Association between body mass index and mortality in hospitalised patients with community-acquired pneumonia

The obesity paradox postulates that increased body mass index (BMI) is protective in certain patient populations. We aimed to investigate the association of BMI and different weight classes with outcomes in hospitalised patients with community-acquired pneumonia (CAP).This cohort study is a secondary data analysis of the University of Louisville Pneumonia Study database, a prospective study of hospitalised adult patients with CAP from June of 2014 to May of 2016 in Louisville, KY. BMI as a predictor was assessed both as a continuous and categorical variable. Patients were categorised as weight classes based on WHO definitions: BMI<18.5 (underweight), BMI of 18.5 to <25 (normal weight), BMI of 25.0 to <30 (overweight), BMI of 30 to <35 (obesity class I), BMI of 35 to <40 (obesity class II), and BMI≥40 (obesity class III). Study outcomes, including time to clinical stability, length of stay, clinical failure, and mortality, were assessed in hospital, at 30-days, at 6-months, and at 1-year. Clinical failure was defined as the need for noninvasive ventilation, invasive ventilation, or vasopressors within 1 week of admission. Patient characteristics and crude outcomes were stratified by BMI categories, and generalised additive binomial regression models were performed to analyse the impact of BMI as a continuous variable on study outcomes adjusting for possible confounding variables.7449 patients were included in the study. Median time to clinical stability was 2 days for every BMI group. There was no association between BMI as a continuous predictor and length of stay <5 days (χ2=1.83, EDF=2.74, p=0.608). Clinical failure was highest in the class III obesity group, and higher BMI as a continuous predictor was associated with higher odds of clinical failure. BMI as a continuous predictor was significantly associated with 30-day (χ2=39.97, EDF=3.07, p<0.001), 6-month (χ2=89.42, EDF=3.44, p<0.001) and 1-year (χ2=83.97, EDF=2.89, p<0.001) mortalities. BMI ≤24.14 was a risk factor whereas BMI ≥26.97 was protective for mortality at 1-year. The incremental benefit of increasing BMI plateaued at 35.We found a protective benefit of obesity on mortality in CAP patients. However, we uniquely demonstrate that the association between BMI and mortality is not linear, and no incremental benefit of increasing BMI levels is observed in those with obesity classes II and III.

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Blood pressure levels and body mass index in Brazilian adults with Down syndrome

Sao Paulo Medical Journal ◽

10.1590/1516-3180.2016.0057180316 ◽

2016 ◽

Vol 134 (4) ◽

pp. 330-334 ◽

Cited By ~ 4

Author(s):

Felipe Pucci ◽

Guilherme Machado ◽

Edcarlo Solera ◽

Fernanda Cenovicz ◽

Christian Arruda ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Down Syndrome ◽

Body Mass ◽

Normal Weight ◽

Class Iii ◽

Special Schools ◽

Cross Sectional ◽

Obesity Class ◽

Age Range

ABSTRACT CONTEXT AND OBJECTIVE: Increased life expectancy among people with Down syndrome (DS) has introduced new environmental factors that may affect blood pressure (BP) and/or lead to obesity in this population. The aim here was to investigate BP levels and body mass index (BMI) in adults with DS, correlating these data with the patients' sex and age. DESIGN AND SETTING: Analytical cross-sectional observational study conducted in special schools in Curitiba (PR), Brazil. METHODS: 97 adult patients were included. BP was measured in accordance with the established guidelines. BMI was calculated by dividing the weight by the height squared (kg/m2). RESULTS: Sex had no influence on BMI; nor did systolic BP (SBP) or diastolic BP (DBP). The age range was from 18 to 56 years. No correlation was observed between increasing age and greater BMI or BP. Eighty-six individuals (88.7%) presented normal BP, eleven (11.3%) prehypertension and none hypertension. Twenty patients (20.4%) presented BP lower than 90 × 60 mmHg. BMI ranged from 18 to 48 kg/m2 (mean of 28.8 ± 3.92 kg/m2): 21.9% had normal weight; 40.7% were overweight; and 25.3% had obesity class I, 9.9% class II and 2.2% class III. Higher BMI was associated with significantly greater SBP and DBP (P = 0.0175 and P = 0.0015). CONCLUSION: Sex and age did not influence SBP, DBP or BMI in Brazilian adults with DS. Higher BMI was associated with greater BP (both systolic and diastolic).

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Body Mass Index is Strongly Associated with Hypertension: Results from the Longevity Check-up 7+ Study

Nutrients ◽

10.3390/nu10121976 ◽

2018 ◽

Vol 10 (12) ◽

pp. 1976 ◽

Cited By ~ 6

Author(s):

Francesco Landi ◽

Riccardo Calvani ◽

Anna Picca ◽

Matteo Tosato ◽

Anna Maria Martone ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

Diastolic Blood Pressure ◽

Body Mass ◽

Class I ◽

Blood Cholesterol ◽

World Health ◽

Class Iii ◽

Cross Sectional Survey ◽

Obesity Class

The present study was undertaken to provide a better insight into the relationship between different levels of body mass index (BMI) and changing risk for hypertension, using an unselected sample of participants assessed during the Longevity Check-up 7+ (Lookup7+) project. Lookup7+ is an ongoing cross-sectional survey started in June 2015 and conducted in unconventional settings (i.e., exhibitions, malls, and health promotion campaigns) across Italy. Candidate participants are eligible for enrolment if they are at least 18 years of age and provide written informed consent. Specific health metrics are assessed through a brief questionnaire and direct measurement of standing height, body weight, blood glucose, total blood cholesterol, and blood pressure. The present analyses were conducted in 7907 community-living adults. According to the BMI cutoffs recommended by the World Health Organization, overweight status was observed among 2896 (38%) participants; the obesity status was identified in 1135 participants (15%), with 893 (11.8%) participants in class I, 186 (2.5%) in class II, and 56 (0.7%) in class III. Among enrollees with a normal BMI, the prevalence of hypertension was 45% compared with 67% among overweight participants, 79% in obesity class I and II, and up to 87% among participants with obesity class III (p for trend < 0.001). After adjusting for age, significantly different distributions of systolic and diastolic blood pressure across BMI levels were consistent. Overall, the average systolic blood pressure and diastolic blood pressure increased significantly and linearly across BMI levels. In conclusion, we found a gradient of increasing blood pressure with higher levels of BMI. The fact that this gradient is present even in the fully adjusted analyses suggests that BMI may cause a direct effect on blood pressure, independent of other clinical risk factors.

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Bariatric Embolization in the Treatment of Patients with a Body Mass Index Between 30 and 39.9 kg/m2 (Obesity Class I and II) and Metabolic Syndrome, a Pilot Study

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02776-7 ◽

2021 ◽

Author(s):

Raphael Braz Levigard ◽

Henrique Serrão ◽

Camille Castro ◽

Priscila Matos ◽

Fernanda Mattos ◽

...

Keyword(s):

Metabolic Syndrome ◽

Body Mass Index ◽

Pilot Study ◽

Body Mass ◽

Class I ◽

Obesity Class ◽

Bariatric Embolization

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Maternal Body Mass Index and Use of Labor Neuraxial Analgesia

Anesthesiology ◽

10.1097/aln.0000000000002322 ◽

2018 ◽

Vol 129 (3) ◽

pp. 448-458 ◽

Cited By ~ 13

Author(s):

Alexander J. Butwick ◽

Cynthia A. Wong ◽

Nan Guo

Keyword(s):

Body Mass Index ◽

Relative Risk ◽

Body Mass ◽

Normal Body Mass Index ◽

Adjusted Relative Risk ◽

Obese Women ◽

Obesity Class ◽

Normal Body ◽

Neuraxial Analgesia ◽

Obese Class

Abstract What We Already Know about This Topic What This Article Tells Us That Is New Background Neuraxial labor analgesia may benefit obese women by optimizing cardiorespiratory function and mitigating complications related to emergency general anesthesia. We hypothesized that obese women have a higher rate of neuraxial analgesia compared with nonobese parturients. Methods Using U.S. natality data, our cohort comprised 17,220,680 deliveries, which accounts for 61.5% of 28 million births in the United States between 2009 and 2015. We examined the relationships between body mass index class and neuraxial labor analgesia, adjusting for sociodemographic, antenatal, pregnancy, and peripartum factors. Results The study cohort comprised 17,220,680 women; 0.1% were underweight, 12.7% were normal body mass index, 37% were overweight, and 28.3%, 13.5%, and 8.4% were obesity class I, II, and III, respectively. Rates of neuraxial analgesia by body mass index class were as follows: underweight, 59.7% (9,030/15,128); normal body mass index, 68.1% (1,487,117/2,182,797); overweight, 70.3% (4,476,685/6,368,656); obesity class I, 71.8% (3,503,321/4,881,938); obesity class II, 73.4% (1,710,099/2,330,028); and obesity class III, 75.6% (1,089,668/1,442,133). Compared to women with normal body mass index, the likelihood of receiving neuraxial analgesia was slightly increased for overweight women (adjusted relative risk, 1.02; 95% CI, 1.02 to 1.02), obese class I (adjusted relative risk, 1.04; 95% CI, 1.04 to 1.04), obese class II (adjusted relative risk, 1.05; 95% CI, 1.05 to 1.05), and obese class III (adjusted relative risk, 1.06; 95% CI, 1.06 to 1.06). Conclusions Our findings suggest that the likelihood of receiving neuraxial analgesia is only marginally increased for morbidly obese women compared to women with normal body mass index.

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Disease characteristics and management of hospitalised adolescents and adults with community-acquired pneumonia in China: a retrospective multicentre survey

BMJ Open ◽

10.1136/bmjopen-2017-018709 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018709 ◽

Cited By ~ 15

Author(s):

Liang Chen ◽

Fei Zhou ◽

Hui Li ◽

Xiqian Xing ◽

Xiudi Han ◽

...

Keyword(s):

Southern China ◽

Pneumonia Severity Index ◽

Community Acquired Pneumonia ◽

Teaching Hospitals ◽

Secondary Outcome ◽

Standard Case ◽

Risk Class ◽

Illness Onset ◽

Hospitalised Patients ◽

Clinical Stability

ObjectivesTo describe the clinical characteristics and management of patients hospitalised with community-acquired pneumonia (CAP) in China.DesignThis was a multicentre, retrospective, observational study.Setting13 teaching hospitals in northern, central and southern China from 1 January 2014 to 31 December 2014ParticipantsInformation on hospitalised patients aged ≥14 years with radiographically confirmed pneumonia with illness onset in the community was collected using standard case report forms.Primary and secondary outcome measuresResource use for CAP management.ResultsOf 14 793 patients screened, 5828 with radiographically confirmed CAP were included in the final analysis. Low mortality risk patients with a CURB-65 score 0–1 and Pneumonia Severity Index risk class I–II accounted for 81.2% (4434/5594) and 56.4% (2034/3609) patients, respectively. 21.7% (1111/5130) patients had already achieved clinical stability on admission. A definite or probable pathogen was identified only in 12.7% (738/5828) patients. 40.9% (1575/3852) patients without pseudomonal infection risk factors received antimicrobial overtreatment regimens. The median duration between clinical stability to discharge was 5.0 days with 30-day mortality of 4.2%.ConclusionsThese data demonstrated the overuse of health resources in CAP management, indicating that there is potential for improvement and substantial savings to healthcare systems in China.Trial registration numberNCT02489578; Results.

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Association of donor age, body mass index, hemoglobin, and smoking status with in‐hospital mortality and length of stay among red blood cell–transfused recipients

Transfusion ◽

10.1111/trf.15541 ◽

2019 ◽

Vol 59 (11) ◽

pp. 3362-3370 ◽

Cited By ~ 3

Author(s):

Nareg H. Roubinian ◽

Matt Westlake ◽

Elizabeth M. St. Lezin ◽

Gustaf Edgren ◽

Don J. Brambilla ◽

...

Keyword(s):

Body Mass Index ◽

Length Of Stay ◽

Blood Cell ◽

Hospital Mortality ◽

Body Mass ◽

Red Blood Cell ◽

Smoking Status ◽

Donor Age

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Effect of Maternal Body Mass Index on Postpartum Hemorrhage

Anesthesiology ◽

10.1097/aln.0000000000002082 ◽

2018 ◽

Vol 128 (4) ◽

pp. 774-783 ◽

Cited By ~ 17

Author(s):

Alexander J. Butwick ◽

Anisha Abreo ◽

Brian T. Bateman ◽

Henry C. Lee ◽

Yasser Y. El-Sayed ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Postpartum Hemorrhage ◽

Class I ◽

Normal Body Mass Index ◽

Delivery Mode ◽

Obese Women ◽

Obesity Class ◽

Normal Body ◽

Severe Hemorrhage

Abstract Background It is unclear whether obesity is a risk factor for postpartum hemorrhage. The authors hypothesized that obese women are at greater risk of hemorrhage than women with a normal body mass index. Methods The authors conducted a cohort study of women who underwent delivery hospitalization in California between 2008 and 2012. Using multilevel regression, the authors examined the relationships between body mass index with hemorrhage (primary outcome), atonic hemorrhage, and severe hemorrhage (secondary outcomes). Stratified analyses were performed according to delivery mode. Results The absolute event rate for hemorrhage was 60,604/2,176,673 (2.8%). In this cohort, 4% of women were underweight, 49.1% of women were normal body mass index, 25.9% of women were overweight, and 12.7%, 5.2%, and 3.1% of women were in obesity class I, II, and III, respectively. Compared to normal body mass index women, the odds of hemorrhage and atonic hemorrhage were modestly increased for overweight women (hemorrhage: adjusted odds ratio [aOR], 1.06; 99% CI, 1.04 to 1.08; atonic hemorrhage: aOR, 1.07; 99% CI, 1.05 to 1.09) and obesity class I (hemorrhage: aOR, 1.08; 99% CI, 1.05 to 1.11; atonic hemorrhage; aOR, 1.11; 99% CI, 1.08 to 1.15). After vaginal delivery, overweight and obese women had up to 19% increased odds of hemorrhage or atonic hemorrhage; whereas, after cesarean delivery, women in any obesity class had up to 14% decreased odds of severe hemorrhage. Conclusions The authors’ findings suggest that, at most, maternal obesity has a modest effect on hemorrhage risk. The direction of the association between hemorrhage and body mass index may differ by delivery mode.

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