Reverse epidemiology of obesity paradox: Fact or fiction?

IF 2.2 Q3 PHYSIOLOGY Physiological Reports Pub Date : 2024-11-01 DOI:10.14814/phy2.70107
Bellamkonda K Kishore
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Abstract

Obesity paradox refers to the clinical observation that when acute cardiovascular decompensation occurs, patients with obesity may have a survival benefit. This apparently runs counter to the epidemiology of obesity, which may increase the risk for non-communicable diseases (NCDs). The scientific community is split on obesity paradox, with some supporting it, while others call it BMI paradox. This review: (a) defines the obesity paradox, and its proposed role in overall mortality in NCDs; (b) delineates evidence for and against obesity paradox; (c) presents the importance of using different indices of body mass to assess the risk in NCDs; (d) examines the role of metabolically healthy obesity in obesity paradox, and emerging importance of cardio-respiratory fitness (CRF) as an independent predictor of CVD risk and all-cause mortality in patients with/without obesity. Evidence suggests that the development of obesity and insulin resistance are influenced by genetic (or ethnic) make up and dietary habits (culture) of the individuals. Hence, this review presents lean diabetes, which has higher total CVD and non-CVD mortality as compared to diabetics with obesity and the possibility of maternal factors programming cardiometabolic risk during fetal development, which may lead to a paradigm shift in our understanding of obesity.

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肥胖症反向流行病学悖论:事实还是虚构?
肥胖悖论是指临床观察发现,当心血管急性失代偿发生时,肥胖患者可能会获得生存益处。这显然与肥胖的流行病学背道而驰,因为肥胖可能会增加罹患非传染性疾病(NCDs)的风险。科学界对肥胖悖论的看法不一,有些人支持肥胖悖论,有些人则称之为体重指数悖论。本综述(a) 界定肥胖悖论及其在非传染性疾病总死亡率中的拟议作用;(b) 划分支持和反对肥胖悖论的证据;(c) 介绍使用不同体重指数评估非传染性疾病风险的重要性;(d) 研究代谢健康的肥胖在肥胖悖论中的作用,以及心肺功能(CRF)作为有/无肥胖患者心血管疾病风险和全因死亡率独立预测指标的新重要性。有证据表明,肥胖症和胰岛素抵抗的发生受遗传(或种族)构成和个人饮食习惯(文化)的影响。因此,本综述介绍了与肥胖糖尿病患者相比,瘦型糖尿病患者的心血管疾病和非心血管疾病总死亡率更高,以及在胎儿发育过程中母体因素导致心脏代谢风险的可能性,这可能会使我们对肥胖的认识发生范式转变。
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来源期刊
Physiological Reports
Physiological Reports PHYSIOLOGY-
CiteScore
4.20
自引率
4.00%
发文量
374
审稿时长
9 weeks
期刊介绍: Physiological Reports is an online only, open access journal that will publish peer reviewed research across all areas of basic, translational, and clinical physiology and allied disciplines. Physiological Reports is a collaboration between The Physiological Society and the American Physiological Society, and is therefore in a unique position to serve the international physiology community through quick time to publication while upholding a quality standard of sound research that constitutes a useful contribution to the field.
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