We searched PubMed to identify English language articles on the association between obesity and infection. Relevant articles published between 1975 and 2005 were sought using the term “obesity” in combination with other terms including “immune system”, “cellular immunity”, “humoral immunity”, “sepsis”, “white blood cell”, “cytokine”, “chemotaxis”, or “transplantation”, as well as “obesity” in combination with various specific organ and system infections. To expand our search strategy, we
ReviewObesity and infection
Introduction
The US National Institutes of Health and the WHO classify people regarding their body weight according to the body mass index (BMI), calculated as body weight (in kg) divided by the body height (in m) squared. Overweight, obese, and morbidly obese people are those with a BMI 25–30 kg/m2, 30–40 kg/m2, and greater than 40 kg/m2, respectively. Normal weight and underweight people are those with BMI 20–25 kg/m2 and less than 20 kg/m2, respectively. Obesity, through various well-described pathophysiological interactions, increases the risk of cardiovascular and other diseases, compromises the quality of life, and increases overall mortality.1, 2 However, the various aspects of the association between obesity and infection have not been reviewed.
We review the available evidence regarding the various aspects of the association between obesity and infection, including obesity-related mechanisms that lead to predisposition to infections, the epidemiology of nosocomial and community-acquired infections in the obese population, and special issues related to the management of infections in the obese patient. We briefly review infections that are the result of procedures for the management of obesity. In addition, we mention the evidence for the reverse association between obesity and infection—namely, the possibility that infectious agents may have an aetiological role in obesity, an idea known as “infectobesity”.
Section snippets
Mechanisms that predispose obese patients to infection
It has been recently recognised that the adipose tissue participates actively in inflammation and immunity, producing and releasing a variety of proinflammatory and anti-inflammatory factors, including the well-studied adipokines leptin and adiponectin, as well as cytokines and chemokines.3 Adiponectin is potently immunosuppressive,4 while leptin activates polymorphonuclear neutrophils,5 exerts proliferative and anti-apoptotic activities on T lymphocytes, affects cytokine production, regulates
Nosocomial infections
The incidence of nosocomial infections in overweight and obese patients is increased compared with normal weight patients. Routine medical care of obese patients in everyday practice may present certain difficulties. In some instances usual diagnostic and treatment procedures must be modified. For example, some computed tomography equipment cannot accommodate obese patients above a certain weight limit. Routine care of non-ambulatory morbidly obese patients (eg, lifting and bathing) requires
Infections in critically ill patients
Obese and morbidly obese patients in the intensive care unit setting are reported to have higher mortality compared with normal weight patients.80, 81 A matched cohort study compared 170 mechanically ventilated patients with BMI over 30 kg/m2 with 170 normal weight mechanically ventilated patients. The obese patients had increased intensive care unit mortality (OR 2·1, 95% CI 1·2–3·6), explained by a higher risk of complications (OR 4·0, 95% CI 1·4–11·8), including sepsis, ventilator-associated
Obesity and HIV infection
Only a few studies have addressed the association of baseline obesity with the natural progression of HIV infection, the response to antiretroviral treatment, and other outcomes in HIV-infected patients. The effects of obesity on immune function, disease progression, and mortality were evaluated longitudinally in 125 HIV-1-seropositive drug users and 148 HIV-1-seronegative controls followed at a community clinic from 1992 to 1996, before administration of highly active antiretroviral therapy
Infections following procedures for the management of obesity
Several procedures have been used in obese patients for the management of obesity itself and for the restoration of the accompanying cosmetic deformities. These procedures are sometimes complicated by infections caused by common or rare microorganisms.
Liposuction is a common cosmetic procedure. Infectious complications following liposuction have occasionally been reported and include subcutaneous abscesses, herpes zoster virus infection, necrotising fasciitis, and wound infection caused by
Management of infection in obese patients
Despite the growing prevalence of obesity worldwide, there are no well-established guidelines about the management of infections in obese patients, including specific recommendations regarding adjustment of dosage of therapy with antimicrobial agents, when necessary.
Several variables related to body weight have been used in pharmacokinetic studies in obese individuals, including body weight, lean body weight, ideal body weight, body surface area, BMI, fat-free mass, percent ideal body weight,
Obesity of infectious origin
Obesity of infectious origin is a concept that has been studied in animal models during the past two decades. Seven different pathogens (canine distemper virus, Rous-associated virus 7, Borna disease virus, scrapie agent, SMAM-1 avian adenovirus, and human adenoviruses Ad36 and Ad37) have been reported to cause obesity in animal models.119, 120 Canine distemper virus, a morbillivirus closely related to the human measles virus, was the first reported obesity-promoting virus, inducing
Conclusions
Although obesity is a well-known risk factor for several morbid conditions, its relation to infection has not been adequately studied. The available evidence suggests that infections of several organs and systems are more common in obese people than those of normal weight. However, the literature is so far lacking large epidemiological studies that could verify obvious or expected associations between obesity and infection and reject biased assumptions. In addition, it should be noted that
Search strategy and selection criteria
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