The obesity paradox and diabetes
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REVIEW
The obesity paradox and diabetes Giovanni Gravina1 · Federica Ferrari2 · Grazia Nebbiai1 Received: 17 June 2020 / Accepted: 7 September 2020 © Springer Nature Switzerland AG 2020
Abstract Background Obesity has been proven to be a risk factor for type 2 diabetes mellitus (T2DM) through numerous pathogenetic mechanisms. Unexpectedly, some studies suggest that subjects with overweight/obesity and T2DM have better clinical outcome than their normal weight peers. This finding is described as “obesity paradox” and calls into question the importance of weight loss in this specific population. Objective This article is a narrative overview on the obesity and type 2 diabetes mellitus, particularly regarding the obesity paradox in T2DM patients. Methods We used as sources MEDLINE/PubMed, CINAHL, EMBASE, and Cochrane Library, from inception to March 2020; we chose 30 relevant papers regarding the association of obesity with clinical outcome and mortality of patients affected by T2DM. Results Many studies report that in patients with T2DM, overweight and obesity are associated with a better prognosis than underweight or normal weight, suggesting the presence of an obesity paradox. However, these studies have numerous limitations due to their mainly retrospective nature and to numerous confounding factors, such as associated pathologies, antidiabetic treatments, smoking habit, lack of data about distribution of body fat or weight history. Conclusion Literature data regarding the phenomenon of obesity paradox in T2DM patients are controversial due to the several limitations of the studies; therefore in the management of patients with overweight/obesity and T2DM is recommended referring to the established guidelines, which indicate diet and physical activity as the cornerstone of the treatment. Level of evidence Level V: narrative review. Keywords Obesity · Obesity paradox · Type 2 diabetes
Introduction Epidemiological studies show an increasing prevalence and incidence of type 2 diabetes mellitus (T2DM) and obesity over the past decades. In 2014, in the world, 422 million people (8.5% of the adult population) had diabetes and in more than 90% of cases it was T2DM. Diabetes caused directly 1.5 million deaths in 2012, with an additional 2.2 million due to the
This article is part of the Topical Collection on Obesity Paradox. * Giovanni Gravina [email protected] 1
Center for Eating Behaviour and Metabolism Disorders, Casa di Cura San Rossore, Pisa, Italy
Obesity and Lipodystrophy Center, Endocrinology Unit, University Hospital of Pisa, Pisa, Italy
2
increased risk of fatal cardiovascular diseases. Many of these deaths (43%) occur under the age of 70 [1]. The prevalence of obesity nearly doubled worldwide since 1980 [2] and severe obesity, that is associated with the highest mortality risk, is a rapidly growing segment of the global epidemic [3]. In 2016, more than 39% and 13% of the adults were affected by overweight and obesity, respectively [4]. Obesity is known to be the main risk factor fo
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