lunes, 10 de septiembre de 2012

Does obesity make it better or worse: insights into cardiovascular illnesses

Does obesity make it better or worse: insights into cardiovascular illnesses

Does obesity make it better or worse: insights into cardiovascular illnesses

  1. Stefan D. Anker1,4
+ Author Affiliations
  1. 1Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
  2. 2Center for Cardiovascular Research (CCR), Charité Medical School, Campus Mitte, Berlin, Germany
  3. 3Thermo Scientific Biomarkers, Thermo Fisher Scientific/BRAHMS GmbH, Hennigsdorf, Germany
  4. 4Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy
  1. *Corresponding author. Applied Cachexia Research, Department of Cardiology, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany. Tel: +49 30 450 553506, Fax: +49 30 450 553951, Email: stephan.von.haehling@web.de
This editorial refers to ‘Evidence for obesity paradox in patients with acute coronary syndromes. A report from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR)’, by O. Angerås et al., doi:10.1093/eurheartj/ehs217 and ‘The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness’, by F.B. Ortega et al., doi:10.1093/eurheartj/ehs174
Oodles of studies have been published with regards to the obesity paradox in chronic disease. Still, researchers remain confused, clinicians unconvinced, and Joe Bloggs does not want to be overweight anyway—mostly because over the last three decades he has been exposed to diverse forms of education saying that ‘obesity makes you ill and kills you’. In the words of the Roman philosopher Seneca (4 BC–65 AD): ‘Every man prefers belief to the exercise of judgement’.1 Since public belief prefers being slim to being overweight or obese, the prevailing wisdom holds that being slim must be generally good for you. In addition, numerous studies have shown that overweight and obesity confer disadvantages, as their presence is associated with the development of cardiovascular disease, diabetes mellitus, and several other metabolic perturbations. Thus, obesity must be bad.
The question that has arisen over the last 13 years is whether this concept is true, irrespective of a given individual's circumstances. The original description of the obesity paradox was published in 1999 using data from >1300 patients with chronic kidney disease undergoing haemodialysis.2 The authors of that study concluded that ‘nutrition aimed to achieve the high end of normal body mass index (BMI) may help to reduce the high mortality and morbidity in hemodialysis patients’. This conclusion extrapolated far beyond the data obtained in the study, because nutritional intake was not even analysed; however, it paved the way for a vast array of similar studies in patients with chronic obstructive pulmonary disease, …

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