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Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations

Current Obesity Reports volume 9, pages 231–244 (2020)Cite this article

Abstract

Purpose of Review

Obesity represents a global epidemic with serious implications in public health due to its increasing prevalence and its known association with a high morbidity and mortality burden. However, a growing number of data support a survival benefit of obesity in critical illness. This review summarizes current evidence regarding the obesity paradox in critical illness, discusses methodological issues and metabolic implications, and presents potential pathophysiologic mechanisms.

Recent Findings

Data from meta-analyses and recent studies corroborate the obesity-related survival benefit in critically ill patients as well as in selected populations such as patients with sepsis and acute respiratory distress syndrome, but not trauma. However, this finding warrants a cautious interpretation due to certain methodological limitations of these studies, such as the retrospective design, possible selection bias, the use of BMI as an obesity index, and inadequate adjustment for confounding variables. Main pathophysiologic mechanisms related to obesity that could explain this phenomenon include higher energy reserves, inflammatory preconditioning, anti-inflammatory immune profile, endotoxin neutralization, adrenal steroid synthesis, renin-angiotensin system activation, cardioprotective metabolic effects, and prevention of muscle wasting.

Summary

The survival benefit of obesity in critical illness is supported from large meta-analyses and recent studies. Due to important methodological limitations, more prospective studies are needed to further elucidate this finding, while future research should focus on the pathophysiologic role of adipose tissue in critical illness.

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Authors and Affiliations

  1. Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St, Haidari, 12462, Athens, Greece

    Irene Karampela & Evangelia Chrysanthopoulou

  2. Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527, Athens, Greece

    Irene Karampela, Gerasimos Socrates Christodoulatos & Maria Dalamaga

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  1. Irene Karampela
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  2. Evangelia Chrysanthopoulou
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  3. Gerasimos Socrates Christodoulatos
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  4. Maria Dalamaga
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Correspondence to Irene Karampela.

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Irene Karampela, Evangelia Chrysanthopoulou, Gerasimos Socrates Christodoulatos, and Maria Dalamaga declare that they have no conflict of interest.

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Karampela, I., Chrysanthopoulou, E., Christodoulatos, G.S. et al. Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations. Curr Obes Rep 9, 231–244 (2020). https://doi.org/10.1007/s13679-020-00394-x

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  • DOI: https://doi.org/10.1007/s13679-020-00394-x

Keywords

  • Body mass index
  • Critically ill
  • Mortality
  • Obese
  • Obesity paradox
  • Overweight
  • Sepsis
  • Survival

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