entwickeln einen praktischen Algorithmus zur Identifikation übergewichtiger Patienten mit kardiometabolischem Risiko.

Schlüsselwörter

Adipositas Übergewicht Kardiovaskuläres Risiko Body Mass Index Fettzellphysiologie 

Overweight

A valid predictor of cardiometabolic risk?

Abstract

A commonly held notion directly correlates overweight and obesity with cardiometabolic risk. A number of studies have recently questioned this belief. The classic measure of obesity, the body mass index, appears less valid to properly indicate increased fat mass and, in particular, potentially harmful changes in fat depots. Moreover, depot- and age-specific alterations including increases in fat mass are physiologic throughout life and may not be associated with an increased risk for diabetes or cardiovascular complications. In contrast, they may rather entail multi-system adaptations that are protective, e. g. to cardiovascular and bone health, and represent an explanation for what has recently been called “benign obesity”. Endocrine as well as thermogenic functions of fat cells appear to be critical for the underlying biology. In this article, we highlight recent epidemiologic and biologic insights arguing against the assumption of overweight as a simple measure of disease. Finally, using selected clinical cases we demonstrate the ill-informed nature of an “overweight-focused” approach and delineate a practical algorithm to identify overweight patients at cardiometabolic risk.

Keywords

Adiposity Obesity Cardiovascular risk Body mass index Adipocyte physiology 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Medizinische Klinik 1Universitätsklinikum Schleswig-Holstein, Campus LübeckLübeckDeutschland

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