Blog - INTERNET MÉDICA

¨Paradoxo da Obesidade¨ (Obesity Paradox)

Por Paulo Leite 27/10/2022

– A obesidade nos últimos anos tornou-se uma epidemia.

– Um alto índice de massa corporal (IMC) é um dos indicadores de saúde da população mais importantes da atualidade. O IMC não quantifica diretamente a gordura corporal, mas se correlaciona bem com medições mais fáceis de gordura corporal.

– Assim como o tabagismo, a obesidade afeta vários sistemas orgânicos e é um importante fator de risco modificável para inúmeras doenças.

– Apesar dessas consequências negativas, alguns estudos descobriram que a obesidade melhora o prognóstico de doenças crônicas, incluindo insuficiência cardíaca crônica (ICC) e DPOC, fenômeno conhecido como “paradoxo da obesidade”.

– Tal como está, duas teorias explicam esse paradoxo. A hipótese da massa muscular afirma que pacientes obesos são mais bem adaptados à maré por meio de exacerbações agudas devido ao aumento da reserva devido à maior massa muscular. A outra teoria se concentra no tecido adiposo marrom e seus efeitos anti-inflamatórios no corpo.

– Atualmente várias pesquisas já publicadas analisaram as diferenças no risco de mortalidade por COVID-19 nas categorias de IMC. Seu foco principal está relacionado ao “paradoxo da obesidade”.

A obesidade está associada a um risco aumentado de doença cardiovascular (DCV) e outros resultados adversos à saúde. Em pacientes com insuficiência cardíaca pré-existente ou doença coronariana, indivíduos obesos têm prognóstico mais favorável em comparação com indivíduos com peso normal. Essa relação paradoxal entre obesidade e DCV tem sido chamada de “paradoxo da obesidade”.

– Esse fenômeno também foi observado em pacientes com outras condições cardiovasculares e doenças dos sistemas respiratório e renal.

– Levando em consideração a relação bem estabelecida entre osteoartrite (OA) e DCV, evidências emergentes mostram que indivíduos com sobrepeso e obesos submetidos à artroplastia total de quadril ou joelho para OA têm menor risco de mortalidade em comparação com indivíduos com peso normal, sugerindo um paradoxo da obesidade.

■ The obesity paradox in chronic heart disease and chronic obstructive pulmonar disease

Suganya Giri Ravindran, Debistuti Saha, Iffat Iqbal et al

Cureus. 2022 Jun; 14(6): e25674

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9259072/

■ Body mass index, muscle mass, and all-cause mortality in patients with acute heart failure: the obesity paradox revisited

In-Chang Hwang, Hong-Mi Choi, Yeonyee E. Yoon et al

Int J Heart Fail. 2022 Apr; 4(2): 95–109.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9383349/

■ High percent body fat mass predicts lower risk of cardiac events in patients with heart failure: an explanation of the obesity paradox

Katsuhiko Ohori, Toshiyuki Yano, Satoshi Katano, et al

BMC Geriatr. 2021; 21: 16

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789382/

■ The impact of underweight and obesity on outcomes in anticoagulated patients with atrial fibrillation: a systematic review and meta-analysis on the obesity paradox

Maxim Grymonprez, Andreas Capiau, Tine L. De Backer et al

Clin Cardiol. 2021 May; 44(5): 599–608

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8119828/

■ O paradoxo da obesidade na insuficiência cardíaca depende da aptidão cardiorrespiratória com fração de ejeção reduzida

R I Moreira, T P Silva, A V Gonçalves et al

Arq Bras Cardiol 2020, vol 115 (4)

https://www.scielo.br/j/abc/a/PLVzBtmdkk3HKFyLJpGqK9k/?lang=pt (portuguese)

https://www.scielo.br/j/abc/a/PLVzBtmdkk3HKFyLJpGqK9k/?lang=en (english)

■ O paradoxo da obesidade na insuficiência cardíaca depende da aptidão cardiorrespiratória?

J A Laukkanen, S K Kunutsor

Arq Bras Cardiol 2020, vol 115 (4)

https://www.scielo.br/j/abc/a/wjk7QHKStwMZjhR6TvtsZNn/?lang=en

■ Obesity paradox of all-cause mortality in 4,133 patientes treated with coronary revascularization

Chengzhuo Li, Didi Han, Fengshuo Xu, et al

J Interv Cardiol. 2021; 2021: 3867735

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8616700/

■ Obesity and stroke: Does the paradox apply for stroke?

Gabriel A Quiñones-Ossa, Carolina Lobo, Ezequiel Garcia-Ballestas et al

Neurointervention. 2021 Mar; 16(1): 9–19

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946563/

■ Obesity and mortality after the first ischemic stroke: Is obesity paradox real?

Durgesh Chaudhary, Ayesha Khan, Mudit Gupta et al

PLoS One. 2021; 16(2): e0246877

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875337/

■ Vascular regenerative capacity and the obesity paradox in coronary artery disease

Anurag Mehta, Qi Meng, Xiaona Li, et al

Arterioscler Thromb Vasc Biol. 2021 Jun; 41(6): 2097–2108.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8147702/

■ A targeted proteomics investigations of the obesity paradox in venous thromboembolism

Vincent Ten Cate, Thomas Koeck, Jürgen Prochaska et al

Blood Adv. 2021 Jul 27; 5(14): 2909–2918

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341360/

■ The impact of obesity on the outcome of severe sARS-CoV-2 ARDS in a high volume ECMO centre: ECMO and corticosteroids support the obesity paradox

Balik, E. Svobodova, M. Porizka, M. Maly, P. Brestovansky, et al

J Crit Care. 2022 Dec; 72: 154162

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9547545/

■ Body mass index and clinical outcome of severe COVID-19 patients with acute hypoxic respiratory failure: unravelling the ¨obesity paradox¨ phenomenon

Michael Jennings, Maria Burova, Laura G. Hamilton et al

the REACT COVID-19 Investigators

Clin Nutr ESPEN. 2022 Oct; 51: 377–384

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9356629/

■ Does there exist an obesity paradox in COVID-19? Insights of the international HOPE-COVID-19-registry

Mohammad Abumayyaleh, Iván J. Núñez Gil, Ibrahim El-Battrawy, et al

on behalf of HOPE COVID-19 investigators

Obes Res Clin Pract. 2021 May-June; 15(3): 275–280

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927637/

■ Obesity impact on SARS-CoV-2 infection: pros and cons ¨Obesity Paradox¨ – a systematic review

Damiana-Maria Vulturar, Carmen-Bianca Crivii, Olga Hilda Orăsan et al

J Clin Med. 2022 Jul; 11(13): 3844

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9267674/

■ Malnutrition outweights the effect of the obesity paradox

Suriya Prausmüller, Gregor Heitzinger, Noemi Pavo et al

J Cachexia Sarcopenia Muscle. 2022 Jun; 13(3): 1477–1486

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9178364/

■ Paradoxical obesity and overweight disparities among sexual minority men: a meta-analysis

Humberto López Castillo, Christopher W. Blackwell, Eric W. Schrimshaw

Am J Mens Health. 2022 Mar-Apr; 16(2): 15579883221095387

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067055/

■ Exploring the impact of the obesity paradox on lung cancre and other malignancies

Lindsay Joyce Nitsche, Sarbajit Mukherjee, Kareena Cheruvu, et al

Cancers (Basel) 2022 Mar; 14(6): 1440

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946288/

■ The obesity paradox and mortality after pathological hip fractures: a Swedish registry study

Jessica EHNE, Panagiotis TSAGOZIS, Anja LIND et al

Acta Orthop. 2022; 93: 185–189.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8788673/

■ Survival bias may explain the appearance of the obesity paradox in hip fracture patients

R.M. Amin, M. Raad, S.S. Rao, F. Musharbash, M.J. Best, D.F. Amanatullah

Osteoporos Int. 2021 Dec; 32(12): 2555–2562

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8819709/

■ Obesity paradox in joint replacement for osteoarthritis – thruth or paradox?

Setor K. Kunutsor, Michael R. Whitehouse, Ashley W. Blom

GeroScience. 2022 Apr; 44(2): 651–659.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8396800/

■ The effect of body mass index on the developmento of acute kidney injury and mortality in intensive care unit: is obesity paradox valid?

Mehmet Süleyman Sabaz, Sinan Aşar, Gökhan Sertçakacılar et al

Ren Fail. 2021; 43(1): 543–555

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993374/

■ Obesity paradox in ICU? A topic of discussion, not a key issue!

Gérard Audibert, Aurélie Bannay, Olivier Ziegler

Int J Obes (Lond) 2022; 46(6): 1248–124

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866110/

■ ¨Obesity Paradox¨ in acute respiratory distress syndrome patients undergoing cardiac surgery: a retrospective study

Yan Liu, Man Song, Lixue Huang, Guangfa Zhu

Med Sci Monit. 2021; 27: e931808-1–e931808-13

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8404469/

■ The obesity paradox and hypoglycemia in critically ill patients

Drago Plečko, Nicolas Bennett, Johan Mårtensson, Rinaldo Bellomo

Crit Care. 2021; 25: 378.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559391/

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■ Médico Responsável: Dr Paulo Fernando Leite

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Belo Horizonte/MG/Brasil

Email: pfleite1873@gmail.com

Outubro 2022

Exercício & Obesidade: Artigos de Revisão (Exercise & Obesity: Reviews II)

Por Paulo Leite 27/10/2022

■ Review of the role of interleukin-6 in obesity and physical exercise

B O Arantes, R Q Alcântara, L L Borges et al

Brasília Med 2022, vol 59 (Anual): 1-8

https://www.rbm.org.br/details/393/en-US/review-of-the-role-of-interleukin-6-in-obesity-and-physical-exercise

■ Effect of physical training in obese patients with low back pain: a systematic review

R R da Silva Júnior, V I O Rodrigues, C F M de Carvalho et al

Coluna 2022, vol 21 (3)

https://www.scielo.br/j/coluna/a/p9LMDqrgYtp4j5JrLrzDRhQ/?lang=en

■ Effect of aerobic exercise on waist circumference in adults with overweight or obesity: a systematic review and meta-analysis

Alex Armstrong, Klaus Jungbluth Rodriguez, Angelo Sabag, et al

Obes Rev. 2022 Aug; 23(8): e13446

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9540641/

■ Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: a systematic review and meta-analysis

Pedro Lopez, Dennis R. Taaffe, Daniel A. Galvão et al

Obes Rev. 2022 May; 23(5): e13428

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9285060/

■ Effects of exercise training on obesity-related parameters in people with intelectual disabilities: systematic review and meta-analysis

Salse‐Batán, M. A. Sanchez‐Lastra, D. Suárez‐Iglesias, C. Ayán Pérez

J Intellect Disabil Res. 2022 May; 66(5): 413–441

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314046/

■ Body composition and bone health status of Jockeys: current findings, assessment methods and classification criteria

A Dunne, G Warrington, A McGoldrick et al

Sports Med Open 2022, vol 8: 23

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8844321/

■ Use of physical activity and exercise to reduce inflammation in children and adolescentes with obesity

Valeria Calcaterra, Matteo Vandoni, Virginia Rossi, et al

Int J Environ Res Public Health. 2022 Jun; 19(11): 6908

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9180584/

■ Benefits of exercise in multidisciplinar treatment of binge eating disorder in adolescentes with obesity

Hellas Cena, Matteo Vandoni, Vittoria Carlotta Magenes et al

Int J Environ Res Public Health. 2022 Jul; 19(14): 8300

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9315465/

■ Internationl Society of sports nutrition position stand: tactical athlete nutrition

Drew E. Gonzalez, Matthew J. McAllister, Hunter S. Waldman et al

J Int Soc Sports Nutr. 2022; 19(1): 267–315

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9261739/

■ Physiological responses to combat sports in metabolic diseases: a systematic review

Max Lennart Eckstein, Melanie Schwarzinger, Sandra Haupt,et al

J Clin Med. 2022 Feb; 11(4): 107

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8878771/

■ Nutritional ergogenic resource in sport: lights and shadows on their use

A B Balko, C F C Palavissini et al

Research, Society and Development 2022, vol 11 (1)

https://rsdjournal.org/index.php/rsd/article/view/25056/22000

■ Obesidade no Blog Internet Médica (Obesity on Blog Internet Médica)

Arquivos Blog Internet Médica – agosto 2022

https://internetmedica.com.br/obesidade-no-blog-internet-medica-obesity/