ArticleObesity (Silver Spring, Md.)2015
Smoking and reverse causation create an obesity paradox in cardiovascular disease.
Article in Obesity (Silver Spring, Md.), 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 62 papers, 1 of them a synthesis that pooled it.
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Who cites it
62 citing papers in PubMed, 1 synthesis or guideline pooled it, 109 citations in OpenAlex.
- Association between early menopause and adverse cardiovascular events in postmenopausal women: a systematic review and meta-analysis stratified by smoking status and type 2 diabetes mellitus.Frontiers in public health · 2026Pooled it
- No obesity paradox in patients with community-acquired pneumonia - secondary analysis of a randomized controlled trial.Nutrition & diabetes · 2022Trial
- Trial
- Clinical obesity phenotypes among older adults: prevalence, determinants, and morbidity burden from the Longitudinal Ageing Study in India.International journal of obesity (2005) · 2026Article
- Magnitude and correlates of overweight or obesity among adults with diabetes mellitus duration of five or more years in rural Uganda: A cross-sectional study.Global epidemiology · 2026Article
- Association between biological aging and coronary heart disease: A secondary analysis of two observational studies.iScience · 2026Article
- Article
- Adherence to American Cancer Society Guideline and Mortality in Men With Nonmetastatic Prostate Cancer.JAMA network open · 2025Article
- Predictors of 1-year mortality in a clinical cohort of hip fracture patients.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- Associations between Dietary Patterns and Incident Colorectal Cancer in 114,443 Individuals from the UK Biobank: A Prospective Cohort Study.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2024Article
- The Relationship of Waist Circumference with the Morbidity of Cardiovascular Diseases and All-Cause Mortality in Metabolically Healthy Individuals: A Population-Based Cohort Study.Reviews in cardiovascular medicine · 2024Article
- Article
- Body mass index and waist-to-height ratio effect on mortality in non-alcoholic fatty liver: revisiting the obesity paradox.Frontiers in endocrinology · 2024Article
- The Taiwanese Map of Axial Spondyloarthritis: Living with the Condition.Medicina (Kaunas, Lithuania) · 2023Article
- Relationship of cardiorenal risk factors with albuminuria based on age, smoking, glycaemic status and BMI: a retrospective cohort study of the UK Biobank data.BMJ public health · 2023Article
- Review
- Obesity and renal cell carcinoma: Biological mechanisms and perspectives.Seminars in cancer biology · 2023Review
- Unfolding the reality of the smoking paradox in a South Asian cohort of patients presenting with ST-elevation acute coronary syndrome undergoing primary percutaneous coronary intervention.SAGE open medicine · 2023Article
- The Impact of Nonalcoholic Fatty Liver Disease on Severe Community-Acquired Pneumonia Outcomes.Life (Basel, Switzerland) · 2022Article
- Body mass index versus surrogate measures of central adiposity as independent predictors of mortality in type 2 diabetes.Cardiovascular diabetology · 2022Article
2 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
2 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveMany studies find that excess weight is associated with better survival among individuals with cardiovascular disease (CVD). Investigations were carried out to see whether this "obesity paradox" can be explained by biases.
methodsThe association between weight status and mortality in the US population ages 35 and above with CVD was investigated. Data were obtained from the National Health and Nutrition Examination Survey, 1988-2010, linked to mortality records through 2011. To minimize biases resulting from illness-induced weight loss, a reference category consisting of individuals who have always maintained normal weight was used. Age-standardized mortality rates and Cox models were estimated, comparing overweight/obesity (body mass index (BMI) ≥25.0 kg m(-2) ) to normal weight (BMI 18.5-24.9 kg m(-2) ).
resultsThe paradox was present among those with overweight/obesity at the time of survey (hazard ratio (HR) = 0.89; 95% confidence interval (CI) 0.78-1.01). However, when the reference category was limited to the always-normal-weight, the paradox disappeared (HR = 1.16; 95% CI 0.95-1.41). When analysis was additionally confined to never-smokers, mortality risks were significantly higher in the overweight/obesity group (HR = 1.51; 95% CI 1.07-2.15; P = 0.021).
conclusionsThe findings provide support for the hypothesis that lower mortality among individuals with CVD and overweight/obesity is a product of biases involving reverse causation and confounding by smoking.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.