Does increasing adiposity affect the incidence of cardiovascular disease, and is the obesity paradox explained by confounding in BMI measurements?
The obesity paradox is an artifact of confounding related to BMI and pre-existing comorbidities, confirming that increasing adiposity is detrimental to cardiovascular health.
Increasing adiposity has a detrimental association with CVD health in middle-aged men and women. The association of BMI with CVD appears more susceptible to confounding due to pre-existing comorbidities when compared with other adiposity measures. Any public misconception of a potential 'protective' effect of fat on CVD risk should be challenged. Take home figureThe obesity paradox is mainly due to the effect of confounding on BMI and disappears on other adiposity measures.
Iliodromiti et al. (2018) studied this question.