A paper by a scientist at UC San Diego in La Jolla is challenging a “one-size-fits-all” approach to health by introducing apparent paradoxes in patient needs. And its author has become the namesake of this phenomenon of apparent contradictions.
The paper, written by Raphael Cuomo, an associate professor in the UCSD School of Medicine’s Department of Anesthesiology, is based on his evaluation of overall scientific literature on the influence of nutritional factors on disease prevention and mortality.
RELATED: New Stanford study could help doctors address diabetes, prediabetes
He posits that factors commonly viewed as harmful to health can paradoxically predict better survival in people who later develop cancer or cardiovascular disease.
Everything from obesity and alcohol intake to high amounts of cholesterol and antioxidant supplements can pose increased risk of chronic diseases, the paper states. But what can harm someone in some circumstances could help in others.
People who are considered obese, for example, are at greater risk of developing cancer or cardiovascular disease but have higher chances of survival than patients of normal or less than normal weight, Cuomo reports.
Alcohol consumption, too, especially in higher amounts, is known to elevate cancer risk, while at the same time, it is associated with improved chances of survival for certain people diagnosed with cancer or cardiovascular disease.
Though originally described as the nutritional epidemiology risk-survival paradox, online commenters have referred to it as “Cuomo’s Paradox” since the paper was published in The Journal of Nutrition on Aug. 1.
“At this point, the name has taken hold,” Cuomo said. “It was surprising to me, but I hope it helps in some way to bring more awareness to these paradoxical observations that we see. I think it’s important as a topic because it really points to the need for us to personalize the guidance we give to patients based on their disease state.
“There is a broader construct going on that … we should not be following the one-size-fits-all approach and we should be seriously considering a patient’s health status before giving them advice about what behaviors to follow.”
With his name attached so prominently, Cuomo said he feels the onus to get the word out.
“I do feel a sense of responsibility to make sure that it is having the beneficial impact on medical science that I would like it to have,” he said.
Cuomo said the paper focuses on cancer and cardiovascular disease because they are associated with the majority of deaths around the world and there are conditions in which paradoxical observations between prevention and survival have been most observed.
His findings come with an important caveat, however. The paper concludes with “a cautious statement that changes to current guidelines require further studies.”
People need to be careful about claiming causality when observing Cuomo’s Paradox, he emphasized.
The paradox may not be universal, as some diseases such as hypertension and diabetes don’t show evidence of risk reversal.
“Clinical guidance itself is based on evidence,” Cuomo said. “You cannot just simply take the fact that there are paradoxical observations observed in the scientific literature and use that as an excuse to adopt whatever behaviors that may be most pleasurable or may feel right.
“There is a lot of science out there for beneficial and harmful behaviors, and those really should be taken into account, despite the fact that paradoxical observations exist in scientific literature.”
Read Cuomo’s full paper at jn.nutrition.org/article/S0022-3166(25)00472-9/fulltext.
As previously reported, Cuomo also recently published a study indicating a close association between frequent cannabis use and increased threat of oral cancer. To read that one, go to sciencedirect.com/science/article/pii/S2211335525002244. 