Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations
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METABOLISM (M DALAMAGA, SECTION EDITOR)
Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations Irene Karampela 1,2
&
Evangelia Chrysanthopoulou 1 & Gerasimos Socrates Christodoulatos 2 & Maria Dalamaga 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Obesity represents a global epidemic with serious implications in public health due to its increasing prevalence and its known association with a high morbidity and mortality burden. However, a growing number of data support a survival benefit of obesity in critical illness. This review summarizes current evidence regarding the obesity paradox in critical illness, discusses methodological issues and metabolic implications, and presents potential pathophysiologic mechanisms. Recent Findings Data from meta-analyses and recent studies corroborate the obesity-related survival benefit in critically ill patients as well as in selected populations such as patients with sepsis and acute respiratory distress syndrome, but not trauma. However, this finding warrants a cautious interpretation due to certain methodological limitations of these studies, such as the retrospective design, possible selection bias, the use of BMI as an obesity index, and inadequate adjustment for confounding variables. Main pathophysiologic mechanisms related to obesity that could explain this phenomenon include higher energy reserves, inflammatory preconditioning, anti-inflammatory immune profile, endotoxin neutralization, adrenal steroid synthesis, renin-angiotensin system activation, cardioprotective metabolic effects, and prevention of muscle wasting. Summary The survival benefit of obesity in critical illness is supported from large meta-analyses and recent studies. Due to important methodological limitations, more prospective studies are needed to further elucidate this finding, while future research should focus on the pathophysiologic role of adipose tissue in critical illness. Keywords Body mass index . Critically ill . Mortality . Obese . Obesity paradox . Overweight . Sepsis . Survival
This article is part of the Topical Collection on Metabolism * Irene Karampela [email protected] Evangelia Chrysanthopoulou [email protected] Gerasimos Socrates Christodoulatos [email protected] Maria Dalamaga [email protected] 1
Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462 Athens, Greece
2
Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527 Athens, Greece
Introduction Obesity, which represents the increase of body weight due to expansion of adipose tissue, has become a global epidemic with important implications in public health. Epidemiologic studies have shown that obesity exhibits an overtly increasing prevalence in both economically developed and developing countries during the last four decades [1–4]. Ac
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