Obesity Paradox in Chronic Liver Diseases: Product of Bias or a Real Thing? - PubMed (original) (raw)

Review

Obesity Paradox in Chronic Liver Diseases: Product of Bias or a Real Thing?

Ines Bilic Curcic et al. J Clin Transl Hepatol. 2019.

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: Chronic liver disease; Cirrhosis; NAFLD; NASH; Obesity paradox.

© 2019 Authors.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1.

Fig. 1.. Schematic presentation of obesity as a risk factor for chronic liver diseases, such as NASH and NAFLD.

The latter are denoted by blue arrows (increasing impact). This risk factor could also have beneficial effects (denoted by red arrows; decreasing impact) on liver disease-associated mortality, which might be hampered when associated with sarcopenia, due to impact of sarcopenia on malnutrition and weight loss. Abbreviations: NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis.

References

    1. Lonardo A, Bellentani S, Argo CK, Ballestri S, Byrne CD, Caldwell SH, et al. Epidemiological modifiers of non-alcoholic fatty liver disease: Focus on high-risk groups. Dig Liver Dis. 2015;47:997–1006. doi: 10.1016/j.dld.2015.08.004. - DOI - PubMed
    1. de Herder WW, Eng C. Obesity, diabetes mellitus, and cancer. Endocr Relat Cancer. 2012;19:E5–E7. doi: 10.1530/ERC-12-0264. - DOI - PubMed
    1. Niedziela J, Hudzik B, Niedziela N, Gąsior M, Gierlotka M, Wasilewski J, et al. The obesity paradox in acute coronary syndrome: a meta-analysis. Eur J Epidemiol. 2014;29:801–812. doi: 10.1007/s10654-014-9961-9. - DOI - PMC - PubMed
    1. Oreopoulos A, Padwal R, Norris CM, Mullen JC, Pretorius V, Kalantar-Zadeh K. Effect of obesity on short- and long-term mortality postcoronary revascularization: a meta-analysis. Obesity (Silver Spring) 2008;16:442–450. doi: 10.1038/oby.2007.36. - DOI - PubMed
    1. Romero-Corral A, Montori VM, Somers VK, Korinek J, Thomas RJ, Allison TG, et al. Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: a systematic review of cohort studies. Lancet. 2006;368:666–678. doi: 10.1016/S0140-6736(06)69251-9. - DOI - PubMed

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