rfhealthЗдравоохранение Российской ФедерацииHealth care of the Russian Federation0044-197X2412-0723Federal Scientific Center of Hygiene named after F.F. Erisman10.47470/0044-197X-2021-65-2-135-142rfhealth-357Research ArticleОБЗОРЫREVIEWSПарадокс ожирения при сердечно-сосудистых заболеваниях и сахарном диабете (аналитический обзор)Obesity paradox in patients with cardiovascular diseases and diabetes mellitus type 2 (analytical review)https://orcid.org/0000-0001-8118-0522ЗаикинаМаргарита ПавловнаZaikinaMargarita P.

Студентка Международной школы «Медицина будущего», ФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский Университет), 119991, Москва.

e-mail: zaikina.rita@gmail.com

Student of “The International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russian Federation.

e-mail: zaikina.rita@gmail.com

zaikina.rita@gmail.comhttps://orcid.org/0000-0001-6512-1629КапустинаВ. А.KapustinaValentina A.noemail@neicon.ruhttps://orcid.org/0000-0002-3273-4602СавельевС. И.Savel'evStanislav I.noemail@neicon.ruФГАОУ ВО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenov University)Russian FederationФБУЗ «Центр гигиены и эпидемиологии в Липецкой области»РоссияThe Center of Hygiene and Epidemiology in Lipetsk regionRussian Federation202113052021652135142Copyright © Заикина М.П., Капустина В.А., Савельев С.И., 20212021Заикина М.П., Капустина В.А., Савельев С.И.Zaikina M.P., Kapustina V.A., Savel'ev S.I.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rfhealth.ru/jour/article/view/357

Ожирение и избыточная масса тела являются серьёзной проблемой в современном мире. Большинство исследований, клинических рекомендаций и обзоров представляют ожирение как негативный прогностический фактор сердечно-сосудистых заболеваний и сахарного диабета. Однако появляется всё больше доказательств того, что повышенный индекс массы тела тем не менее может являться прогностически благоприятным фактором для ряда заболеваний. Особенно много таких работ, касающихся заболеваний, для которых повышенная масса тела является наиболее значимым фактором риска. В литературе такое явление получило название «парадокс ожирения». Несмотря на то, что многие исследования показывают достоверность парадокса ожирения, нет определённых патогенетических механизмов, которые могли бы подтвердить это явление, да и сами исследования оставляют больше вопросов, чем ответов. Данный обзор посвящён их разбору при следующих нозологиях: артериальная гипертензия, ишемическая болезнь сердца, хроническая сердечная недостаточность, сахарный диабет 2-го типа. 

Целью данной работы является выявление проблем уже существующих исследований и поиск способов объяснения парадокса ожирения. Подбор литературы осуществлялся по базам данных PubМed. Для оценки проблематики современных исследований были проанализированы клинические исследования, для поиска причин данного парадокса – обзоры литературы. Единственным заболеванием, при котором парадокс ожирения получил свое подтверждение, и удалось найти возможные патогенетические механизмы его развития, является хроническая сердечная недостаточность.

Obesity and overweight are severe problems in modern life. Research, clinical guidelines, and reviews present obesity as an adverse prognostic factor for cardiovascular disease and diabetes. However, there is growing evidence that an increased body mass index can be a prognostically favorable factor for some conditions. A lot of such works are related to diseases for which increased body weight is the most significant risk factor. This phenomenon has been called the “obesity paradox”. Although many studies show this paradox, there are no specific pathogenic mechanisms that could confirm this phenomenon. The research leaves more questions than answers. This review contains their analysis in the following nosologies: arterial hypertension, coronary artery disease, heart failure, diabetes mellitus type 2. The objectives of this study are to identify problems with existing research and find ways to explain the obesity paradox. A literature search was carried out on the databases of PubМed. To assess the problems of modern research, clinical studies were analyzed. To find the causes of this paradox, literature reviews were examined. The obesity paradox has been confirmed in heart failure.

ожирениеповышенная масса телапарадокс ожиренияиндекс массы теламетаболический синдромсердечно-сосудистые заболеваниясахарный диабетаналитический обзорobesityweight gainobesity paradoxbody mass indexcardiovascular diseasesdiabetes mellitus type 2analytical reviewReferencesВОЗ. Ожирение и избыточный вес. Available at: https://www.who.int/ru/news-room/fact-sheets/detail/obesity-and-overweightWHO. Obesity and overweight. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweightPi-Sunyer X. The medical risks of obesity. Postgrad. Med. 2009; 121(6): 21-33. https://doi.org/10.3810/pgm.2009.11.2074Pi-Sunyer X. The medical risks of obesity. Postgrad. Med. 2009; 121(6): 21–33. https://doi.org/10.3810/pgm.2009.11.2074Seidell J.C. Time trends in obesity: an epidemiological perspective. Horm. Metab. Res. 1997; 29(4): 155-8. https://doi.org/10.1055/s-2007-979011Seidell J.C. Time trends in obesity: an epidemiological perspective. Horm. Metab. Res. 1997; 29(4): 155–8. https://doi.org/10.1055/s-2007-979011Ожегов С.И., Шведова Н.Ю. Толковый словарь русского языка: 80 000 слов и фразеологических выражений. М.; 1997.Ozhegov S.I., Shvedova N.Yu. Explanatory Dictionary of the Russian Language: 80,000 Words and Phraseological Expressions [Tolkovyy slovar’ russkogo yazyka: 80 000 slov i frazeologicheskikh vyrazheniy]. Moscow; 1997. (in Russian)Preston S.H., Vierboom Y.C., Stokes A. The role of obesity in exceptionally slow US mortality improvement. Proc. Natl Acad. Sci. USA. 2018; 115(5): 957-61. https://doi.org/10.1073/pnas.1716802115Preston S.H., Vierboom Y.C., Stokes A. The role of obesity in exceptionally slow US mortality improvement. Proc. Natl Acad. Sci. USA. 2018; 115(5): 957–61. https://doi.org/10.1073/pnas.1716802115The WHO MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) Project. Available at: https://thl.fi/monica/The WHO MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) Project. Available at: https://thl.fi/monica/Horwich T.B., Fonarow G.C., Hamilton M.A., MacLellan W.R., Woo M.A., Tillisch J.H. The relationship between obesity and mortality in patients with heart failure. J. Am. Coll. Cardiol. 2001; 38(3): 789-95. https://doi.org/10.1016/S0735-1097(01)01448-6Horwich T.B., Fonarow G.C., Hamilton M.A., MacLellan W.R., Woo M.A., Tillisch J.H. The relationship between obesity and mortality in patients with heart failure. J. Am. Coll. Cardiol. 2001; 38(3): 789–95. https://doi.org/10.1016/S0735-1097(01)01448-6Fonarow G.C., Srikanthan P., Costanzo M.R., Cintron G.B., Lopatin M. ADHERE Scientific Advisory Committee and Investigators. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am. Heart J. 2007; 153(1): 74-81. https://doi.org/10.1016/j.ahj.2006.09.007Fonarow G.C., Srikanthan P., Costanzo M.R., Cintron G.B., Lopatin M. ADHERE Scientific Advisory Committee and Investigators. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am. Heart J. 2007; 153(1): 74–81. https://doi.org/10.1016/j.ahj.2006.09.007Karrowni W., Kennedy K., Jones P., Valle J., Abdallah M., Daugherty S., et al. Obesity paradox among survivors of acute myocardial infarction and its interaction with time. J. Am. Coll. Cardiol. 2015; 65(10): A31. https://doi.org/10.1016/S0735-1097(15)60031-6Karrowni W., Kennedy K., Jones P., Valle J., Abdallah M., Daugherty S., et al. Obesity paradox among survivors of acute myocardial infarction and its interaction with time. J. Am. Coll. Cardiol. 2015; 65(10): A31. https://doi.org/10.1016/S0735-1097(15)60031-6Che L., Xu L., Wang M.Y., Huang Y.G. Obesity paradox among elderly patients with coronary artery disease undergoing non-cardiac surgery. J. Geriatr. Cardiol. 2018; 15(9): 598-604. https://doi.org/10.11909/j.issn.1671-5411.2018.09.004Che L., Xu L., Wang M.Y., Huang Y.G. Obesity paradox among elderly patients with coronary artery disease undergoing non-cardiac surgery. J. Geriatr. Cardiol. 2018; 15(9): 598–604. https://doi.org/10.11909/j.issn.1671-5411.2018.09.004Han S.J., Boyko E.J. The evidence for an obesity paradox in type 2 diabetes mellitus. Diabetes Metab. J. 2018; 42(3): 179-87. https://doi.org/10.4093/dmj.2018.0055Han S.J., Boyko E.J. The evidence for an obesity paradox in type 2 diabetes mellitus. Diabetes Metab. J. 2018; 42(3):179–87. https://doi.org/10.4093/dmj.2018.0055Иванов Г.Г., Сыркин А.Л., Дворников В.Е., Николаев Д.В., Остапченко Д.А., Котлярова Л.В. и др. Мультичастотный сегментарный биоимпедансный анализ в оценке изменений объема водных секторов организма. Российский журнал анестезиологии и интенсивной терапии. 1999; (2): 41-7.Ivanov G.G., Syrkin A.L., Dvornikov V.E., Nikolaev D.V., Ostapchenko D.A., Kotlyarova L.V., et al. Multi-frequency segmental bioimpedance analysis in assessing changes in the volume of water sectors of the body. Rossiyskiy zhurnal anesteziologii i intensivnoy terapii. 1999; (2): 41–7. (in Russian)Zoppini G., Verlato G., Leuzinger C., Zamboni C., Brun E., Bonora E., et al. Body mass index and the risk of mortality in type II diabetic patients from Verona. Int. J. Obes. Relat. Metab. Disord. 2003; 27(2): 281-5. https://doi.org/10.1038/sj.ijo.802199Zoppini G., Verlato G., Leuzinger C., Zamboni C., Brun E., Bonora E., et al. Body mass index and the risk of mortality in type II diabetic patients from Verona. Int. J. Obes. Relat. Metab. Disord. 2003; 27(2): 281–5. https://doi.org/10.1038/sj.ijo.802199Lopez J.C., Montesinos R., Velazquez C., Gonzalez-Barranco J. Short stature is related to high body fat composition despite body mass index in a Mexican population. Arch. Med. Res. 2003; 34(2): 137-40. https://doi.org/10.1016/S0188-4409(03)00002-XLopez J.C., Montesinos R., Velazquez C., Gonzalez-Barranco J. Short stature is related to high body fat composition despite body mass index in a Mexican population. Arch. Med. Res. 2003; 34(2): 137–40. https://doi.org/10.1016/S0188-4409(03)00002-XAffuso O., Pradhan L., Zhang C., Gao S., Wiener H.W., Gower B., et al. A method for measuring human body composition using digital images. PLoS ONE. 2018; 13(11): e0206430. https://doi.org/10.1371/journal.pone.0206430Affuso O., Pradhan L., Zhang C., Gao S., Wiener H.W., Gower B., et al. A method for measuring human body composition using digital images. PLoS ONE. 2018; 13(11): e0206430. https://doi.org/10.1371/journal.pone.0206430Русакова Д.С., Щербакова М.Ю., Гаппарова К.М., Зайнудинов З.М., Ткачев С.И., Сахаровская В.Г. Современные методы оценки состава тела. Экспериментальная и клиническая гастроэнтерология. 2012; (8): 71-81.Rusakova D.S., Shcherbakova M.Yu., Gapparova K.M., Zaynudinov Z.M., Tkachev S.I., Sakharovskaya V.G. Modern evaluating methods of the body. Eksperimental’naya i klinicheskaya gastroenterologiya. 2012; (8): 71–81. (in Russian)Жернакова Ю.В., Железнова Е.А., Чазова И.Е., Ощепкова Е.В., Долгушева Ю.А., Яровая Е.Б. и др. Распространенность абдоминального ожирения в субъектах Российской Федерации и его связь с социально-экономическим статусом, результаты эпидемиологического исследования ЭССЕ-РФ. Терапевтический архив. 2018; 90(10): 14-22. https://doi.org/10.26442/terarkh201890104-22Zhernakova Yu.V., Zheleznova E.A., Chazova I.E., Oshchepkova E.V., Dolgusheva Yu.A., Yarovaya E.B., et al. The prevalence of abdominal obesity and the association with socioeconomic status in regions of the Russian Federation, the results of the epidemiological study – ESSE-RF. Terapevticheskiy arkhiv. 2018; 90(10): 14–22. https://doi.org/10.26442/terarkh201890104-22 (in Russian)Antonopoulos A.S., Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc. Res. 2017; 113(9): 1074-86. https://doi.org/10.1093/cvr/cvx106Antonopoulos A.S., Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc. Res. 2017; 113(9): 1074–86. https://doi.org/10.1093/cvr/cvx106Menchine M.D., Arora S., Camargo C.A., Ginde A.A. Prevalence of undiagnosed and suboptimally controlled diabetes by point-of-care HbA1C in unselected emergency department patients. Acad. Emerg. Med. 2011; 18(3): 326-9. https://doi.org/10.1111/j.1553-2712.2011.01014.xMenchine M.D., Arora S., Camargo C.A., Ginde A.A. Prevalence of undiagnosed and suboptimally controlled diabetes by point-of-care HbA1C in unselected emergency department patients. Acad. Emerg. Med. 2011; 18(3): 326–9. https://doi.org/10.1111/j.1553-2712.2011.01014.xPatel N., Elsaid O., Shenoy A., Sharma A., McFarlane S.I. Obesity paradox in patients undergoing coronary intervention: A review. World J. Cardiol. 2017; 9(9): 731-6. https://doi.org/10.4330/wjc.v9.i9.731Patel N., Elsaid O., Shenoy A., Sharma A., McFarlane S.I. Obesity paradox in patients undergoing coronary intervention: A review. World J. Cardiol. 2017; 9(9): 731–6. https://doi.org/10.4330/wjc.v9.i9.731Azhari Z., Ismail M.D., Zuhdi A.S.M., Md Sari N., Zainal Abidin I., Wan Ahmad W.A. Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population: a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. BMJ Open. 2017; 7(11): e017794. https://doi.org/10.1136/bmjopen-2017-017794Azhari Z., Ismail M.D., Zuhdi A.S.M., Md Sari N., Zainal Abidin I., Wan Ahmad W.A. Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population: a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. BMJ Open. 2017; 7(11): e017794 https://doi.org/10.1136/bmjopen-2017-017794Preston S.H., Stokes A. Obesity paradox: conditioning on disease enhances biases in estimating the mortality risks of obesity. Epidemiology. 2014; 25(3): 454-61. https://doi.org/10.1097/EDE.0000000000000075Preston S.H., Stokes A. Obesity paradox: conditioning on disease enhances biases in estimating the mortality risks of obesity. Epidemiology. 2014; 25(3): 454–61. https://doi.org/10.1097/EDE.0000000000000075Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018; 39(33): 3021-104. https://doi.org/10.1093/eurheartj/ehy339Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018; 39(33): 3021–104. https://doi.org/10.1093/eurheartj/ehy339Hall J.E., do Carmo J.M., da Silva A.A., Wang Z., Hall M.E. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ. Res. 2015; 116(6): 991-1006. https://doi.org/10.1161/CIRCRESAHA.116.305697Hall J.E., do Carmo J.M., da Silva A.A., Wang Z., Hall M.E. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ. Res. 2015; 116(6): 991–1006. https://doi.org/10.1161/CIRCRESAHA.116.305697Aneja A., El-Atat F., McFarlane S.I., Sowers J.R. Hypertension and obesity. Recent Prog. Horm. Res. 2004; 59: 169-205. https://doi.org/10.1210/rp.59.1.169Aneja A., El-Atat F., McFarlane S.I., Sowers J.R. Hypertension and obesity. Recent Prog. Horm. Res. 2004; 59: 169–205. https://doi.org/10.1210/rp.59.1.169Farre N., Aranyo J., Enjuanes C., Verdu-Rotellar J.M., Ruiz S., Gonzalez-Robledo G., et al. Differences in neurohormonal activity partially explain the obesity paradox in patients with heart failure: The role of sympathetic activation. Int. J. Cardiol. 2015; 181: 120-6. https://doi.org/10.1016/j.ijcard.2014.12.025Farre N., Aranyo J., Enjuanes C., Verdu-Rotellar J.M., Ruiz S., Gonzalez-Robledo G., et al. Differences in neurohormonal activity partially explain the obesity paradox in patients with heart failure: The role of sympathetic activation. Int. J. Cardiol. 2015; 181: 120–6. https://doi.org/10.1016/j.ijcard.2014.12.025Uretsky S., Messerli F.H., Bangalore S., Champion A., Cooper-Dehoff R.M., Zhou Q., et al. Obesity paradox in patients with hypertention and coronary artery disease. Am. J. Med. 2007; 120(10): 863-70. https://doi.org/10.1016/j.amjmed.2007.05.011Uretsky S., Messerli F.H., Bangalore S., Champion A., Cooper-Dehoff R.M., Zhou Q., et al. Obesity paradox in patients with hypertention and coronary artery disease. Am. J. Med. 2007; 120(10): 863–70. https://doi.org/10.1016/j.amjmed.2007.05.011Thomsen M., Nordestgaard B.G. Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome. JAMA Intern. Med. 2014; 174(1): 15-22. https://doi.org/10.1001/jamainternmed.2013.10522Thomsen M., Nordestgaard B.G. Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome. JAMA Intern. Med. 2014; 174(1): 15–22. https://doi.org/10.1001/jamainternmed.2013.10522Шварц В. Воспаление жировой ткани. Часть 3. Патогенетическая роль в развитии атеросклероза. Проблемы эндокринологии. 2009; 55(6): 40-5. https://doi.org/10.14341/probl200955640-45Shvarts V. Inflammation of adipose tissue. Part 3. Pathogenetic role in the development of atherosclerosis. Problemy endokrinologii. 2009; 55(6): 40–5. https://doi.org/10.14341/probl200955640-45 (in Russian)Kim B.G., Hong S.J., Kim B.K., Ahn C.M., Shin D.H., Kim J.S., et al. Association between body mass index and clinical outcomes after new-generation drug-eluting stent implantation: Korean multi-center registry data. Atherosclerosis. 2018; 277: 155-62. https://doi.org/10.1016/j.atherosclerosis.2018.08.047Kim B.G., Hong S.J., Kim B.K., Ahn C.M., Shin D.H., Kim J.S., et al. Association between body mass index and clinical outcomes after new-generation drug-eluting stent implantation: Korean multi-center registry data. Atherosclerosis. 2018; 277: 155–62. https://doi.org/10.1016/j.atherosclerosis.2018.08.047Oreopoulos A., Padwal R., Kalantar-Zadeh K., Fonarow G.C., Norris C.M., McAlister F.A. Body mass index and mortality in heart failure: a meta-analysis. Am. Heart J. 2008; 156(1): 13-22. https://doi.org/10.1016/j.ahj.2008.02.014Oreopoulos A., Padwal R., Kalantar-Zadeh K., Fonarow G.C., Norris C.M., McAlister F.A. Body mass index and mortality in heart failure: a meta-analysis. Am. Heart J. 2008; 156(1): 13–22. https://doi.org/10.1016/j.ahj.2008.02.014Fonarow G.C., Chelimsky-Fallick C., Stevenson L.W., Luu M., Hamilton M.A., Moriguchi J.D., et al. Effect of direct vasodilation with hydralazine versus angiotensin-converting enzyme inhibition with captopril on mortality in advanced heart failure: The HyC trial. J. Am. Coll. Cardiol. 1992; 19(4): 842-50. https://doi.org/10.1016/0735-1097(92)90529-VFonarow G.C., Chelimsky-Fallick C., Stevenson L.W., Luu M., Hamilton M.A., Moriguchi J.D., et al. Effect of direct vasodilation with hydralazine versus angiotensin-converting enzyme inhibition with captopril on mortality in advanced heart failure: The HyC trial. J. Am. Coll. Cardiol. 1992; 19(4): 842–50. https://doi.org/10.1016/0735-1097(92)90529-VShamliyan T., Talley K.M., Ramakrishnan R., Kane R.L. Association of frailty with survival: A systematic literature review. Ageing Res. Rev. 2013; 12(2): 719-36. https://doi.org/10.1016/j.arr.2012.03.001Shamliyan T., Talley K.M., Ramakrishnan R., Kane R.L. Association of frailty with survival: A systematic literature review. Ageing Res. Rev. 2013; 12(2): 719–36. https://doi.org/10.1016/j.arr.2012.03.001Carnethon M.R., De Chavez P.J., Biggs M.L., Lewis C.E., Pankow J.S., Bertoni A.G., et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012; 308(6): 581-90. https://doi.org/10.1001/jama.2012.9282Carnethon M.R., De Chavez P.J., Biggs M.L., Lewis C.E., Pankow J.S., Bertoni A.G., et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012; 308(6): 581–90. https://doi.org/10.1001/jama.2012.9282Sluik D., Boeing H., Montonen J., Pischon T., Kaaks R., Teucher B., et al. Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus. Am. J. Epidemiol. 2011; 174(1): 22-34. https://doi.org/10.1093/aje/kwr048Sluik D., Boeing H., Montonen J., Pischon T., Kaaks R., Teucher B., et al. Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus. Am. J. Epidemiol. 2011; 174(1): 22–34. https://doi.org/10.1093/aje/kwr048Rydén L., Grant P.J., Anker S.D., Berne C., Cosentino F., Danchin N., et al. Рекомендации по диабету, предиабету и сердечно-сосудистым заболеваниям. EASD/ESC. Российский кардиологический журнал. 2014; (3): 7-61. https://doi.org/10.15829/1560-4071-2014-3-7-61Rydén L., Grant P.J., Anker S.D., Berne C., Cosentino F., Danchin N., et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Russian Journal of Cardiology. 2014; (3): 7–61. https://doi.org/10.15829/1560-4071-2014-3-7-61 (In Russian)Шальнова С.А., Деев А.Д. Масса тела у мужчин и женщин (результаты обследования российской, национальной, представительной выборки населения). Кардиоваскулярная терапия и профилактика. 2008; 7(6): 60-3.Shal’nova S.A., Deev A.D. Body mass in men and women: the Russian national representative sample data. Kardiovaskulyarnaya terapiya i profilaktika. 2008; 7(6): 60–3. (in Russian)Borracci R.A., Ingino C.A., Miranda J.M. Association of body mass index with short-term outcomes after cardiac surgery: retrospective study and meta-analysis. Medicina (B Aires). 2018; 78(3): 171-9.Borracci R.A., Ingino C.A., Miranda J.M. Association of body mass index with short-term outcomes after cardiac surgery: retrospective study and meta-analysis. Medicina (B Aires). 2018; 78(3): 171–9.Островская Е.В., Романцова Т.И., Герасимов А.Н., Новоселова Т.Е. Распространенность метаболически здорового ожирения по данным выборки Московского региона. Ожирение и метаболизм. 2017; 14(4): 51-6. https://doi.org/10.14341/OMET2017451-56Ostrovskaya E.V., Romantsova T.I., Gerasimov A.N., Novoselova T.E. The prevalence of metabolically healthy obesity according to the sample of the Moscow region. Ozhirenie i metabolizm. 2017; 14(4): 51–6. https://doi.org/10.14341/OMET2017451-56 (in Russian)

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