An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases

Elagizi, Andrew; Kachur, Sergey; Lavie, Carl J.; Carbone, Salvatore; Pandey, Ambarish; Ortega, Francisco B.; Milani, Richard V.

doi:10.1016/j.pcad.2018.07.003

Cited by 559 publications

(477 citation statements)

References 110 publications

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“…37 The Authors found that genetically determined hepatic fat accumulation is associated to insulin resistance The less robust evidence of a causal relationship between NAFLD and CVD, compared to T2DM, could suggest that the constellation of the metabolic disturbances related to insulin resistance are more strongly related to T2DM than CVD, while other factors, such as smoking and cardiorespiratory fitness, might be more relevant than insulin resistance in determining CVD risk. 41,42 In line with this hypothesis, the relationship between body mass index (which is a good epidemiological surrogate of insulin resistance) and risk of CVD death is non-linear, both in subjects with and without T2DM. 43,44 Moreover, dietary interventions aiming at reducing body weight have been recently shown to induce remission of T2DM while so far there is no clear experimental evidence of a reduced risk of CVD following weight loss interventions.…”

Section: Discussionmentioning

confidence: 87%

“…The less robust evidence of a causal relationship between NAFLD and CVD, compared to T2DM, could suggest that the constellation of the metabolic disturbances related to insulin resistance are more strongly related to T2DM than CVD, while other factors, such as smoking and cardiorespiratory fitness, might be more relevant than insulin resistance in determining CVD risk . In line with this hypothesis, the relationship between body mass index (which is a good epidemiological surrogate of insulin resistance) and risk of CVD death is non‐linear, both in subjects with and without T2DM .…”

Section: Discussionmentioning

confidence: 99%

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Causality between non‐alcoholic fatty liver disease and risk of cardiovascular disease and type 2 diabetes: A meta‐analysis with bias analysis

Morrison

Zaccardi

Khunti

et al. 2018

Liver International

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Background & Aims A causal association of non‐alcoholic fatty liver disease (NAFLD) with cardiovascular disease (CVD) and type 2 diabetes (T2DM) remains unproved. We aimed to quantify the likelihood of causality examining the sensitivity of observational associations to possible confounding. Methods Studies investigating longitudinal associations of NAFLD with CVD or T2DM were searched on 5 June 2018. Study‐specific relative risks (RRs) were combined in random‐effects meta‐analyses and pooled estimates used in bias analyses. Results Associations of NAFLD with CVD and T2DM were reported in 13 (258 743/18 383 participants/events) and 20 (240 251/12 891) studies respectively. Comparing patients with NAFLD to those without, the pooled RR was 1.48 (95% CI: 0.96, 2.29) for CVD and 2.17 (1.77, 2.65) for T2DM. In bias analyses, for an unmeasured confounder associated to both NAFLD and CVD with a RR of 1.25, the proportion of studies with a true (causal) effect of NAFLD on CVD surpassing a RR of 1.10 (ie, 10% increased risk of CVD in participants with NAFLD) was 0.67 (95% CI: 0.42, 0.92) while for 75% increase, it was 0.36 (0.11, 0.62). Corresponding figures for T2DM were 0.97 (0.91, 1.00) for a 10% increased risk of T2DM in participants with NAFLD to 0.70 (0.49, 0.92) for a 75% increase. Conclusions The results of this study are strongly suggestive for a causal relationship between NAFLD and T2DM, while the evidence for a causal link between NAFLD and CVD is less robust. Therapeutic strategies targeting NAFLD are likely to reduce the risk of developing T2DM.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Causality between non‐alcoholic fatty liver disease and risk of cardiovascular disease and type 2 diabetes: A meta‐analysis with bias analysis

Morrison

Zaccardi

Khunti

et al. 2018

Liver International

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“…We observed that being overweight or obese was associated with reduced risk for P&I hospitalization among short-stay residents. This may reflect the obesity paradox [37]; however, the underlying mechanism for this likely non-linear relationship remains unclear and has been reported for pneumonia in reduction of mortality rather than hospitalization [38].…”

Section: Discussionmentioning

confidence: 96%

Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

et al. 2020

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Background: Older adults who reside in long-term care facilities (LTCFs) are at particularly high risk for infection, morbidity and mortality from pneumonia and influenza (P&I) compared to individuals of younger age and those living outside institutional settings. The risk factors for P&I hospitalizations that are specific to LTCFs remain poorly understood. Our objective was to evaluate the incidence of P&I hospitalization and associated person-and facility-level factors among post-acute (short-stay) and long-term (long-stay) care residents residing in LTCFs from 2013 to 2015. Methods: In this retrospective cohort study, we used Medicare administrative claims linked to Minimum Data Set and LTCF-level data to identify short-stay (< 100 days, index = admission date) and long-stay (100+ days, index = day 100) residents who were followed from the index date until the first of hospitalization, LTCF discharge, Medicare disenrollment, or death. We measured incidence rates (IRs) for P&I hospitalization per 100, 000 person-days, and estimated associations with baseline demographics, geriatric syndromes, clinical characteristics, and medication use using Cox regression models.Results: We analyzed data from 1,118,054 short-stay and 593,443 long-stay residents. The crude 30-day IRs (95% CI) of hospitalizations with P&I in the principal position were 26.0 (25.4, 26.6) and 34.5 (33.6, 35.4) among short-and long-stay residents, respectively. The variables associated with P&I varied between short and long-stay residents, and common risk factors included: advanced age (85+ years), admission from an acute hospital, select cardiovascular and respiratory conditions, impaired functional status, and receipt of antibiotics or Beers criteria medications. Facility staffing and care quality measures were important risk factors among long-stay residents but not in short-stay residents.Conclusions: Short-stay residents had lower crude 30-and 90-day incidence rates of P&I hospitalizations than long-stay LTCF residents. Differences in risk factors for P&I between short-and long-stay populations suggest the importance of considering distinct profiles of post-acute and long-term care residents in infection prevention and control strategies in LTCFs. These findings can help clinicians target interventions to subgroups of LTCF residents at highest P&I risk.

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“…The prevalence of overweight and obesity has dramatically increased over the last decades, being currently a worldwide public health problem . Although obesity is multifactorial, its etiology is mainly based on a chronic imbalance between energy intake and energy expenditure.…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of overweight and obesity has dramatically increased over the last decades, being currently a worldwide public health problem. 1,2 Although obesity is multifactorial, its etiology is mainly based on a chronic imbalance between energy intake and energy expenditure. This chronic imbalance is not always due to hyperphagia since a high proportion of overweight individuals present a low metabolic rate, low rates of fat oxidation, an impaired sympathetic nervous activity, and metabolic inflexibility.…”

Section: Introductionmentioning

confidence: 99%

Assessment of maximal fat oxidation during exercise: A systematic review

Amaro-Gahete

Sánchez-Delgado

Jurado‐Fasoli

et al. 2019

Scandinavian Med Sci Sports

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Maximal fat oxidation during exercise (MFO) and the exercise intensity eliciting MFO (Fatmax) are considered biological markers of metabolic health and performance. A wide range of studies have been performed to increase our knowledge about their regulation by exercise and/or nutritional intervention. However, numerous data collection and analysis approaches have been applied, which may have affected the MFO and Fatmax estimation. We aimed to systematically review the available studies describing and/or comparing different data collection and analysis approach factors that could affect MFO and Fatmax estimation in healthy individuals and patients. Two independent researchers performed the search. We included all original studies in which MFO and/or Fatmax were estimated by indirect calorimetry through an incremental graded exercise protocol published from 2002 to 2019. This systematic review provides key information about the factors that could affect MFO and Fatmax estimation: ergometer type, metabolic cart used, warm‐up duration and intensity, stage duration and intensities imposed in the graded exercise protocol, time interval selected for data analysis, stoichiometric equation selected to estimate fat oxidation, data analysis approach, time of the day when the test was performed, fasting time/previous meal before the test, and testing days for MFO/Fatmax and maximal oxygen uptake assessment. We suggest that researchers measuring MFO and Fatmax should take into account these key methodological issues that can considerably affect the accuracy, validity, and reliability of the measurement. Likewise, when comparing different studies, it is important to check whether the above‐mentioned key methodological issues are similar in such studies to avoid ambiguous and unacceptable comparisons.

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An Overview and Update on Obesity and the Obesity Paradox in Cardiovascular Diseases

Cited by 559 publications

References 110 publications

Causality between non‐alcoholic fatty liver disease and risk of cardiovascular disease and type 2 diabetes: A meta‐analysis with bias analysis

Causality between non‐alcoholic fatty liver disease and risk of cardiovascular disease and type 2 diabetes: A meta‐analysis with bias analysis

Risk factors for pneumonia and influenza hospitalizations in long-term care facility residents: a retrospective cohort study

Assessment of maximal fat oxidation during exercise: A systematic review

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