Reconciling the obesity paradox: Obese patients suffer the highest critical illness associated mortality rates [Scholarly Article - Journal of Critical Care, 2021]

Title:

Reconciling the obesity paradox: Obese patients suffer the highest critical illness associated mortality rates 

 

Authors:

Kevin B. Laupland MD, PhD, FRCPC, FCICM ab

Felicity Edwards BHlthSc b

Mahesh Ramana nMBBS, FCICM cd

Kiran Shekar MBBS, FCICM, FCCCM, PhD ce

Alexis Tabah MD, FCICM cf 

 

a Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia 

b Queensland University of Technology (QUT), Brisbane, Queensland, Australia 

c Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia 

d Intensive Care Unit, Caboolture Hospital, Caboolture, Queensland, Australia 

e Intensive Care Unit, The Prince Charles Hospital, Brisbane, Queensland, Australia 

f Intensive Care Unit, Redcliffe Hospital, Redcliffe, Queensland, Australia

 

Published:

Journal of Critical Care, 27 August 2021

https://www.sciencedirect.com/science/article/abs/pii/S0883944121001775?via%3Dihub

 

Abstract:

The obesity paradox refers to the observation that obese patients admitted to intensive care units (ICU) have lower case fatality as compared to healthy weight patients. However, selection bias could explain the apparent paradox. Our objective was to assess whether obese people have a different overall burden of critical illness associated mortality. A retrospective population-based cohort study was conducted in North Brisbane ICUs during 2017–2019. Patients were classified as underweight, healthy weight, overweight, and obese according to BMIs <18.5, 18.5–24.9, 25–29.9, and ≥ 30 kg/m2, respectively. ICU admission incidence rates were 245.6, 138.2, 178.9, and 421.9 per 100,000 population; 90-day all cause case fatalities were 24.0%, 17.0%, 18.1%, and 16.0%; and critical illness associated mortality rates were 58.8, 23.4, 32.4, and 67.7 per 100,000 population among underweight, healthy weight, overweight, and obese patients, respectively. As compared to patients of healthy weight, those who were underweight (relative risk; RR 2.51; 95% CI, 1.79–3.44), overweight (RR 1.38; 95% CI, 1.16–1.65), and obese (RR 2.89; 2.43–3.43) were each at significantly higher risk for critical illness associated mortality. While obese patients have lower case fatality they are at much higher risk for ICU admission and as result suffer the highest burden of critical illness associated mortality in our region.

 

The obesity wars and the education of a researcher: A personal account [Scholarly Article - progress in Cardiovascular Diseases, June 2021]

Title:

The obesity wars and the education of a researcher: A personal account

 

Author:

Katherine M Flegal

Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA 

 

Published:

Progress in Cardiovascular Diseases, 15 June 2021

https://www.sciencedirect.com/science/article/pii/S0033062021000670

 

Abstract:

A naïve researcher published a scientific article in a respectable journal. She thought her article was straightforward and defensible. It used only publicly available data, and her findings were consistent with much of the literature on the topic. Her coauthors included two distinguished statisticians. To her surprise her publication was met with unusual attacks from some unexpected sources within the research community. These attacks were by and large not pursued through normal channels of scientific discussion. Her research became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer. The goal appeared to be to undermine and discredit her work. The controversy was something deliberately manufactured, and the attacks primarily consisted of repeated assertions of preconceived opinions. She learned first-hand the antagonism that could be provoked by inconvenient scientific findings. Guidelines and recommendations should be based on objective and unbiased data. Development of public health policy and clinical recommendations is complex and needs to be evidence-based rather than belief-based. This can be challenging when a hot-button topic is involved.

 

bioRxiv, 14 October 2020 [preprint] - Obesity alters Ace2 and Tmprss2 expression in lung, trachea, and esophagus in a sex-dependent manner: Implications for COVID-19

Title:

Obesity alters Ace2 and Tmprss2 expression in lung, trachea, and esophagus in a sex-dependent manner: Implications for COVID-19

 

Authors:

Dylan C Sarver & G William Wong

 

Published:

bioRxiv, 14 October 2020

[Keep in mind that this article is a preprint and not yet peer reviewed.]

https://www.biorxiv.org/content/10.1101/2020.10.13.337907v1

 

Abstract:

Obesity is a major risk factor for SARS-CoV-2 infection and COVID-19 severity. The underlying basis of this association is likely complex in nature. The host-cell receptor angiotensin converting enzyme 2 (ACE2) and the type II transmembrane serine protease (TMPRSS2) are important for viral cell entry. It is unclear whether obesity alters expression of Ace2 and Tmprss2 in the lower respiratory tract. Here, we show that: 1) Ace2 expression is elevated in the lung and trachea of diet-induced obese male mice and reduced in the esophagus of obese female mice relative to lean controls; 2) Tmprss2 expression is increased in the trachea of obese male mice but reduced in the lung and elevated in the trachea of obese female mice relative to lean controls; 3) in chow-fed lean mice, females have higher expression of Ace2 in the lung and esophagus as well as higher Tmprss2 expression in the lung but lower expression in the trachea compared to males; and 4) in diet-induced obese mice, males have higher expression of Ace2 in the trachea and higher expression of Tmprss2 in the lung compared to females, whereas females have higher expression of Tmprss2 in the trachea relative to males. Our data indicate diet- and sex-dependent modulation of Ace2 and Tmprss2 expression in the lower respiratory tract and esophagus. Given the high prevalence of obesity worldwide and a sex-biased mortality rate, we discuss the implications and relevance of our results for COVID-19.

Potential Treatment for Obesity Discovered: Drug Prevents Weight Gain and Reduces Blood Sugar

Title:
Potential Treatment for Obesity Discovered: Drug Prevents Weight Gain and Reduces Blood Sugar

By:
Pennington Biomedical Research Center

Published:
SciTechDaily, 10 June 2020
https://scitechdaily.com/potential-treatment-for-obesity-discovered-drug-prevents-weight-gain-and-reduces-blood-sugar/

From the article:
A new study offers the first evidence that a protein named BAM15 acts as an energy uncoupler and could be an effective drug for treating obesity and related diseases.

MRC London Institute of Medical Sciences, UK - Sugar leads to early death, but not due to obesity

Title:
Sugar leads to early death, but not due to obesity

By:
MRC London Institute of Medical Sciences, UK

Published:
Medical Xpress, 19 March 2020

From the article:
"Sugar-rich diets have a negative impact on health independent of obesity reports a new study led by the MRC London Institute of Medical Sciences, UK."

To read this article:
https://medicalxpress.com/news/2020-03-sugar-early-death-due-obesity.html

For more information, see scholarly article:
Van Dam, E. [et al.]. (19 March 2020). Sugar-Induced Obesity and Insulin Resistance Are Uncoupled from Shortened Survival in Drosophila. Cell Metabolism. DOI: 10.1016/j.cmet.2020.02.016