Obesity Paradox in Chronic Liver Diseases: Product of Bias or a Real Thing?
Open Access
- 28 September 2019
- journal article
- review article
- Published by Xia & He Publishing in Journal of Clinical and Translational Hepatology
- Vol. 7 (3), 1-5
- https://doi.org/10.14218/jcth.2019.00029
Abstract
In recent years, evidence supporting the theory of obesity paradox has increased, showing that obese/overweight people with prevalent chronic diseases experience lower mortality compared with patients of normal weight. So far, evidence is most comprehensive in cardiovascular and chronic renal diseases; however, published studies are prone to many biases, enabling us to reach a definite conclusion. Available data in chronic liver disease is scarce and ambiguous. Obesity is traditionally associated with nonalcoholic fatty liver disease and steatosis in viral hepatitis and as such one would not expect the obesity paradox to be a real possibility in liver disease. Yet, there seem to be new data indicating the opposite – the obesity paradox exists in severe and end-stage liver cirrhosis, which could be attributed to a better lean mass in patients with higher body mass index, meaning that sarcopenia, as one of the most important prognostic factors of survival, is less likely to be present. Nonetheless, the problem of various methodological problems addressing the association between body weight and mortality, which is present both in liver disease and other chronic diseases, are preventing us from attaining an unanimous conclusion. Still, we should be aware that the obesity paradox might be true, especially in severe and end-stage illness. This suggests focusing our efforts toward preserving or building up fat-free mass and decreasing inflammatory activity responsible for catabolism and sarcopenia, and implying that the underlaying cause should be treated.Keywords
This publication has 45 references indexed in Scilit:
- Obesity and nonalcoholic fatty liver disease: current perspectivesDiabetes, Metabolic Syndrome and Obesity, 2018
- Sarcopenia and Sarcopenic Obesity Are Prognostic Factors for Overall Survival in Patients with CirrhosisInternal Medicine, 2016
- The Safety and Benefit of Statins in Liver Cirrhosis: a ReviewExperimental and Clinical Endocrinology & Diabetes, 2015
- Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD scoreWorld Journal of Gastroenterology, 2015
- The obesity paradox in acute coronary syndrome: a meta-analysisEuropean Journal of Epidemiology, 2014
- The obesity paradox in elderly patients with heart failure: Analysis of nutritional statusNutrition, 2012
- Weight-Related Effects on Disease Progression in the Hepatitis C Antiviral Long-Term Treatment Against Cirrhosis TrialGastroenterology, 2009
- Rheumatoid cachexia, central obesity and malnutrition in patients with low-active rheumatoid arthritis: feasibility of anthropometry, Mini Nutritional Assessment and body composition techniquesEuropean Journal of Nutrition, 2009
- Effect of Obesity on Short‐ and Long‐term Mortality Postcoronary Revascularization: A Meta‐analysisObesity, 2008
- Prevalence of Type 2 Diabetes Mellitus among Persons with Hepatitis C Virus Infection in the United StatesAnnals of Internal Medicine, 2000