Evidence map›Paper›PMID 31118651›Full record

ReviewVascular health and risk management2019

Obesity paradox in cardiovascular disease: where do we stand?

Salvatore Carbone, Justin M Canada, Hayley E Billingsley, Mohammad S Siddiqui, Andrew Elagizi, Carl J Lavie

Registry-linked trialOpen access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Vascular health and risk management, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04440540 (Effectiveness of Lifestyle Modification Program in Reversal of Non-alcoholic Fatty Liver Disease), which is not on this map. Cited by 175 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
175citing papers in PubMed, 8 pooled it
29.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04440540 naterminatednot on this mapstarted 2020, after this paper: background citation

Effectiveness of Lifestyle Modification Program in Reversal of Non-alcoholic Fatty Liver Disease (NAFLD) and Reduction of Cardiovascular Risks in Moderate Obesity: A Ultrasound Attenuation Imaging-Based Study

TypeinterventionalSponsorChinese University of Hong KongRan2020 to 2023Enrolled10ConditionsNon-alcoholic Fatty Liver DiseaseArmsDietitian led life style modification intervention, Conventional care (control)
3 · Its place in the literature

Who cites it

175 citing papers in PubMed, 8 syntheses or guidelines pooled it, 351 citations in OpenAlex.

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  6. Intermittent fasting for the prevention of cardiovascular disease.The Cochrane database of systematic reviews · 2021
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  19. Exploring obesity phenotypes: a longitudinal perspective.Reviews in endocrine & metabolic disorders · 2025
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115 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Salvatore CarboneVCU Pauley Heart Center, Department of Internal Medicine, Richmond, VA, USA.
Justin M CanadaVCU Pauley Heart Center, Department of Internal Medicine, Richmond, VA, USA.
Hayley E BillingsleyVCU Pauley Heart Center, Department of Internal Medicine, Richmond, VA, USA.
Mohammad S SiddiquiDivision of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA.
Andrew ElagiziJohn Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA.
Carl J LavieJohn Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine, New Orleans, LA, USA.
Ochsner Medical Center · USVirginia Commonwealth University · US

Funding

Research Supplement to Promote Diversity in Health Related ResearchUL1TR002649 · NCATS · VIRGINIA COMMONWEALTH UNIVERSITY · PI MOELLER, FREDERICK GERARD · 2018 to 2022
$19.1M
NCATS NIH HHS UL1 TR002649
6 · The paper itself

Abstract

Obesity is associated with an increased risk of developing cardiovascular disease (CVD), particularly heart failure (HF) and coronary heart disease (CHD). The mechanisms through which obesity increases CVD risk involve changes in body composition that can affect hemodynamics and alters heart structure. Pro-inflammatory cytokines produced by the adipose tissue itself which can induce cardiac dysfunction and can promote the formation of atherosclerotic plaques. When obesity and HF or CHD coexist, individuals with class I obesity present a more favorable prognosis compared to individuals who are normal or underweight. This phenomenon has been termed the "obesity paradox." Obesity is defined as an excess fat mass (FM), but individuals with obesity typically also present with an increased amount of lean mass (LM). The increase in LM may explain part of the obesity paradox as it is associated with improved cardiorespiratory fitness (CRF), a major determinant of clinical outcomes in the general population, but particularly in those with CVD, including HF. While increased LM is a stronger prognosticator in HF compared to FM, in patients with CHD excess FM can exert protective effects particularly when not associated with increased systemic inflammation. In the present review, we discuss the mechanisms through which obesity may increase the risk for CVD, and how it may exert protective effects in the setting of established CVD, with a focus on body composition. We also highlight the importance of measuring or estimating CRF, including body composition-adjusted measures of CRF (ie, lean peak oxygen consumption) for an improved risk status stratification in patients with CVD and finally, we discuss the potential non-pharmacologic therapeutics, such as exercise training and dietary interventions, aimed at improving CRF and perhaps clinical outcomes.

Indexed as

Body CompositionHemodynamicsCardiorespiratory FitnessCardiovascular DiseasesComorbidityDiet, HealthyExerciseHumansInflammationInflammation MediatorsNutritional StatusObesityPrognosisProtective FactorsRisk FactorsRisk Reduction BehaviorInflammation Mediatorsbody compositioncardiorespiratory fitnesscardiovascular diseaseobesityobesity paradox

Identifiers

PMID31118651
PMCPMC6503652
OpenAlexW2943483386

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

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.