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Obesity in the critically ill: a narrative review

Authors
  • Schetz, Miet1
  • De Jong, Audrey2
  • Deane, Adam M.3, 4
  • Druml, Wilfried5
  • Hemelaar, Pleun6
  • Pelosi, Paolo7, 8
  • Pickkers, Peter6, 9
  • Reintam-Blaser, Annika10, 11
  • Roberts, Jason12, 13, 14, 14
  • Sakr, Yasser15
  • Jaber, Samir2
  • 1 KU Leuven University, Herestraat 49, Leuven, 3000, Belgium , Leuven (Belgium)
  • 2 Saint Eloi, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, Montpellier Cedex 5, 34295, France , Montpellier Cedex 5 (France)
  • 3 The University of Melbourne, Parkville, VIC, Australia , Parkville (Australia)
  • 4 University of Melbourne, Parkville, VIC, Australia , Parkville (Australia)
  • 5 Klinik für Innere Medizin III, Abteilung für Nephrologie, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria , Vienna (Austria)
  • 6 Radboud University Medical Centre, Geert Grooteplein Zuid 10, Nijmegen, 6500 HB, The Netherlands , Nijmegen (Netherlands)
  • 7 University of Genoa, Genoa, Italy , Genoa (Italy)
  • 8 IRCCS for Oncology and Neurosciences, Genoa, Genoa, Italy , Genoa (Italy)
  • 9 Radboud Center for Infectious Diseases, Nijmegen, The Netherlands , Nijmegen (Netherlands)
  • 10 Lucerne Cantonal Hospital, Lucerne, Switzerland , Lucerne (Switzerland)
  • 11 University of Tartu, Tartu, Estonia , Tartu (Estonia)
  • 12 University of Queensland, Herston, Australia , Herston (Australia)
  • 13 The University of Queensland, Woolloongabba, Australia , Woolloongabba (Australia)
  • 14 Royal Brisbane and Women’s Hospital, Brisbane, Australia , Brisbane (Australia)
  • 15 Uniklinikum Jena, Jena, Germany , Jena (Germany)
Type
Published Article
Journal
Intensive Care Medicine
Publisher
Springer Berlin Heidelberg
Publication Date
Mar 19, 2019
Volume
45
Issue
6
Pages
757–769
Identifiers
DOI: 10.1007/s00134-019-05594-1
Source
Springer Nature
Keywords
License
Yellow

Abstract

The World Health Organization defines overweight and obesity as the condition where excess or abnormal fat accumulation increases risks to health. The prevalence of obesity is increasing worldwide and is around 20% in ICU patients. Adipose tissue is highly metabolically active, and especially visceral adipose tissue has a deleterious adipocyte secretory profile resulting in insulin resistance and a chronic low-grade inflammatory and procoagulant state. Obesity is strongly linked with chronic diseases such as type 2 diabetes, hypertension, cardiovascular diseases, dyslipidemia, non-alcoholic fatty liver disease, chronic kidney disease, obstructive sleep apnea and hypoventilation syndrome, mood disorders and physical disabilities. In hospitalized and ICU patients and in patients with chronic illnesses, a J-shaped relationship between BMI and mortality has been demonstrated, with overweight and moderate obesity being protective compared with a normal BMI or more severe obesity (the still debated and incompletely understood “obesity paradox”). Despite this protective effect regarding mortality, in the setting of critical illness morbidity is adversely affected with increased risk of respiratory and cardiovascular complications, requiring adapted management. Obesity is associated with increased risk of AKI and infection, may require adapted drug dosing and nutrition and is associated with diagnostic and logistic challenges. In addition, negative attitudes toward obese patients (the social stigma of obesity) affect both health care workers and patients.

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