Risk factor paradox in wasting diseases

Kamyar Kalantar-Zadeh, Tamara B. Horwich, Antigone Oreopoulos, Csaba Kovesdy, Houman Younessi, Stefan D. Anker, John E. Morley

Research output: Contribution to journalReview article

204 Citations (Scopus)

Abstract

PURPOSE OF REVIEW: Emerging data indicate that conventional cardiovascular risk factors (e.g. hypercholesterolemia and obesity) are paradoxically associated with better survival in distinct populations with wasting. We identify these populations and review survival paradoxes and common pathophysiologic mechanisms. RECENT FINDINGS: A 'reverse epidemiology' of cardiovascular risk is observed in chronic kidney disease, chronic heart failure, chronic obstructive lung disease, cancer, AIDS and rheumatoid arthritis, and in the elderly. These populations apparently have slowly progressive to full-blown wasting and significantly greater short-term mortality than the general population. The survival paradoxes may result from the time differential between the two competing risk factors [i.e. over-nutrition (long-term killer but short-term protective) versus undernutrition (short-term killer)]. Hemodynamic stability of obesity, protective adipokine profile, endotoxin-lipoprotein interaction, toxin sequestration of fat, antioxidation of muscle, reverse causation, and survival selection may also contribute. SUMMARY: The seemingly counterintuitive risk factor paradox is the hallmark of chronic disease states or conditions associated with wasting disease at the population level. Studying similarities among these populations may help reveal common pathophysiologic mechanisms of wasting disease, leading to a major shift in clinical medicine and public health beyond the conventional Framingham paradigm and to novel therapeutic approaches related to wasting and short-term mortality.

Original languageEnglish (US)
Pages (from-to)433-442
Number of pages10
JournalCurrent Opinion in Clinical Nutrition and Metabolic Care
Volume10
Issue number4
DOIs
StatePublished - Jul 1 2007

Fingerprint

Wasting Syndrome
Population
Obesity
Adipokines
Mortality
Clinical Medicine
Hypercholesterolemia
Chronic Renal Insufficiency
Endotoxins
Malnutrition
Causality
Chronic Obstructive Pulmonary Disease
Lipoproteins
Lung Neoplasms
Rheumatoid Arthritis
Acquired Immunodeficiency Syndrome
Epidemiology
Chronic Disease
Heart Failure
Public Health

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Kalantar-Zadeh, K., Horwich, T. B., Oreopoulos, A., Kovesdy, C., Younessi, H., Anker, S. D., & Morley, J. E. (2007). Risk factor paradox in wasting diseases. Current Opinion in Clinical Nutrition and Metabolic Care, 10(4), 433-442. https://doi.org/10.1097/MCO.0b013e3281a30594

Risk factor paradox in wasting diseases. / Kalantar-Zadeh, Kamyar; Horwich, Tamara B.; Oreopoulos, Antigone; Kovesdy, Csaba; Younessi, Houman; Anker, Stefan D.; Morley, John E.

In: Current Opinion in Clinical Nutrition and Metabolic Care, Vol. 10, No. 4, 01.07.2007, p. 433-442.

Research output: Contribution to journalReview article

Kalantar-Zadeh, K, Horwich, TB, Oreopoulos, A, Kovesdy, C, Younessi, H, Anker, SD & Morley, JE 2007, 'Risk factor paradox in wasting diseases', Current Opinion in Clinical Nutrition and Metabolic Care, vol. 10, no. 4, pp. 433-442. https://doi.org/10.1097/MCO.0b013e3281a30594
Kalantar-Zadeh K, Horwich TB, Oreopoulos A, Kovesdy C, Younessi H, Anker SD et al. Risk factor paradox in wasting diseases. Current Opinion in Clinical Nutrition and Metabolic Care. 2007 Jul 1;10(4):433-442. https://doi.org/10.1097/MCO.0b013e3281a30594
Kalantar-Zadeh, Kamyar ; Horwich, Tamara B. ; Oreopoulos, Antigone ; Kovesdy, Csaba ; Younessi, Houman ; Anker, Stefan D. ; Morley, John E. / Risk factor paradox in wasting diseases. In: Current Opinion in Clinical Nutrition and Metabolic Care. 2007 ; Vol. 10, No. 4. pp. 433-442.
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