What is so bad about reverse epidemiology anyway

摘要: The term "reverse epidemiology" is used to indicate that such surrogates of cardiovascular risk and metabolic syndrome as obesity, hypercholesterolemia hypertension are paradoxically associated with greater survival in individuals chronic disease states wasting, including dialysis patients, whom the short-term issue at hand. It being debated whether crossing curves obesity-mortality association patients vs. general population reflect residual confounding needs be controlled away statistically, or they have biological plausibility sharp contradistinction currently dominating Framingham paradigm. In rush define statistical artifact dismiss a misnomer, we may miss opportunity gain information housed those lines bigger picture, i.e., how improve longevity patients. Even though some paradoxes appear fulfill Hill's criteria causation, there still two major drawbacks: (1) convincing pathophysiologic pathways link patient fat accumulation, higher serum lipoprotein levels slightly than normal blood pressure values yet verified animal other scientifically sound models; (2) randomized trials need show nutritional interventions resulting weight can lead Studying paradigm shift by establishing targets beyond guidelines for populations states.