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      The obesity paradox in chronic disease: facts and numbers

      editorial

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          Abstract

          Body size, particularly large, is a matter of concern among the lay public. Whether this is justified depends upon the state of health and should be judged individually. For patients with established chronic disease, there is sufficient evidence to support the benefits of large body size, i.e., the obesity paradox. This uniform finding is shared over a variety of cardiovascular, pulmonary, and renal diseases and is counterintuitive to the current concepts on ideal body weight. The scientific community has to increase the awareness about differences for optimal body size in health and disease. Simultaneously, clinicians have to be aware about body weight dynamics implications and should interpret the changes in the context of an underlying disease in order to implement the best available management.

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          Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old.

          Kenneth F Adams, Arthur Schatzkin, Tamara Harris … (2006)
          Obesity, defined by a body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) of 30.0 or more, is associated with an increased risk of death, but the relation between overweight (a BMI of 25.0 to 29.9) and the risk of death has been questioned. We prospectively examined BMI in relation to the risk of death from any cause in 527,265 U.S. men and women in the National Institutes of Health-AARP cohort who were 50 to 71 years old at enrollment in 1995-1996. BMI was calculated from self-reported weight and height. Relative risks and 95 percent confidence intervals were adjusted for age, race or ethnic group, level of education, smoking status, physical activity, and alcohol intake. We also conducted alternative analyses to address potential biases related to preexisting chronic disease and smoking status. During a maximum follow-up of 10 years through 2005, 61,317 participants (42,173 men and 19,144 women) died. Initial analyses showed an increased risk of death for the highest and lowest categories of BMI among both men and women, in all racial or ethnic groups, and at all ages. When the analysis was restricted to healthy people who had never smoked, the risk of death was associated with both overweight and obesity among men and women. In analyses of BMI during midlife (age of 50 years) among those who had never smoked, the associations became stronger, with the risk of death increasing by 20 to 40 percent among overweight persons and by two to at least three times among obese persons; the risk of death among underweight persons was attenuated. Excess body weight during midlife, including overweight, is associated with an increased risk of death. Copyright 2006 Massachusetts Medical Society.
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            The obesity paradox: body mass index and outcomes in patients with heart failure.

            Mikhail Kosiborod, Thomas P Curtis, Yongfei Wang … (2005)
            In the general population, obesity is associated with increased risk of adverse outcomes. However, studies of patients with chronic disease suggest that overweight and obese patients may paradoxically have better outcomes than lean patients. We sought to examine the association of body mass index (BMI) and outcomes in stable outpatients with heart failure (HF). We analyzed data from 7767 patients with stable HF enrolled in the Digitalis Investigation Group trial. Patients were categorized using baseline BMI (calculated as weight in kilograms divided by the square of height in meters) as underweight (BMI or =30.0). Risks associated with BMI groups were evaluated using multivariable Cox proportional hazards models over a mean follow-up of 37 months. Crude all-cause mortality rates decreased in a near linear fashion across successively higher BMI groups, from 45.0% in the underweight group to 28.4% in the obese group (P for trend <.001). After multivariable adjustment, overweight and obese patients were at lower risk for death (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.80-0.96, and HR, 0.81; 95% CI, 0.72-0.92, respectively), compared with patients at a healthy weight (referent). In contrast, underweight patients with stable HF were at increased risk for death (HR 1.21; 95% CI, 0.95-1.53). In a cohort of outpatients with established HF, higher BMIs were associated with lower mortality risks; overweight and obese patients had lower risk of death compared with those at a healthy weight. Understanding the mechanisms and impact of the "obesity paradox" in patients with HF is necessary before recommendations are made concerning weight and weight control in this population.
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              Adolphe Quetelet (1796-1874)--the average man and indices of obesity.

              Garabed Eknoyan (2008)
              The quest for a practical index of relative body weight that began shortly after actuaries reported the increased mortality of their overweight policyholders culminated after World War II, when the relationship between weight and cardiovascular disease became the subject of epidemiological studies. It became evident then that the best index was the ratio of the weight in kilograms divided by the square of the height in meters, or the Quetelet Index described in 1832. Adolphe Quetelet (1796-1874) was a Belgian mathematician, astronomer and statistician, who developed a passionate interest in probability calculus that he applied to study human physical characteristics and social aptitudes. His pioneering cross-sectional studies of human growth led him to conclude that other than the spurts of growth after birth and during puberty, 'the weight increases as the square of the height', known as the Quetelet Index until it was termed the Body Mass Index in 1972 by Ancel Keys (1904-2004). For his application of comparative statistics to social conditions and moral issues, Quetelet is considered a founder of the social sciences. His principal work, 'A Treatise of Man and the development of his faculties' published in 1835 is considered 'one of the greatest books of the 19th century'. A tireless promoter of statistical data collection based on standard methods and definitions, Quetelet organized in 1853 the first International Statistical Congress, which launched the development of 'a uniform nomenclature of the causes of death applicable to all countries', progenitor of the current International Classification of Diseases.
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                Author and article information

                Contributors
                : +386-31-379533 , +386-4-2569117 , mitja.lainscak@guest.arnes.si
                Journal
                Journal ID (nlm-ta): J Cachexia Sarcopenia Muscle
                Journal ID (iso-abbrev): J Cachexia Sarcopenia Muscle
                Title: Journal of Cachexia, Sarcopenia and Muscle
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 2190-5991
                ISSN (Electronic): 2190-6009
                Publication date (Electronic): 14 March 2012
                Publication date PMC-release: 14 March 2012
                Publication date (Print): March 2012
                Volume: 3
                Issue: 1
                Pages: 1-4
                Affiliations
                [1 ]Division of Cardiology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik 36, SI-4204 Golnik, Slovenia
                [2 ]Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
                [3 ]Center for Cardiovascular Research (CCR), Charité Medical School, Campus Mitte, Berlin, Germany
                [4 ]Center for Stroke Research, Berlin, Charite Medical School, Berlin, Germany
                [5 ]Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
                Article
                Publisher ID: 59
                DOI: 10.1007/s13539-012-0059-5
                PMC ID: 3302984
                PubMed ID: 22450395
                SO-VID: 764bf853-b686-4a53-b623-cede14bb90e6
                Copyright © © The Author(s) 2012
                History
                Date received : 13 February 2012
                Date accepted : 14 February 2012
                Categories
                Subject: Editorial
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2012

                ScienceOpen disciplines: Orthopedics
                Data availability:
                ScienceOpen disciplines: Orthopedics

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