Das Adipositasparadoxon oder Reverse Epidemiologie

Zusammenfassung

Übergewicht und Adipositas sind in der Allgemeinbevölkerung unumstrittene unabhängige Risikofaktoren für erhöhte Krankheitswahrscheinlichkeit und Mortalität. Andererseits zeigte sich, dass bei bestimmten Bevölkerungsgruppen und Patientinnen und Patienten mit verschiedenen medizinischen Konditionen (hohes Alter, konsumierende Erkrankungen, Herzerkrankungen, dialysepflichtige Niereninsuffizienz) Übergewicht und Adipositas mit einer höheren Überlebensrate assoziiert sind. Um dieses Phänomen zu beschreiben, wurden die Begriffe „Reverse Epidemiologie” und „Adipositasparadoxon” vorgeschlagen. Ob dieses Phänomen tatsächlich durch einen protektiven Effekt eines hohen Fettgewebsanteils zustande kommt, ist bis jetzt weitgehend ungeklärt. Methodische Probleme in Studiendesigns, in denen ein Adipositasparadoxon nahegelegt wird, wie „Surviver-Bias”, „Selection-Bias”, „Lead Time Bias” oder in Metaanalysen auch der „Publication-Bias” sowie Confounder wurden diskutiert, können aber das beobachtete Phänomen sicher nicht zur Gänze erklären. Auch physiologische Erklärungsmodelle, in denen ein tatsächlicher protektiver Effekt eines hohen Body Mass Index bei Patientinnen und Patienten mit konsumierenden Erkrankungen oder bei Hochbetagten nahegelegt wird, wurden erstellt. Insbesondere erhöhte Inflammationsmarker, verbunden mit Malnutrition prädizieren bei Personen mit diversen medizinischen Bedingungen eine hohe Mortalität und Übergewicht und Adipositas können diesem Effekt entgegenwirken. Die möglichen Implikationen für klinische Empfehlungen und Public Health Empfehlungen bezüglich Gewichtsmanagement und Ernährung sind Gegenstand zukünftiger Forschung. Bei Hochbetagten Personen und Patientinnen und Patienten mit Erkrankungen mit schlechter Prognose sollten im Gewichtsmanagement auch Auswirkungen auf die Lebensqualität berücksichtigt werden.

Abstract

Overweight and obesity are independent risk factors for the development of disease and death in the general population. However, in people with various conditions (old age, wasting diseases, heart diseases or renal dialysis) overweight and obesity are associated with a higher survival rate. The terms „reverse epidemiology” or „obesity paradox” have been suggested to describe this finding. However, it still remains uncertain, whether this phenomenon is attributable to a real protective effect of high body fat mass. Methodological problems in studies suggesting an obesity paradox such as survivor bias, selection bias, lead time bias or, in meta analyses, publication bias and confounders have been discussed. These cannot, however, entirely explain the observed phenomenon. Biological models, examining possible explanations for the protective effect of high body mass, for instance, in wasting diseases and elderly patients, have also been produced. In particular high inflammation markers combined with malnutrition predict a high mortality rate among patients with various medical conditions: overweight and obesity could counter these effects. Possible implications for clinical and public health recommendations regarding weight management and nutrition are issues for future research. In elderly subjects and patients with a poor prognosis the impact of weight management on quality of life should also be taken into account.

Mortalität - Übergewicht - Herzinsuffizienz - Dialysepatienten - geriatrische Personen

mortality - overweight - heart failure - dialysis - geriatric patients

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