[The obesity paradox].

Area of Science:

• Cardiology
• Obesity Research
• Public Health

Context:

• Cardiovascular (CV) mortality generally rises with obesity severity, measured by body mass index (BMI).
• A contrasting trend, the "obesity paradox," is observed in patients with existing coronary diseases or heart failure.
• This paradox shows reduced global mortality in older adults (over 65) with moderate obesity (BMI 30-35) compared to normal weight (BMI 20-25) and morbidly obese (BMI > 35) individuals.

Purpose:

• To investigate the "obesity paradox" in cardiovascular patient cohorts.
• To explore potential reasons for the observed mortality differences in relation to obesity levels.
• To highlight the limitations of Body Mass Index (BMI) in assessing cardiovascular risk.

Summary:

• In older patients with heart failure or coronary disease, moderate obesity (BMI 30-35) is linked to lower mortality than normal weight or severe obesity.
• This phenomenon may stem from the healthier metabolic profiles and lifestyles of the moderately obese individuals studied.
• Body Mass Index (BMI) is insufficient for evaluating abdominal obesity, a key factor in metabolic syndrome and CV risk, as it doesn't differentiate fat mass from lean mass.

Impact:

• Challenges the universal association between obesity and increased mortality, particularly in specific patient populations.
• Underscores the need for nuanced understanding of obesity's role in cardiovascular health beyond simple BMI categorization.
• Suggests further research into the interplay of body composition, metabolic health, lifestyle, and outcomes in obese cardiovascular patients.