Obesity paradox


In certain conditions especially in individuals with cardiovascular disease, obesity might be related to a lower risk of mortality, obesity-mortality paradox.

While obesity is increasing the rates of death and myocardial infarction are decreasing, a trend that is not explained by preventive medicine alone.

Higher rates of death have been observed in normal weight individuals compared with overweight individuals.

A higher risk of death has been observed in normal weight patients with cardiovascular disease, and patients with type two diabetes, than in overweight individuals with these diseases.

Monozygotic twins with different body mass indexes, do not have a higher risk of myocardial infarction or death in the heavier twin, but the heavier twin has a higher risk of diabetes (Nordstrom P).

Although obesity increases the risk of heart failure, once a diagnosis is confirmed, patients with heart failure who are also obese have a better prognosis compared with their leaner counterparts.

In patients with established CHF, several studies have demonstrated the phenomenon of obesity paradox, the higher the BMI level the better the outcome.

An obesity paradox occurs in patients with lower exercise capacity of less than four metabolic equivalents of task, but not in those with higher exercise capacity of 4 METs or greater.

The obesity paradox is greatly influenced by physical activity and fitness because generally those with high physical activity and fitness have a good prognosis regardless of weight, whereas the leaner patients with cardiovascular disease and low physical activity/fitness have a particularly poor prognosis.

Other cardiovascular conditions including: coronary heart disease and atrial fibrillation are associated with the obesity paradox.

The obesity paradox has been demonstrated in patients with lung diseases, including COPD and pulmonary embolism, as well as in patients with against renal disease.

Overweight/normal waist circumference individuals have cardiovascular risk factors and a the high 10 year cardiovascular risk, but have a lower risk of all cause mortality mainly driven by the decrease in noncardiovascular mortality.

In patients with cardiovascular disease the obesity paradox disappeared when body fat is measured instead of BMI.

Higher body fat is associated with adverse cardiovascular events and on the contrary, higher fat free mass is associated with a lower risk of events.

Obese patients with heart failure have levels of BNP there are disproportionately lower then might be predicted from the elevation of left ventricular filling pressures.

NHANES III Compared with normal weight individuals without central obesity, as assessed by weight circumference, overweight individuals without central adiposity had a lower risk of mortality despite a high of burden of cardiovascular risk factors such as hypertension, diabetes, and hyper cholesterolemia, and a higher estimated 10 year atherosclerotic cardiovascular disease risk.

Several studies have reported that obese patients with cardiovascular disease, heart failure, atrial fibrillation, renal disease, COPD and pulmonary embolus have a better prognosis, this so-called obesity paradox.

Obesity paradox is a term for a medical hypothesis which holds that obesity and high cholesterol, may, counterintuitively, be protective and associated with greater survival in certain groups of people, such as very elderly individuals or those with certain chronic diseases.

It is postulated that normal to low body mass index or normal values of cholesterol may be detrimental and associated with higher mortality in asymptomatic people.

Metabolically healthy obese individuals are more active and spend less time being sedentary compared with those with metabolic rate unhealthy obesity.

Metabolically healthy obese individuals are still at increased risk for all-cause morbidity and mortality as well as cardiovascular disease morbidity and mortality compared with those classified as metabolically healthy normal weight.

It is a contradiction to concepts of prevention of atherosclerosis and cardiovascular disease.

The mechanism responsible for this reversed association is unknown, but it has been suggested that, in chronic kidney disease patients: may be explained by adipose tissue storing lipophilic chemicals that would otherwise be toxic to the body.

Patients with obesity have a paradoxical improved outcomes probably as a result of the adipose tumor microenvironment.

Patients with obesity have a paradoxical improved outcomes probably as a result of the adipose tumor microenvironment in renal cell cancer.

Described in overweight and obese people undergoing hemodialysis, heart failure, myocardial infarction, acute coronary syndrome, older nursing home residents, and chronic obstructive pulmonary disease (COPD).

In people with heart failure, those with a body mass index between 30.0–34.9 have a lower mortality than those with what would normally be considered an ideal weight.

The presence of the obesity paradox has been criticized on the grounds of being an artifact arising from biases in observational studies: smoking group, illness-induced weight loss population, inadequacy of BMI data.

And obesity paradox exists among patients with severe aortic stenosis undergoing TAVR.
The obesity paradox exists in improved oncological outcomes in patients with advanced cancer, despite the fact of metabolically healthy obese individuals have an increased risk of developing cancer.

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