The incidence and prevalence of OBESITY are fast increasing worldwide. Various indices have been used to measure and assess OBESITY. The body mass index (BMI) is the most common and practical of these indices. Overweight and OBESITY exert considerable adverse effects on the cardiovascular system. These effects are mediated through various neurohormonal and cytokine pathways, most of which are inflammatory mediators. Systolic and / or diastolic heart failure is more prevalent among obese and overweight individuals than among normal weight people. The concept of the “ OBESITY paradox” has been proposed by some previously published studies, in which the prognosis of obese patients with established cardiovascular diseases, especially heart failure, is better than that of their leaner counterparts. In this review, we discuss the OBESITY paradox and its possible pathophysiologic mechanisms.

Background: Although numerous studies have assessed the relation between water intake and OBESITY, most previous studies were clinical trials that examined the impact of higher intakes of water rather than its habitual intake. In addition previous studies have examined the association with general OBESITY and limited information on water intake and abdominal OBESITY are available. The aim of this study was to investigate the relationship between patterns of water consumption and prevalence of general and abdominal OBESITY in Iranian adults.Method: In a cross-sectional study on 7847 Iranian adults for general OBESITY and 5980 subjects for abdominal adiposity, required data on anthropometric measures, sociodemographic information and dietary intakes along with physical activity was accumulated through the use of a pretested self-administered questionnaire. Data about daily water intake and fluid intake with meals was assessed by a self- administered questionnaire. People could report their fluid intake based on 4 glasses. Daily water consumption war reported based on 8 glasses during the day.Results: After adjustment for potential confounders, subjects who consumed 3-2 glasses of fluids with meals had a 34 percent increased risk for OBESITY 1.34 (1.04, 1.59), than those who consumed one cup or less. Subjects who were taking more than eight glasses of water a day had a 78 percent increased risk of OBESITY, than those who consumed fewer than two glasses of water daily 1.78 (2.94, 1.08). Consuming more than four glasses of liquids between meals was associated with increased risk of abdominal OBESITY 1.99 (1.16, 3.41), compared with consuming a cup of liquid or less. However, this association disappeared after adjustment for confounders (1.65 (0.81, 3.34)).Conclusion: Consuming more water with meals was associated with an increased risk of OBESITY and abdominal OBESITY. Also taking more than eight glasses of water a day, was associated with an increased risk of OBESITY, compared to less than 2 glasses of water daily.