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More fuel in the obesity paradox debate

International Journal of Obesity volume 37, page 320 (2013)Cite this article

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We enjoyed reading the paper by Kolade et al.1 on the association of body size indices with central blood pressure and arterial stiffness in healthy individuals and populations with cardiovascular and kidney disease. We congratulate the authors for the meticulous selection of study population subgroups and their excellent work, which demonstrated that although body mass index (BMI) was clearly correlated with central systolic blood pressure (SBP) in apparently healthy individuals, this association was not observed in the subgroups with established vascular disease. What is more, none of the examined body size measures was able to predict arterial stiffness in the healthy control subgroup with relevant data after correcting for brachial BP.

In our opinion, these results may actually add another stone in the pathophysiological foundation of the so-named obesity paradox. Although increased BMI represents a well-acknowledged cardiovascular risk factor aggravating mortality risk in the general population, consistent findings among specific population subgroups with various manifestations of established vascular disease, including those examined in the present study (coronary heart disease, type 2 diabetes mellitus, chronic kidney disease, heart failure, hypertension, peripheral artery disease), support a protective role of overweight towards mortality. Interestingly, a similar role has also been reported in divergent healthier populations.2 Of note, a recent study on a nationally representative sample demonstrated that being overweight and underweight was associated with a decreased and increased risk for all-cause mortality, respectively.3 With the association between BMI and cardiovascular mortality being eliminated after adjustment for several traditional cardiovascular risk factors, it has been suggested that a substantial part of the BMI-associated risk of cardiovascular mortality is mediated through conventional risk factors.4

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References

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Authors and Affiliations

  1. 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece

    P Anyfanti, M Doumas, E Gavriilaki, A Triantafyllou & B Nikolaidou

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  1. P Anyfanti
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  2. M Doumas
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  3. E Gavriilaki
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  4. A Triantafyllou
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  5. B Nikolaidou
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Correspondence to P Anyfanti.

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Anyfanti, P., Doumas, M., Gavriilaki, E. et al. More fuel in the obesity paradox debate. Int J Obes 37, 320 (2013). https://doi.org/10.1038/ijo.2012.43

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