School of Public Health, Chengdu Medical College, Chengdu, China.
College of Animal and Veterinary Sciences, Southwest Minzu University, Chengdu, China.
Obes Facts. 2023;16(5):411-426. doi: 10.1159/000531792. Epub 2023 Jul 18.
Obesity is a globally increasing health problem that impacts multiple organ systems and a potentially modifiable risk factor for many diseases. Obesity has a significant impact on lung function and is strongly linked to the pathophysiology that contributes to lung diseases. On the other hand, reports have emerged that obesity is associated with a better prognosis than for normal weight individuals in some lung diseases, including pneumonia, acute lung injury/acute respiratory distress syndrome, chronic obstructive pulmonary disease, and lung cancer. The lesser mortality and better prognosis in patients with obesity is known as obesity paradox. While obesity paradox is both recognized and disputed in epidemiological studies, recent research has suggested possible mechanisms.
In this review, we attempted to explain and summarize these factors and mechanisms, including immune response, pulmonary fibrosis, lung function, microbiota, fat and muscle reserves, which are significantly altered by obesity and may contribute to the obesity paradox in lung diseases. We also discuss contrary literature that attributes the "obesity paradox" to confounding.
The review will illustrate the possible role of obesity in the prognosis or course of lung diseases, leading to a better understanding of the obesity paradox and provide hints for further basic and clinical research in lung diseases.
肥胖是一个在全球范围内不断加剧的健康问题，影响多个器官系统，也是许多疾病的潜在可改变的风险因素。肥胖对肺功能有重大影响，并与导致肺部疾病的病理生理学密切相关。另一方面，有报道称，在一些肺部疾病中，肥胖与正常体重个体相比预后更好，包括肺炎、急性肺损伤/急性呼吸窘迫综合征、慢性阻塞性肺疾病和肺癌。这种肥胖患者死亡率较低、预后较好的现象被称为肥胖悖论。虽然肥胖悖论在流行病学研究中得到了认可和争议，但最近的研究提出了一些可能的机制。
在这篇综述中，我们试图解释和总结这些因素和机制，包括肥胖引起的免疫反应、肺纤维化、肺功能、微生物群、脂肪和肌肉储备的变化，这些变化可能导致肺部疾病中的肥胖悖论。我们还讨论了一些相反的文献，这些文献将“肥胖悖论”归因于混杂因素。
本文综述说明了肥胖在肺部疾病的预后或病程中的可能作用，有助于更好地理解肥胖悖论，并为肺部疾病的进一步基础和临床研究提供线索。
