nach oben

Current Obesity Reports

Erschienen in:

20.06.2020 | Metabolism (M Dalamaga, Section Editor)

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

verfasst von: Irene Karampela, Evangelia Chrysanthopoulou, Gerasimos Socrates Christodoulatos, Maria Dalamaga

Erschienen in: Current Obesity Reports | Ausgabe 3/2020

Einloggen, um Zugang zu erhalten

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.

Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66(Suppl 2):7–12. https://doi.org/10.1159/000375143.CrossRefPubMed

Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:766–81. https://doi.org/10.1016/s0140-6736(14)60460-8.CrossRefPubMedPubMedCentral

Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27. https://doi.org/10.1056/NEJMoa1614362.CrossRefPubMed

Chooi YC, Ding C, Magkos F. The epidemiology of obesity. Metabolism. 2019;92:6–10. https://doi.org/10.1016/j.metabol.2018.09.005.CrossRefPubMed

World Health Organization. Obesity and overweight fact sheet. In: WHO Media Centre. Cited February 16, 2018. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed November 25, 2019.

Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32:1431–7. https://doi.org/10.1038/ijo.2008.102.CrossRef

Dixon JB. The effect of obesity on health outcomes. Mol Cell Endocrinol. 2010;316:104–8. https://doi.org/10.1016/j.mce.2009.07.008.CrossRefPubMed

Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol. 2018;6:944–53. https://doi.org/10.1016/s2213-8587(18)30288-2.CrossRefPubMedPubMedCentral

Kim DD, Basu A. Estimating the medical care costs of obesity in the United States: systematic review, meta-analysis, and empirical analysis. Value Health. 2016;19:602–13. https://doi.org/10.1016/j.jval.2016.02.008.CrossRefPubMed

10.

Sakr Y, Alhussami I, Nanchal R, Wunderink RG, Pellis T, Wittebole X, et al. Being overweight is associated with greater survival in ICU patients: results from the intensive care over nations audit. Crit Care Med. 2015;43:2623–32. https://doi.org/10.1097/ccm.0000000000001310.CrossRefPubMed

11.

De Jong A, Verzilli D, Sebbane M, Monnin M, Belafia F, Cisse M, et al. Medical versus surgical ICU obese patient outcome: a propensity-matched analysis to resolve clinical trial controversies. Crit Care Med. 2018;46:e294–301. https://doi.org/10.1097/ccm.0000000000002954.CrossRefPubMed

12.

Schetz M, De Jong A, Deane AM, Druml W, Hemelaar P, Pelosi P, et al. Obesity in the critically ill: a narrative review. Intensive Care Med. 2019;45:757–69. https://doi.org/10.1007/s00134-019-05594-1.CrossRefPubMed

13.

Oliveros H, Villamor E. Obesity and mortality in critically ill adults: a systematic review and meta-analysis. Obesity (Silver Spring). 2008;16:515–21. https://doi.org/10.1038/oby.2007.102.CrossRef

14.

Hogue CW Jr, Stearns JD, Colantuoni E, Robinson KA, Stierer T, Mitter N, et al. The impact of obesity on outcomes after critical illness: a meta-analysis. Intensive Care Med. 2009;35:1152–70. https://doi.org/10.1007/s00134-009-1424-5.CrossRefPubMed

15.

•• Zhao Y, Li Z, Yang T, Wang M, Xi X. Is body mass index associated with outcomes of mechanically ventilated adult patients in intensive critical units? A systematic review and meta-analysis. PLoS One 2018;13:e0198669. Doi:https://doi.org/10.1371/journal.pone.0198669. This large meta-analysis of 23 studies from 4 continents and 199,421 critically ill patients receiving mechanical ventilation demonstrated that obese had lower ICU, hospital, short- and long-term mortality compared to non-obese, while obese and severely obese had lower hospital mortality compared to normal weight patients. It is the most recent meta-analysis that supports the obesity paradox in critically ill patients, despite showing that obesity is associated with longer duration of mechanical ventilation and ICU stay.

16.

• Karampela I, Christodoulatos GS, Dalamaga M. The role of adipose tissue and adipokines in sepsis: inflammatory and metabolic considerations, and the obesity paradox. Curr Obes Rep 2019;8:434-57. Doi:https://doi.org/10.1007/s13679-019-00360-2. This review highlights recent insights in the metabolic responses to sepsis and the obesity paradox and summarizes current evidence on the role of adipose tissue and adipokines in sepsis severity and outcome.

17.

Pepper DJ, Sun J, Welsh J, Cui X, Suffredini AF, Eichacker PQ. Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis. Crit Care. 2016;20:181. https://doi.org/10.1186/s13054-016-1360-z.CrossRefPubMedPubMedCentral

18.

• Ni YN, Luo J, Yu H, Wang YW, Hu YH, Liu D et al. Can body mass index predict clinical outcomes for patients with acute lung injury/acute respiratory distress syndrome? A meta-analysis. Crit Care 2017;21:36. Doi:https://doi.org/10.1186/s13054-017-1615-3. This meta-analysis exploring the association of BMI with outomes of adult patients with ARDS included 5 multicenter studies from the USA and found that obese and morbidly obese had lower mortality compared to normal weight patients.

19.

Carbone S, Canada JM, Billingsley HE, Siddiqui MS, Elagizi A, Lavie CJ. Obesity paradox in cardiovascular disease: where do we stand? Vasc Health Risk Manag. 2019;15:89–100. https://doi.org/10.2147/vhrm.s168946.CrossRefPubMedPubMedCentral

20.

De Schutter A, Lavie CJ, Milani RV. The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease-the obesity paradox. Prog Cardiovasc Dis. 2014;56:401–8. https://doi.org/10.1016/j.pcad.2013.08.003.CrossRefPubMed

21.

Vareldzis R, Naljayan M, Reisin E. The incidence and pathophysiology of the obesity paradox: should peritoneal dialysis and kidney transplant be offered to patients with obesity and end-stage renal disease? Curr Hypertens Rep. 2018;20:84. https://doi.org/10.1007/s11906-018-0882-y.CrossRefPubMedPubMedCentral

22.

Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: a meta-analysis. Crit Care Med. 2008;36:151–8. https://doi.org/10.1097/01.ccm.0000297885.60037.6e.CrossRefPubMed

23.

•• Wang S, Liu X, Chen Q, Liu C, Huang C, Fang X. The role of increased body mass index in outcomes of sepsis: a systematic review and meta-analysis. BMC Anesthesiol 2017;17:118. Doi:https://doi.org/10.1186/s12871-017-0405-4. This systematic review and meta-analysis pooled data from 8 studies and 9696 patients with sepsis and showed that overweight, but not obese and morbidly obese, had significantly lower mortality.

24.

Zhi G, Xin W, Ying W, Guohong X, Shuying L. “Obesity paradox” in acute respiratory distress syndrome: asystematic review and meta-analysis. PLoS One. 2016;11:e0163677. https://doi.org/10.1371/journal.pone.0163677.CrossRefPubMedPubMedCentral

25.

Liu T, Chen JJ, Bai XJ, Zheng GS, Gao W. The effect of obesity on outcomes in trauma patients: a meta-analysis. Injury. 2013;44:1145–52. https://doi.org/10.1016/j.injury.2012.10.038.CrossRefPubMed

26.

Harris K, Zhou J, Liu X, Hassan E, Badawi O. The obesity paradox is not observed in critically ill patients on early enteral nutrition. Crit Care Med. 2017;45:828–34. https://doi.org/10.1097/ccm.0000000000002326.CrossRefPubMed

27.

Mukhopadhyay A, Kowitlawakul Y, Henry J, Ong V, Leong CS, Tai BC. Higher BMI is associated with reduced mortality but longer hospital stays following ICU discharge in critically ill Asian patients. Clin Nutr ESPEN. 2018;28:165–70. https://doi.org/10.1016/j.clnesp.2018.08.009.CrossRefPubMed

28.

•• Acharya P, Upadhyay L, Qavi A, Naaraayan A, Jesmajian S, Acharya S et al. The paradox prevails: outcomes are better in critically ill obese patients regardless of the comorbidity burden. J Crit Care 2019;53:25–31. Doi:https://doi.org/10.1016/j.jcrc.2019.05.004. This is an interesting retrospective review of a large US single-center database of critically ill patients exploring the possibility that differences in the comorbidity burden might explain the obesity paradox in critical illness. The authors evaluated 30 comorbidities in a cohort of 11,433 ICU patients and found that, regardless of the comorbidity burden, overweight and obese had decreased risk for hospital and 30-day mortality compared to normal weight with a consistent trend towards lower mortality with higher BMI.

29.

•• Toft-Petersen AP, Wulff J, Harrison DA, Ostermann M, Margarson M, Rowan KM et al. Exploring the impact of using measured or estimated values for height and weight on the relationship between BMI and acute hospital mortality. J Crit Care 2018;44:196–202. Doi:https://doi.org/10.1016/j.jcrc.2017.11.021. This study of 690,405 critically ill patients in the UK addresses the methodological problem of whether estimated weight and height affects the association of BMI with mortality compared to measured values. The researchers report that this association was independent of measurement or estimation of weight and height and also demonstrated a J-shaped association of BMI with mortality with the “optimal” range well above the normal BMI values, in the obesity range, supporting the obesity-related survival benefit in critical illness.

30.

Kumar SI, Doo K, Sottilo-Brammeier J, Lane C, Liebler JM. Super obesity in the medical intensive care unit. J Intensive Care Med. 2018;885066618761363:478–84. https://doi.org/10.1177/0885066618761363.CrossRef

31.

• Li S, Hu X, Xu J, Huang F, Guo Z, Tong L et al. Increased body mass index linked to greater short- and long-term survival in sepsis patients: A retrospective analysis of a large clinical database. Int J Infect Dis 2019;87:109–16. Doi:https://doi.org/10.1016/j.ijid.2019.07.018. In this retrospective analysis from a US medical institution, overweight and obese critically ill patients with sepsis had lower 30-day and 1-year mortality, after adjustment for confounding factors, compared to normal weight patients.

32.

•• Pepper DJ, Demirkale CY, Sun J, Rhee C, Fram D, Eichacker P et al. Does obesity protect against death in sepsis? A retrospective cohort study of 55,038 adult patients. Crit Care Med 2019;47:643–50. Doi:https://doi.org/10.1097/ccm.0000000000003692. This retrospective study of a large clinical data repository of 139 US hospitals demonstrated that adult patients with sepsis and higher body mass indices had lower hospital mortality compared to normal weight patients, both in unadjusted and adjusted analyses.

33.

Gameiro J, Goncalves M, Pereira M, Rodrigues N, Godinho I, Neves M, et al. Obesity, acute kidney injury and mortality in patients with sepsis: a cohort analysis. Ren Fail. 2018;40:120–6. https://doi.org/10.1080/0886022x.2018.1430588.CrossRefPubMedPubMedCentral

34.

Druml W, Zajic P, Winnicki W, Fellinger T, Metnitz B, Metnitz P. Association of body mass index and outcome in acutely ill patients with chronic kidney disease requiring intensive care therapy. J Ren Nutr. 2019. https://doi.org/10.1053/j.jrn.2019.09.006.

35.

Galvagno SM Jr, Pelekhaty S, Cornachione CR, Deatrick KB, Mazzeffi MA, Scalea TM, et al. Does weight matter? Outcomes in adult patients on venovenous extracorporeal membrane oxygenation when stratified by obesity class. Anesth Analg. 2019. https://doi.org/10.1213/ane.0000000000004454.

36.

Ball IM, Bagshaw SM, Burns KE, Cook DJ, Day AG, Dodek PM, et al. Outcomes of elderly critically ill medical and surgical patients: a multicentre cohort study. Can J Anaesth. 2017;64:260–9. https://doi.org/10.1007/s12630-016-0798-4.CrossRefPubMed

37.

Benjamin ER, Dilektasli E, Haltmeier T, Beale E, Inaba K, Demetriades D. The effects of body mass index on complications and mortality after emergency abdominal operations: the obesity paradox. Am J Surg. 2017;214:899–903. https://doi.org/10.1016/j.amjsurg.2017.01.023.CrossRefPubMed

38.

Wacharasint P, Fuengfoo P, Rangsin R, Morakul S, Chittawattanarat K, Chaiwat O. Prevalence and impact of overweight and obesity in critically ill surgical patients: analysis of THAI-SICU study. J Med Assoc Thail. 2016;99(Suppl 6):S55–s62.

39.

Finkielman JD, Gajic O, Afessa B. Underweight is independently associated with mortality in post-operative and non-operative patients admitted to the intensive care unit: a retrospective study. BMC Emerg Med. 2004;4:3. https://doi.org/10.1186/1471-227x-4-3.CrossRefPubMedPubMedCentral

40.

Tafelski S, Yi H, Ismaeel F, Krannich A, Spies C, Nachtigall I. Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. J Infect Public Health. 2016;9:577–85. https://doi.org/10.1016/j.jiph.2015.12.003.CrossRefPubMed

41.

Nasraway SA Jr, Albert M, Donnelly AM, Ruthazer R, Shikora SA, Saltzman E. Morbid obesity is an independent determinant of death among surgical critically ill patients. Crit Care Med. 2006;34:964–70; quiz 71. https://doi.org/10.1097/01.ccm.0000205758.18891.70.CrossRefPubMed

42.

El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J. Morbid obesity in the medical ICU. Chest. 2001;120:1989–97. https://doi.org/10.1378/chest.120.6.1989.CrossRefPubMed

43.

Ray DE, Matchett SC, Baker K, Wasser T, Young MJ. The effect of body mass index on patient outcomes in a medical ICU. Chest. 2005;127:2125–31. https://doi.org/10.1378/chest.127.6.2125.CrossRefPubMed

44.

Cereda E, Klersy C, Hiesmayr M, Schindler K, Singer P, Laviano A, et al. Body mass index, age and in-hospital mortality: the NutritionDay multinational survey. Clin Nutr. 2017;36:839–47. https://doi.org/10.1016/j.clnu.2016.05.001.CrossRefPubMed

45.

Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Jama. 2013;309:71–82. https://doi.org/10.1001/jama.2012.113905.CrossRefPubMedPubMedCentral

46.

Barazzoni R, Sulz I, Schindler K, Bischoff SC, Gortan Cappellari G, Hiesmayr M. A negative impact of recent weight loss on in-hospital mortality is not modified by overweight and obesity. Clin Nutr. 2019. https://doi.org/10.1016/j.clnu.2019.11.007.

47.

Robinson MK, Mogensen KM, Casey JD, McKane CK, Moromizato T, Rawn JD, et al. The relationship among obesity, nutritional status, and mortality in the critically ill. Crit Care Med. 2015;43:87–100. https://doi.org/10.1097/ccm.0000000000000602.CrossRefPubMed

48.

Neeland IJ, Poirier P, Despres JP. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation. 2018;137:1391–406. https://doi.org/10.1161/circulationaha.117.029617.CrossRefPubMedPubMedCentral

49.

Antonopoulos AS, Tousoulis D. The molecular mechanisms of obesity paradox. Cardiovasc Res. 2017;113:1074–86. https://doi.org/10.1093/cvr/cvx106.CrossRefPubMed

50.

Dixon JB, Egger GJ, Finkelstein EA, Kral JG, Lambert GW. ‘Obesity paradox’ misunderstands the biology of optimal weight throughout the life cycle. Int J Obes. 2015;39:82–4. https://doi.org/10.1038/ijo.2014.59.CrossRef

51.

McGee DL. Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies. Ann Epidemiol. 2005;15:87–97. https://doi.org/10.1016/j.annepidem.2004.05.012.CrossRefPubMed

52.

Global BMIMC, Di Angelantonio E, Bhupathiraju Sh N, Wormser D, Gao P, Kaptoge S, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388:776–86. https://doi.org/10.1016/s0140-6736(16)30175-1.CrossRef

53.

Afzal S, Tybjaerg-Hansen A, Jensen GB, Nordestgaard BG. Change in body mass index associated with lowest mortality in Denmark, 1976-2013. Jama. 2016;315:1989–96. https://doi.org/10.1001/jama.2016.4666.CrossRefPubMed

54.

Kershaw EE, Flier JS. Adipose tissue as an endocrine organ. J Clin Endocrinol Metab. 2004;89:2548–56. https://doi.org/10.1210/jc.2004-0395.CrossRefPubMed

55.

Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol. 2011;11:85–97. https://doi.org/10.1038/nri2921.CrossRefPubMedPubMedCentral

56.

Oikonomou EK, Antoniades C. The role of adipose tissue in cardiovascular health and disease. Nat Rev Cardiol. 2019;16:83–99. https://doi.org/10.1038/s41569-018-0097-6.CrossRefPubMed

57.

Wang P, Mariman E, Renes J, Keijer J. The secretory function of adipocytes in the physiology of white adipose tissue. J Cell Physiol. 2008;216:3–13. https://doi.org/10.1002/jcp.21386.CrossRefPubMed

58.

Dalamaga M, Chou SH, Shields K, Papageorgiou P, Polyzos SA, Mantzoros CS. Leptin at the intersection of neuroendocrinology and metabolism: current evidence and therapeutic perspectives. Cell Metab. 2013;18:29–42. https://doi.org/10.1016/j.cmet.2013.05.010.CrossRefPubMed

59.

Pellegrinelli V, Carobbio S, Vidal-Puig A. Adipose tissue plasticity: how fat depots respond differently to pathophysiological cues. Diabetologia. 2016;59:1075–88. https://doi.org/10.1007/s00125-016-3933-4.CrossRefPubMedPubMedCentral

60.

Sun K, Tordjman J, Clement K, Scherer PE. Fibrosis and adipose tissue dysfunction. Cell Metab. 2013;18:470–7. https://doi.org/10.1016/j.cmet.2013.06.016.CrossRefPubMedPubMedCentral

61.

Koliaki C, Liatis S, Dalamaga M, Kokkinos A. Sarcopenic obesity: epidemiologic evidence, pathophysiology, and therapeutic perspectives. Curr Obes Rep. 2019;8:458–71. https://doi.org/10.1007/s13679-019-00359-9.CrossRefPubMed

62.

Vallianou N, Stratigou T, Christodoulatos GS, Dalamaga M. Understanding the role of the gut microbiome and microbial metabolites in obesity and obesity-associated metabolic disorders: current evidence and perspectives. Curr Obes Rep. 2019;8:317–32. https://doi.org/10.1007/s13679-019-00352-2.CrossRefPubMed

63.

Emfietzoglou R, Spyrou N, Mantzoros CS, Dalamaga M. Could the endocrine disruptor bisphenol-A be implicated in the pathogenesis of oral and oropharyngeal cancer? Metabolic considerations and future directions. Metabolism. 2019;91:61–9. https://doi.org/10.1016/j.metabol.2018.11.007.CrossRefPubMed

64.

Avgerinos KI, Spyrou N, Mantzoros CS, Dalamaga M. Obesity and cancer risk: emerging biological mechanisms and perspectives. Metabolism. 2019;92:121–35. https://doi.org/10.1016/j.metabol.2018.11.001.CrossRefPubMed

65.

Langouche L, Perre SV, Thiessen S, Gunst J, Hermans G, D'Hoore A, et al. Alterations in adipose tissue during critical illness: an adaptive and protective response? Am J Respir Crit Care Med. 2010;182:507–16. https://doi.org/10.1164/rccm.200909-1395OC.CrossRefPubMed

66.

Langouche L, Marques MB, Ingels C, Gunst J, Derde S, Vander Perre S, et al. Critical illness induces alternative activation of M2 macrophages in adipose tissue. Crit Care. 2011;15:R245. https://doi.org/10.1186/cc10503.CrossRefPubMedPubMedCentral

67.

Marques MB, Langouche L. Endocrine, metabolic, and morphologic alterations of adipose tissue during critical illness. Crit Care Med. 2013;41:317–25. https://doi.org/10.1097/CCM.0b013e318265f21c.CrossRefPubMed

68.

Gordon S, Martinez FO. Alternative activation of macrophages: mechanism and functions. Immunity. 2010;32:593–604. https://doi.org/10.1016/j.immuni.2010.05.007.CrossRefPubMed

69.

Mittwede PN, Clemmer JS, Bergin PF, Xiang L. Obesity and critical illness: insights from animal models. Shock 2016;45:349–358. Doi:https://doi.org/10.1097/shk.0000000000000512.

70.

Karampela I, Christodoulatos GS, Kandri E, Antonakos G, Vogiatzakis E, Dimopoulos G, et al. Circulating eNampt and resistin as a proinflammatory duet predicting independently mortality in critically ill patients with sepsis: a prospective observational study. Cytokine. 2019;119:62–70. https://doi.org/10.1016/j.cyto.2019.03.002.CrossRefPubMed

71.

Wacharasint P, Boyd JH, Russell JA, Walley KR. One size does not fit all in severe infection: obesity alters outcome, susceptibility, treatment, and inflammatory response. Crit Care. 2013;17:R122. https://doi.org/10.1186/cc12794.CrossRefPubMedPubMedCentral

72.

Stapleton RD, Dixon AE, Parsons PE, Ware LB, Suratt BT. The association between BMI and plasma cytokine levels in patients with acute lung injury. Chest. 2010;138:568–77. https://doi.org/10.1378/chest.10-0014.CrossRefPubMedPubMedCentral

73.

Maia LA, Cruz FF, de Oliveira MV, Samary CS, Fernandes MVS, Trivelin SAA, et al. Effects of obesity on pulmonary inflammation and remodeling in experimental moderate acute lung injury. Front Immunol. 2019;10:1215. https://doi.org/10.3389/fimmu.2019.01215.CrossRefPubMedPubMedCentral

74.

Bornstein SR, Licinio J, Tauchnitz R, Engelmann L, Negrao AB, Gold P, et al. Plasma leptin levels are increased in survivors of acute sepsis: associated loss of diurnal rhythm, in cortisol and leptin secretion. J Clin Endocrinol Metab. 1998;83:280–3. https://doi.org/10.1210/jcem.83.1.4610.CrossRefPubMed

75.

Torpy DJ, Bornstein SR, Chrousos GP. Leptin and interleukin-6 in sepsis. Horm Metab Res. 1998;30:726–9. https://doi.org/10.1055/s-2007-978967.CrossRefPubMed

76.

Grigoras I, Branisteanu DD, Ungureanu D, Rusu D, Ristescu I. Early dynamics of leptin plasma level in surgical critically ill patients. A prospective comparative study. Chirurgia (Bucur). 2014;109:66–72.

77.

Hillenbrand A, Xu P, Zhou S, Blatz A, Weiss M, Hafner S, et al. Circulating adipokine levels and prognostic value in septic patients. J Inflamm (Lond). 2016;13:30. https://doi.org/10.1186/s12950-016-0138-z.CrossRef

78.

Karampela I, Kandri E, Antonakos G, Vogiatzakis E, Christodoulatos GS, Nikolaidou A, et al. Kinetics of circulating fetuin-A may predict mortality independently from adiponectin, high molecular weight adiponectin and prognostic factors in critically ill patients with sepsis: a prospective study. J Crit Care. 2017;41:78–85. https://doi.org/10.1016/j.jcrc.2017.05.004.CrossRefPubMed

79.

Dalamaga M, Karampela I. Fetuin-A to adiponectin ratio is a promising prognostic biomarker in septic critically ill patients. J Crit Care. 2018;44:134–5. https://doi.org/10.1016/j.jcrc.2017.10.040.CrossRefPubMed

80.

Kordonowy LL, Burg E, Lenox CC, Gauthier LM, Petty JM, Antkowiak M, et al. Obesity is associated with neutrophil dysfunction and attenuation of murine acute lung injury. Am J Respir Cell Mol Biol. 2012;47:120–7. https://doi.org/10.1165/rcmb.2011-0334OC.CrossRefPubMedPubMedCentral

81.

Chien JY, Jerng JS, Yu CJ, Yang PC. Low serum level of high-density lipoprotein cholesterol is a poor prognostic factor for severe sepsis. Crit Care Med. 2005;33:1688–93. https://doi.org/10.1097/01.ccm.0000171183.79525.6b.CrossRefPubMed

82.

Li J, Papadopoulos V, Vihma V. Steroid biosynthesis in adipose tissue. Steroids. 2015;103:89–104. https://doi.org/10.1016/j.steroids.2015.03.016.CrossRefPubMed

83.

Kalupahana NS, Moustaid-Moussa N. The adipose tissue renin-angiotensin system and metabolic disorders: a review of molecular mechanisms. Crit Rev Biochem Mol Biol. 2012;47:379–90. https://doi.org/10.3109/10409238.2012.694843.CrossRefPubMed

84.

Yvan-Charvet L, Quignard-Boulange A. Role of adipose tissue renin-angiotensin system in metabolic and inflammatory diseases associated with obesity. Kidney Int. 2011;79:162–8. https://doi.org/10.1038/ki.2010.391.CrossRefPubMed

85.

Hastie CE, Padmanabhan S, Slack R, Pell AC, Oldroyd KG, Flapan AD, et al. Obesity paradox in a cohort of 4880 consecutive patients undergoing percutaneous coronary intervention. Eur Heart J. 2010;31:222–6. https://doi.org/10.1093/eurheartj/ehp317.CrossRefPubMed

86.

Goossens C, Marques MB, Derde S, Vander Perre S, Dufour T, Thiessen SE, et al. Premorbid obesity, but not nutrition, prevents critical illness-induced muscle wasting and weakness. J Cachexia Sarcopenia Muscle. 2017;8:89–101. https://doi.org/10.1002/jcsm.12131.CrossRefPubMed

87.

Derde S, Vanhorebeek I, Guiza F, Derese I, Gunst J, Fahrenkrog B, et al. Early parenteral nutrition evokes a phenotype of autophagy deficiency in liver and skeletal muscle of critically ill rabbits. Endocrinology. 2012;153:2267–76. https://doi.org/10.1210/en.2011-2068.CrossRefPubMed

88.

Vanhorebeek I, Van den Berghe G. Hormonal and metabolic strategies to attenuate catabolism in critically ill patients. Curr Opin Pharmacol. 2004;4:621–8. https://doi.org/10.1016/j.coph.2004.07.007.CrossRefPubMed

89.

Kiraly L, Hurt RT, Van Way CW, 3rd. The outcomes of obese patients in critical care. JPEN J Parenter Enteral Nutr 2011;35:29s–35s. Doi:https://doi.org/10.1177/0148607111413774.

90.

Flegal KM, Ioannidis JPA. The obesity paradox: a misleading term that should be abandoned. Obesity (Silver Spring). 2018;26:629–30. https://doi.org/10.1002/oby.22140.CrossRef

91.

Nie W, Zhang Y, Jee SH, Jung KJ, Li B, Xiu Q. Obesity survival paradox in pneumonia: a meta-analysis. BMC Med. 2014;12:61. https://doi.org/10.1186/1741-7015-12-61.CrossRefPubMedPubMedCentral

Titel: Is There an Obesity Paradox in Critical Illness? Epidemiologic and Metabolic Considerations
verfasst von: Irene Karampela
Evangelia Chrysanthopoulou
Gerasimos Socrates Christodoulatos
Maria Dalamaga
Publikationsdatum: 20.06.2020
Verlag: Springer US
Erschienen in: Current Obesity Reports / Ausgabe 3/2020
Elektronische ISSN: 2162-4968
DOI: https://doi.org/10.1007/s13679-020-00394-x

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Hodgkin Lymphom: BrECADD-Regime übertrifft die Erwartungen

05.06.2024 ASCO 2024 Kongressbericht

Das Kombinationsregime BrECADD mit Brentuximab vedotin ermöglichte in der Studie HD21 beim fortgeschrittenen klassischen Hodgkin-Lymphom eine unerwartet hohe progressionsfreie Überlebensrate von 94,3% nach vier Jahren. Gleichzeitig war das Regime besser tolerabel als der bisherige Standard eBEACOPP.

Antikörper-Drug-Konjugat verdoppelt PFS bei Multiplem Myelom

05.06.2024 ASCO 2024 Nachrichten

Zwei Phase-3-Studien deuten auf erhebliche Vorteile des Antikörper-Wirkstoff-Konjugats Belantamab-Mafodotin bei vorbehandelten Personen mit Multiplem Myelom: Im Vergleich mit einer Standard-Tripeltherapie wurde das progressionsfreie Überleben teilweise mehr als verdoppelt.

Neuer TKI gegen CML: Höhere Wirksamkeit, seltener Nebenwirkungen

05.06.2024 Chronische myeloische Leukämie Nachrichten

Der Tyrosinkinasehemmer (TKI) Asciminib ist älteren Vertretern dieser Gruppe bei CML offenbar überlegen: Personen mit frisch diagnostizierter CML entwickelten damit in einer Phase-3-Studie häufiger eine gut molekulare Response, aber seltener ernste Nebenwirkungen.

Hereditäres Angioödem: Tablette könnte Akuttherapie erleichtern

05.06.2024 Hereditäres Angioödem Nachrichten

Medikamente zur Bedarfstherapie bei hereditärem Angioödem sind bisher nur als Injektionen und Infusionen verfügbar. Der Arzneistoff Sebetralstat kann oral verabreicht werden und liefert vielversprechende Daten.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Abstract

Purpose of Review

Recent Findings

Summary

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 3/2020

Review of the Experience of Weight-Based Stigmatization in Romantic Relationships

Health-Related Quality of Life in Bariatric and Metabolic Surgery

Polycystic ovary Syndrome in Adolescents: Pitfalls in Diagnosis and Management

Outcomes in Bariatric and Metabolic Surgery: an Updated 5-Year Review

Omics Biomarkers in Obesity: Novel Etiological Insights and Targets for Precision Prevention