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Obesity paradox in patients with cardiovascular diseases and diabetes mellitus type 2 (analytical review)

https://doi.org/10.47470/0044-197X-2021-65-2-135-142

Abstract

Obesity and overweight are severe problems in modern life. Research, clinical guidelines, and reviews present obesity as an adverse prognostic factor for cardiovascular disease and diabetes. However, there is growing evidence that an increased body mass index can be a prognostically favorable factor for some conditions. A lot of such works are related to diseases for which increased body weight is the most significant risk factor. This phenomenon has been called the “obesity paradox”. Although many studies show this paradox, there are no specific pathogenic mechanisms that could confirm this phenomenon. The research leaves more questions than answers. This review contains their analysis in the following nosologies: arterial hypertension, coronary artery disease, heart failure, diabetes mellitus type 2. The objectives of this study are to identify problems with existing research and find ways to explain the obesity paradox. A literature search was carried out on the databases of PubМed. To assess the problems of modern research, clinical studies were analyzed. To find the causes of this paradox, literature reviews were examined. The obesity paradox has been confirmed in heart failure.

About the Authors

Margarita P. Zaikina
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation

Student of “The International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, 119991, Russian Federation.

e-mail: zaikina.rita@gmail.com



Valentina A. Kapustina
I.M. Sechenov First Moscow State Medical University (Sechenov University)
Russian Federation


Stanislav I. Savel'ev
The Center of Hygiene and Epidemiology in Lipetsk region
Russian Federation


References

1. WHO. Obesity and overweight. Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

2. Pi-Sunyer X. The medical risks of obesity. Postgrad. Med. 2009; 121(6): 21–33. https://doi.org/10.3810/pgm.2009.11.2074

3. Seidell J.C. Time trends in obesity: an epidemiological perspective. Horm. Metab. Res. 1997; 29(4): 155–8. https://doi.org/10.1055/s-2007-979011

4. Ozhegov S.I., Shvedova N.Yu. Explanatory Dictionary of the Russian Language: 80,000 Words and Phraseological Expressions [Tolkovyy slovar’ russkogo yazyka: 80 000 slov i frazeologicheskikh vyrazheniy]. Moscow; 1997. (in Russian)

5. Preston S.H., Vierboom Y.C., Stokes A. The role of obesity in exceptionally slow US mortality improvement. Proc. Natl Acad. Sci. USA. 2018; 115(5): 957–61. https://doi.org/10.1073/pnas.1716802115

6. The WHO MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) Project. Available at: https://thl.fi/monica/

7. Horwich T.B., Fonarow G.C., Hamilton M.A., MacLellan W.R., Woo M.A., Tillisch J.H. The relationship between obesity and mortality in patients with heart failure. J. Am. Coll. Cardiol. 2001; 38(3): 789–95. https://doi.org/10.1016/S0735-1097(01)01448-6

8. Fonarow G.C., Srikanthan P., Costanzo M.R., Cintron G.B., Lopatin M. ADHERE Scientific Advisory Committee and Investigators. An obesity paradox in acute heart failure: analysis of body mass index and inhospital mortality for 108,927 patients in the Acute Decompensated Heart Failure National Registry. Am. Heart J. 2007; 153(1): 74–81. https://doi.org/10.1016/j.ahj.2006.09.007

9. Karrowni W., Kennedy K., Jones P., Valle J., Abdallah M., Daugherty S., et al. Obesity paradox among survivors of acute myocardial infarction and its interaction with time. J. Am. Coll. Cardiol. 2015; 65(10): A31. https://doi.org/10.1016/S0735-1097(15)60031-6

10. Che L., Xu L., Wang M.Y., Huang Y.G. Obesity paradox among elderly patients with coronary artery disease undergoing non-cardiac surgery. J. Geriatr. Cardiol. 2018; 15(9): 598–604. https://doi.org/10.11909/j.issn.1671-5411.2018.09.004

11. Han S.J., Boyko E.J. The evidence for an obesity paradox in type 2 diabetes mellitus. Diabetes Metab. J. 2018; 42(3):179–87. https://doi.org/10.4093/dmj.2018.0055

12. Ivanov G.G., Syrkin A.L., Dvornikov V.E., Nikolaev D.V., Ostapchenko D.A., Kotlyarova L.V., et al. Multi-frequency segmental bioimpedance analysis in assessing changes in the volume of water sectors of the body. Rossiyskiy zhurnal anesteziologii i intensivnoy terapii. 1999; (2): 41–7. (in Russian)

13. Zoppini G., Verlato G., Leuzinger C., Zamboni C., Brun E., Bonora E., et al. Body mass index and the risk of mortality in type II diabetic patients from Verona. Int. J. Obes. Relat. Metab. Disord. 2003; 27(2): 281–5. https://doi.org/10.1038/sj.ijo.802199

14. Lopez J.C., Montesinos R., Velazquez C., Gonzalez-Barranco J. Short stature is related to high body fat composition despite body mass index in a Mexican population. Arch. Med. Res. 2003; 34(2): 137–40. https://doi.org/10.1016/S0188-4409(03)00002-X

15. Affuso O., Pradhan L., Zhang C., Gao S., Wiener H.W., Gower B., et al. A method for measuring human body composition using digital images. PLoS ONE. 2018; 13(11): e0206430. https://doi.org/10.1371/journal.pone.0206430

16. Rusakova D.S., Shcherbakova M.Yu., Gapparova K.M., Zaynudinov Z.M., Tkachev S.I., Sakharovskaya V.G. Modern evaluating methods of the body. Eksperimental’naya i klinicheskaya gastroenterologiya. 2012; (8): 71–81. (in Russian)

17. Zhernakova Yu.V., Zheleznova E.A., Chazova I.E., Oshchepkova E.V., Dolgusheva Yu.A., Yarovaya E.B., et al. The prevalence of abdominal obesity and the association with socioeconomic status in regions of the Russian Federation, the results of the epidemiological study – ESSE-RF. Terapevticheskiy arkhiv. 2018; 90(10): 14–22. https://doi.org/10.26442/terarkh201890104-22 (in Russian)

18. Antonopoulos A.S., Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc. Res. 2017; 113(9): 1074–86. https://doi.org/10.1093/cvr/cvx106

19. Menchine M.D., Arora S., Camargo C.A., Ginde A.A. Prevalence of undiagnosed and suboptimally controlled diabetes by point-of-care HbA1C in unselected emergency department patients. Acad. Emerg. Med. 2011; 18(3): 326–9. https://doi.org/10.1111/j.1553-2712.2011.01014.x

20. Patel N., Elsaid O., Shenoy A., Sharma A., McFarlane S.I. Obesity paradox in patients undergoing coronary intervention: A review. World J. Cardiol. 2017; 9(9): 731–6. https://doi.org/10.4330/wjc.v9.i9.731

21. Azhari Z., Ismail M.D., Zuhdi A.S.M., Md Sari N., Zainal Abidin I., Wan Ahmad W.A. Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population: a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. BMJ Open. 2017; 7(11): e017794 https://doi.org/10.1136/bmjopen-2017-017794

22. Preston S.H., Stokes A. Obesity paradox: conditioning on disease enhances biases in estimating the mortality risks of obesity. Epidemiology. 2014; 25(3): 454–61. https://doi.org/10.1097/EDE.0000000000000075

23. Williams B., Mancia G., Spiering W., Agabiti Rosei E., Azizi M., Burnier M., et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018; 39(33): 3021–104. https://doi.org/10.1093/eurheartj/ehy339

24. Hall J.E., do Carmo J.M., da Silva A.A., Wang Z., Hall M.E. Obesity-induced hypertension: interaction of neurohumoral and renal mechanisms. Circ. Res. 2015; 116(6): 991–1006. https://doi.org/10.1161/CIRCRESAHA.116.305697

25. Aneja A., El-Atat F., McFarlane S.I., Sowers J.R. Hypertension and obesity. Recent Prog. Horm. Res. 2004; 59: 169–205. https://doi.org/10.1210/rp.59.1.169

26. Farre N., Aranyo J., Enjuanes C., Verdu-Rotellar J.M., Ruiz S., Gonzalez-Robledo G., et al. Differences in neurohormonal activity partially explain the obesity paradox in patients with heart failure: The role of sympathetic activation. Int. J. Cardiol. 2015; 181: 120–6. https://doi.org/10.1016/j.ijcard.2014.12.025

27. Uretsky S., Messerli F.H., Bangalore S., Champion A., Cooper-Dehoff R.M., Zhou Q., et al. Obesity paradox in patients with hypertention and coronary artery disease. Am. J. Med. 2007; 120(10): 863–70. https://doi.org/10.1016/j.amjmed.2007.05.011

28. Thomsen M., Nordestgaard B.G. Myocardial infarction and ischemic heart disease in overweight and obesity with and without metabolic syndrome. JAMA Intern. Med. 2014; 174(1): 15–22. https://doi.org/10.1001/jamainternmed.2013.10522

29. Shvarts V. Inflammation of adipose tissue. Part 3. Pathogenetic role in the development of atherosclerosis. Problemy endokrinologii. 2009; 55(6): 40–5. https://doi.org/10.14341/probl200955640-45 (in Russian)

30. Kim B.G., Hong S.J., Kim B.K., Ahn C.M., Shin D.H., Kim J.S., et al. Association between body mass index and clinical outcomes after new-generation drug-eluting stent implantation: Korean multi-center registry data. Atherosclerosis. 2018; 277: 155–62. https://doi.org/10.1016/j.atherosclerosis.2018.08.047

31. Oreopoulos A., Padwal R., Kalantar-Zadeh K., Fonarow G.C., Norris C.M., McAlister F.A. Body mass index and mortality in heart failure: a meta-analysis. Am. Heart J. 2008; 156(1): 13–22. https://doi.org/10.1016/j.ahj.2008.02.014

32. Fonarow G.C., Chelimsky-Fallick C., Stevenson L.W., Luu M., Hamilton M.A., Moriguchi J.D., et al. Effect of direct vasodilation with hydralazine versus angiotensin-converting enzyme inhibition with captopril on mortality in advanced heart failure: The HyC trial. J. Am. Coll. Cardiol. 1992; 19(4): 842–50. https://doi.org/10.1016/0735-1097(92)90529-V

33. Shamliyan T., Talley K.M., Ramakrishnan R., Kane R.L. Association of frailty with survival: A systematic literature review. Ageing Res. Rev. 2013; 12(2): 719–36. https://doi.org/10.1016/j.arr.2012.03.001

34. Carnethon M.R., De Chavez P.J., Biggs M.L., Lewis C.E., Pankow J.S., Bertoni A.G., et al. Association of weight status with mortality in adults with incident diabetes. JAMA. 2012; 308(6): 581–90. https://doi.org/10.1001/jama.2012.9282

35. Sluik D., Boeing H., Montonen J., Pischon T., Kaaks R., Teucher B., et al. Associations between general and abdominal adiposity and mortality in individuals with diabetes mellitus. Am. J. Epidemiol. 2011; 174(1): 22–34. https://doi.org/10.1093/aje/kwr048

36. Rydén L., Grant P.J., Anker S.D., Berne C., Cosentino F., Danchin N., et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Russian Journal of Cardiology. 2014; (3): 7–61. https://doi.org/10.15829/1560-4071-2014-3-7-61 (In Russian)

37. Shal’nova S.A., Deev A.D. Body mass in men and women: the Russian national representative sample data. Kardiovaskulyarnaya terapiya i profilaktika. 2008; 7(6): 60–3. (in Russian)

38. Borracci R.A., Ingino C.A., Miranda J.M. Association of body mass index with short-term outcomes after cardiac surgery: retrospective study and meta-analysis. Medicina (B Aires). 2018; 78(3): 171–9.

39. Ostrovskaya E.V., Romantsova T.I., Gerasimov A.N., Novoselova T.E. The prevalence of metabolically healthy obesity according to the sample of the Moscow region. Ozhirenie i metabolizm. 2017; 14(4): 51–6. https://doi.org/10.14341/OMET2017451-56 (in Russian)


Review

For citations:


Zaikina M.P., Kapustina V.A., Savel'ev S.I. Obesity paradox in patients with cardiovascular diseases and diabetes mellitus type 2 (analytical review). Health care of the Russian Federation. 2021;65(2):135-142. (In Russ.) https://doi.org/10.47470/0044-197X-2021-65-2-135-142

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