公衆衛生72巻2号

2008年02月発行

連載 予防活動のガイドライン・2

肥満と腹囲

著者： 堀江正知¹

所属機関： ¹産業医科大学産業生態科学研究所産業保健管理学

ページ範囲：P.138 - P.142

　アメリカ合衆国予防医学専門委員会(US Preventive Service Task Force：USPSTF)は，文献の体系的レビューから，臨床家が診療の場で実施すべきスクリーニングや予防に関するガイドラインを1996年に公表した．「成人の肥満のスクリーニングと予防」は2003年12月に改訂している¹⁾．本稿は，その概要と最近の文献的知見を記す．

　体内の脂肪量の測定法には，全身の比重を測る方法，上腕二頭筋に近赤外線を照射して測る方法，生体電気インピーダンスで測る方法，二重エネルギーX線の吸収で測る方法，CTで測る方法などがある．しかし，肥満のスクリーニング法に広く用いられてきた指標は，BMI(body mass index)である．ここで，BMI(kg/m²)が25以上30未満，30以上35未満，35以上40未満，40以上の場合，日本肥満学会は，それぞれ「肥満(1度)」，「肥満(2度)」，「肥満(3度)」，「肥満(4度)」と分類しているが，欧米では「過体重」，「クラスⅠ」，「クラスⅡ」，「クラスⅢ」と分類しており，本稿ではこの呼称で記した．

参考文献

1) McTigue KM, Harris R, Hemphill B, et al:Screening and interventions for obesity in adults;Summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 139:933-949, 2003

2) Shaper AG, Wannamethee SG, Walker M:Body weight;Implications for the prevention of coronary heart disease, stroke, and diabetes mellitus in a cohort study of middle aged men. BMJ 314(7090):1311-1317, 1997

3) Calle EE, Thun MJ, Petrelli JM, et al:Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 341(15):1097-1105, 1999

4) Baik I, Ascherio A, Rimm EB, et al:Adiposity and mortality in men. Am J Epidemiol 152(3):264-271, 2000

5) Folsom AR, Kushi LH, Anderson KE, et al:Associations of general and abdominal obesity with multiple health outcomes in older women;The Iowa Women's Health Study. Arch Intern Med 160(14):2117-2128, 2000

6) Knowler WC, Barrett-Connor E, Fowler SF, et al:Diabetes Prevention Program Research Group;Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393-403, 2002

7) Lindström J, Ilanne-Parikka P, Peltonen M, et al:Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention;follow-up of the Finnish Diabetes Prevention Study. Lancet 368(9548):1673-1679, 2006

8) Klein S, Allison DB, Heymsfield SB, et al:Waist circumference and cardiometabolic risk;A consensus statement from shaping America's health. Association for Weight Management and Obesity Prevention;NAASO, the Obesity Society;the American Society for Nutrition;and the American Diabetes Association. Diabetes Care 30(6):1647-1652, 2007

9) Funahashi T, Matsuzawa Y:Metabolic syndrome;clinical concept and molecular basis. Ann Med 39(7):482-494, 2007

10) Wang J, Thornton JC, Bari S, et al:Comparisons of waist circumferences measured at 4 sites. Am J Clin Nutr 77(2):379-384, 2003

11) Bigaard J, Spanggaard I, Thomsen BL, et al:Self-reported and technician-measured waist circumferences differ in middle-aged men and women. J Nutr 135(9):2263-2270, 2005

12) Adams KF, Schatzkin A, Harris TB, et al:Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med 355(8):763-778, 2006

13) Visscher TL, Seidell JC, Molarius A, et al:A comparison of body mass index, waist-hip ratio and waist circumference as predictors of all-cause mortality among the elderly;The Rotterdam study. Int J Obes Relat Metab Disord 25(11):1730-1735, 2001

14) Price GM, Uauy R, Breeze E, et al:Weight, shape, and mortality risk in older persons;Elevated waist-hip ratio, not high body mass index, is associated with a greater risk of death. Am J Clin Nutr 84(2):449-460, 2006

15) Asia Pacific Cohort Studies Collaboration:Central obesity and risk of cardiovascular disease in the Asia Pacific Region. Asia Pac J Clin Nutr 15(3):287-292, 2006

16) Yusuf S, Hawken S, Ounpuu S, et al:Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries;A case-control study;INTERHEART Study Investigators. Lancet 366(9497):1640-1649, 2005

17) Balkau B, Deanfield JE, Després JP, et al:International Day for the Evaluation of Abdominal Obesity(IDEA);A study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Circulation 116(17):1942-1951, 2007

18) Cui R, Iso H, Toyoshima H, et al:JACC Study Group. Body mass index and mortality from cardiovascular disease among Japanese men and women;The JACC study. Stroke 36(7):1377-1382, 2005