First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko Hospital, Athens, 115 27, Greece.
Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, Athens, 11527, Greece.
Curr Obes Rep. 2023 Jun;12(2):75-85. doi: 10.1007/s13679-023-00497-1. Epub 2023 Feb 20.
Obesity is related to several comorbidities such as type 2 diabetes mellitus, cardiovascular disease, heart failure, and various types of cancers. While the detrimental effect of obesity in both mortality and morbidity has been well established, the concept of the obesity paradox in specific chronic diseases remains a topic of continuous interest. In the present review, we examine the controversial issues around the obesity paradox in certain conditions such as cardiovascular disease, several types of cancer and chronic obstructive pulmonary disease, and the factors that may confound the relation between obesity and mortality.
We refer to the obesity paradox when particular chronic diseases exhibit an interesting "paradoxical" protective association between the body mass index (BMI) and clinical outcomes. This association, however, may be driven by multiple factors among which the limitations of the BMI itself; the unintended weight loss precipitated by chronic illness; the various phenotypes of obesity, i.e., sarcopenic obesity or the athlete's obesity phenotype; and the cardiorespiratory fitness levels of the included patients. Recent evidence highlighted that previous cardioprotective medications, obesity duration, and smoking status seem to play a role in the obesity paradox. The obesity paradox has been described in a plethora of chronic diseases. It cannot be emphasized enough that the incomplete information received from a single BMI measurement may interfere with outcomes of studies arguing in favor of the obesity paradox. Thus, the development of carefully designed studies, unhampered by confounding factors, is of great importance.
肥胖与多种合并症相关，如 2 型糖尿病、心血管疾病、心力衰竭和各种类型的癌症。虽然肥胖对死亡率和发病率的有害影响已得到充分证实，但特定慢性疾病中肥胖悖论的概念仍然是一个持续关注的话题。在本综述中，我们研究了肥胖悖论在某些情况下（如心血管疾病、多种癌症和慢性阻塞性肺疾病）的争议问题，以及可能混淆肥胖与死亡率之间关系的因素。
当特定慢性疾病中体重指数（BMI）与临床结果之间存在有趣的“悖论”保护关联时，我们称之为肥胖悖论。然而，这种关联可能是由多种因素驱动的，其中包括 BMI 本身的局限性；慢性疾病引起的非故意体重减轻；肥胖的各种表型，即肌少症性肥胖或运动员肥胖表型；以及纳入患者的心肺功能水平。最近的证据强调，先前的心脏保护药物、肥胖持续时间和吸烟状况似乎在肥胖悖论中起作用。肥胖悖论在许多慢性疾病中都有描述。需要强调的是，从单一 BMI 测量中获得的不完整信息可能会干扰支持肥胖悖论的研究结果。因此，精心设计、不受混杂因素影响的研究非常重要。
