Author information
1 Division of Cellular and Molecular Medicine, Clinical Department and Laboratory of Intensive Care Medicine, KU Leuven University, Herestraat 49, 3000, Leuven, Belgium. marie.schetz@uzleuven.be.
2 Anesthesia and Critical Care Department (DAR-B), Saint Eloi, University of Montpellier, Research Unit: PhyMedExp, INSERM U-1046, CNRS, 34295, Montpellier Cedex 5, France.
3 Department of Medicine and Radiology, Melbourne Medical School, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
4 Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, VIC, Australia.
5 Klinik für Innere Medizin III, Abteilung für Nephrologie, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria.
6 Department of Intensive Care Medicine (710), Radboud University Medical Centre, Geert Grooteplein Zuid 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
7 Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
8 Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Genoa, Italy.
9 Radboud Center for Infectious Diseases, Nijmegen, The Netherlands.
10 Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.
11 Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
12 University of Queensland Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Australia.
13 Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Woolloongabba, Australia.
14 Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, Australia.
15 Departments of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.
16 Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany.
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.