Table 1 Factors supporting and refuting the obesity paradox in sepsis
Possible pathophysiological mechanisms of the obesity paradox | Possible biases in studies examining the obesity paradox |
|---|---|
Higher metabolic reserves in acute catabolic illnesses | Inadequate adjustment for confounding factors e.g. smoking |
Secretion of anti-inflammatory mediators by adipose tissue e.g. leptin, soluble tumor necrosis factor-receptor-2 | Selection bias of patients with less severe sepsis in obese populations |
Hemodynamic benefits of renin-angiotensin system activation | Protective effect limited to certain subpopulations e.g. older patients with comorbidities |
High-density lipoproteins bind bacterial lipopolysaccharide | Relatively restrictive administration of medications in obese patients due to a non-weight based principle |
Obesity and resulting obstructive sleep apnea contributes to ischemic preconditioning | Misclassification of patients due to inaccurate BMI measurements |
Decreased BMI may be due to sarcopenia |