title: Obesity paradox, obesity orthodox, and the metabolic syndrome: An approach to unity.
abstract: Obesity and the accompanying metabolic syndrome are strongly associated with heightened morbidity and mortality in older adults. In our review of more than 20 epidemiologic studies of major infectious diseases, including leaders such as tuberculosis, community-acquired pneumonia, and sepsis, obesity was associated with better outcomes. A cause-and-effect relationship between over-nutrition and survival with infection is suggested by results of two preliminary studies of infections in mice, where high fat feeding for 8-10 weeks provided much better outcomes. The better outcomes of infections with obesity are reminiscent of many recent studies of "sterile" non-infectious medical and surgical conditions where outcomes for obese patients are better than for their thinner counterparts --- and given the tag "obesity paradox". Turning to the history of medicine and biological evolution, we hypothesize that the metabolic syndrome has very ancient origins and is part of a lifelong metabolic program. While part of that program (the metabolic syndrome) promotes morbidity and mortality with aging, it helps infants and children as well as adults in their fight against infections and recovery from injuries, key roles in the hundreds of centuries before the public health advances of the 20th century. We conclude with speculation on how understanding the biological elements that protect obese patients with infections or injuries might be applied advantageously to thin patients with the same medical challenges.
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.|Hofstra Northwell School of Medicine, Northwell Health, Hempstead, NY.
authors.forename: Jesse
authors.initials: J
authors.lastname: Roth
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.|NYIT College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Navneet
authors.initials: N
authors.lastname: Sahota
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.|NYIT College of Osteopathic Medicine, Old Westbury, NY.
authors.forename: Priya
authors.initials: P
authors.lastname: Patel
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Syed Faizan
authors.initials: SF
authors.lastname: Mehdi
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.|California Northstate University, College of Medicine, Elk Grove, CA 11.
authors.forename: Mohammad Masum
authors.initials: MM
authors.lastname: Wiese
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Hafiz B
authors.initials: HB
authors.lastname: Mahboob
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.|Hofstra Northwell School of Medicine, Northwell Health, Hempstead, NY 12.
authors.forename: Michelle
authors.initials: M
authors.lastname: Bravo
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Eden
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Muhammad A
authors.initials: MA
authors.lastname: Bashir
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Amrat
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Farah
authors.initials: F
authors.lastname: Alsaati
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 13.
authors.forename: Irwin J
authors.initials: IJ
authors.lastname: Kurland
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Wunnie
authors.initials: W
authors.lastname: Brima
authors.affiliation: Department of Medicine, CPL Michael J. Crescenz VA Medical Center, Philadelphia, PA 14.
authors.forename: Ann
authors.initials: A
authors.lastname: Danoff
authors.affiliation: Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 13.
authors.forename: Alessandra L
authors.initials: AL
authors.lastname: Szulc
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Valentin A
authors.initials: VA
authors.lastname: Pavlov
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Tracey
authors.affiliation: Laboratory of Diabetes and Diabetes-Related Research, Feinstein Institute for Medical Research, 8 Northwell Health, Manhasset, NY.
authors.forename: Huan
authors.initials: H
authors.lastname: Yang
keywords: Infectious Diseases; Metabolic Syndrome; Obesity; Obesity Paradox; Tuberculosis