Redefining metabolic syndrome as a fat storage condition based on studies of comparative physiology

Johnson, Richard J.; Stenvinkel, Peter; Martin, Sandra L.; Jani, Alkesh; Sánchez‐Lozada, Laura G.; Hill, James O.; Lanaspa, Miguel A.

doi:10.1002/oby.20026

Cited by 59 publications

(41 citation statements)

References 75 publications

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“…From an evolutionary perspective, predisposition to insulin resistance and fat mass accumulation constitute a survival advantage during periods of external stress, such as infectious complications and shortage of food. 35 However, because an increase in BMI may also reflect more lean body mass, the association between increased BMI and better outcome does not necessarily imply that fat mass is protective. The resilient protection of a high BMI is confined to long-term dialysis patients with indices of normal or high muscle mass.…”

Section: Discussionmentioning

confidence: 99%

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Stenvinkel

Gillespie

Tunks

et al. 2015

JASN

Self Cite

100

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High body mass index (BMI) is paradoxically associated with better outcome in hemodialysis (HD) patients. Persistent inflammation commonly features in clinical conditions where the obesity paradox is described. We examined the relationship between BMI and mortality in HD patients, accounting for inflammation, in a historic cohort study of 5904 incident HD patients enrolled in 2007-2009 (312 facilities; 15 European countries) with $3 months of follow-up. Patients were classified by presence (n=3231) or absence (n=2673) of inflammation (C-reactive protein $10 mg/l and/or albumin #35 g/l). Patients were divided into quintiles by 21.5,and .29.8 kg/m 2 , respectively). Noninflamed patients in BMI Q5 formed the reference group. During a median follow-up period of 36.7 months, 1929 deaths occurred (822 cardiovascular), with 655 patients censored for renal transplantation and 1183 for loss to follow-up. Greater mortality was observed in inflamed patients (P,0.001). In fully adjusted time-dependent analyses, the all-cause mortality risk in noninflamed patients was higher only in the lowest BMI quintile (hazard ratio [HR, 1.80 . Thus, whereas a protective effect of high BMI was observed in inflamed patients, this effect was mitigated in noninflamed patients.

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Section: Discussionmentioning

confidence: 99%

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Stenvinkel

Gillespie

Tunks

et al. 2015

JASN

Self Cite

100

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“…More energy-dense food with high glycemic index and the introduction of high-fructose corn syrup in soft drinks may have contributed to not only the obesity plague but also, the increased prevalence of type 2 diabetes, hypertension, gout, and CKD. 30 Other intriguing hypotheses of causes of the obesity epidemic include mutation of the uricase gene, 31 microRNAs, 32 adenovirus infection, 33 altered gut microbiota, 34 psychosocial stress, 35 and neurocognitive factors. 36 …”

Section: Mechanisms Of Obesity: Why Do We Get Fat?mentioning

confidence: 99%

Obesity in CKD—What Should Nephrologists Know?

Stenvinkel

Zoccali

İkizler

2013

Journal of the American Society of Nephrology

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200

172

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Obesity, the epidemic of the 21st century, carries a markedly increased risk for comorbid complications, such as type 2 diabetes, cancer, hypertension, dyslipidemia, cardiovascular disease, and sleep apnea. In addition, obesity increases the risk for CKD and its progression to ESRD. Paradoxically, even morbid obesity associates with better outcomes in studies of ESRD patients on maintenance dialysis. Because the number of obese CKD and maintenance dialysis patients is projected to increase markedly in developed as well as low-and middle-income countries, obesity is a rapidly emerging problem for the international renal community. Targeting the obesity epidemic represents an unprecedented opportunity for health officials to ameliorate the current worldwide increase in CKD prevalence. Nephrologists need more information about assessing and managing obesity in the setting of CKD. Specifically, more precise estimation of regional fat distribution and the amount of muscle mass should be introduced into regular clinical practice to complement more commonly used practical markers, such as body mass index. Studies examining the effects of obesity on kidney disease progression and other clinical outcomes along with weight management strategies are much needed in this orphan area of research. 24: 172724: -173624: , 201324: . doi: 10.1681 Obesity has emerged as the largest pandemic in near history, with important implications of not only cardiovascular disease (CVD) but also CKD. Recent data from the United States indicate that the incidence and prevalence rates of obesity in maintenance dialysis patients largely exceed the corresponding figures in the general population. 1 A large European population survey documented that a high body mass index (BMI) ranks as one of the strongest risk factors for new-onset CKD. 2 The dimension of the obesity epidemic and the impact of the same epidemic on the kidney demand efforts for understanding the epidemiology and the mechanisms of CKD associated with excess adiposity. It also sets as an absolute public health priority for the development of treatment policies integrated across specialties and general practice to halt this much concerning problem. In this scenario, it is fundamental that nephrologists are updated on current knowledge about obesity in the setting of CKD. However, little attention is still paid to this issue in major nephrology journals. The suboptimal attention to the problem by major sources of dissemination of specialty information suggests that nephrologists may have scarce knowledge of how obesity should be assessed, its epidemiology, mechanisms whereby excess fat mass is conducive to CKD, and management of obesity in the catabolic uremic milieu. 3 J Am Soc Nephrol DEFINITION AND ASSESSMENT OF OBESITYThe most common method for defining obesity is based on BMI (i.e., a person's weight as obese. It should be emphasized that population norms of BMI could be different based on ethnic and racial background (i.e., the proportion of Asian people with a high ...

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“…Retaining the bank account analogy, body fat is rather like a savings account. During periods when food is abundantly available, animals can deposit energy into this savings account so that it is available for periods in the future when demand will exceed supply (34). There are clear limits in the utility of this method, and in many circumstances storing energy external to the body may be a much better option since the amount that can be stored is much greater.…”

Section: Long-term Regulation Of Energy Balance and Fat Storagementioning

confidence: 99%

If Body Fatness is Under Physiological Regulation, Then How Come We Have an Obesity Epidemic?

Speakman

2014

Physiology

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Life involves a continuous use of energy, but food intake, which supplies that energy, is episodic. Feeding is switched on and off by a complex array of predominantly gut-derived peptides (and potentially nutrients) that initiate and terminate feeding bouts. Energy is stored as glucose and glycogen to overcome the problem of the episodic nature of intake compared with the continuous demand. Intake is also adjusted to meet immediate changes in demands. Most animals also store energy as fat. In some cases, this serves the purpose of storing energy in anticipation of a known future shortfall (e.g., hibernation, migration, or reproduction). Other animals, however, store fat in the absence of such anticipated needs, and in this case the fat appears to be stored in preparation for unpredictable catastrophic shortfalls in supply. Fat storage, however, brings disadvantages as well as advantages, in particular an increased risk of predation. Hence, many animals seem to have evolved a dual intervention point system preventing them from storing too little or too much fat. The physiological basis of the lower intervention point is well established, but the upper intervention point is much less studied. Human obesity can potentially be understood in an evolutionary context as due to drift in the upper intervention point following release from predation 2 million years ago (the drifty gene hypothesis) combined with a stimulus in modern society to overconsume calories, possibly attempting to satisfy intake of a limiting microor macro-nutrient like protein (the protein leverage hypothesis).

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Redefining metabolic syndrome as a fat storage condition based on studies of comparative physiology

Cited by 59 publications

References 75 publications

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Inflammation Modifies the Paradoxical Association between Body Mass Index and Mortality in Hemodialysis Patients

Obesity in CKD—What Should Nephrologists Know?

If Body Fatness is Under Physiological Regulation, Then How Come We Have an Obesity Epidemic?

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