The obesity paradox in chronic liver disease may be driven by methodological biases, and management should focus on improving cardiorespiratory fitness and preventing sarcopenia rather than endorsing overweight status.
This review emphasizes that despite the obesity paradox, patients with chronic liver disease should focus on improving cardiorespiratory fitness and preventing sarcopenia rather than maintaining an overweight status.
Obesity is a global health issue that is intricately linked to the development and progression of chronic liver disease (CLD). This bidirectional connection, coupled with the obesity paradox (OP), presents a management dilemma. The established influence of obesity on the development and progression of chronic liver disease (CLD) is surpassed by the liver's impact on the onset and advancement of obesity. Patients with CLD always experience increased energy expenditure, reduced appetite, and low protein synthesis, all of which might lead to weight loss. However, metabolic disturbances, hormonal imbalances, inflammatory signaling, immobility, drugs, and alterations in nutrient metabolism can contribute to the development and exacerbation of obesity. Despite the propagation of the OP concept, none of the guidelines has changed, recommending being overweight. Research bias and confounders might be the lifebuoy explanation. Additionally, overlooking the lethal morbidities of obesity for survival benefits full of suffering seems to be an illogical idea. Therefore, rather than endorsing an overweight status, emphasis should be placed on improving cardiorespiratory fitness and preventing sarcopenia to achieve better outcomes in patients with CLD. Accordingly, the complex interplay between obesity, CLD, and the concept of OP requires a sophisticated individualized management approach. Maximizing cardiorespiratory fitness and mitigating sarcopenia should be considered essential strategies for attaining the most favourable outcomes in patients with chronic liver disease (CLD).
Maha Elsabaawy (Mon,) conducted a review in Chronic liver disease and obesity. Obesity was evaluated. The obesity paradox in chronic liver disease may be driven by methodological biases, and management should focus on improving cardiorespiratory fitness and preventing sarcopenia rather than endorsing overweight status.