Fetal growth, maternal prenatal smoking, and risk of invasive meningococcal disease: a nationwide case-control study

BACKGROUND: The prenatal period may be important for susceptibility to infections. We evaluated whether low birthweight, prematurity, and prenatal maternal smoking were associated with increased risk of invasive meningococcal disease. METHODS: We linked the Danish nationwide National Registry of Patients, the Birth Registry, and social registries to obtain data on fetal growth and social factors on 1921 cases of meningococcal disease hospitalized between 1 January, 1980 and 31 December, 1999 (median age 31 months, interquartiles 13-65 months) and 37 451 population controls. The impact of maternal smoking was examined in a subsample of 462 cases and 9240 controls born after 1990, when data on smoking became available in the Birth Registry. RESULTS: The adjusted odds ratios (OR) of meningococcal disease associated with low birthweight (<2500 g) varied between 1.6 (95% CI: 1.1, 2.3) in infants <12 months to 1.5 (95% CI: 1.0, 2.3) in children >60 months of age at hospitalization for meningococcal disease. Premature children had an increased risk of meningococcal disease during the first year of life only (adjusted OR = 1.3, 95% CI: 1.1, 1.9). The effect of low birthweight was very similar among mature and premature children. The adjusted OR for maternal smoking was 1.8 (95% CI: 1.4, 2.2). CONCLUSIONS: Low birthweight is associated with an increased risk of meningococcal disease throughout childhood, while an effect of prematurity persists only for 12 months. Maternal prenatal smoking was associated with the risk of meningococcal disease.     

Hepatitis B vaccine response in obesity: A meta-analysis

BackgroundHepatitis B vaccination is critical in preventing hepatitis B virus (HBV) infection and transmission. However, the impact of obesity on immune response to hepatitis B vaccine remains unclear.MethodsWe performed a meta-analysis of the literature and summarized the results of immune response to hepatitis B vaccine among persons with and without obesity. We used Pubmed, Embase, Web of Science and Cochrane Library to identify all related studies between January 1973 and November 2015. Unadjusted and adjusted pooled OR and 95% CI were calculated by fixed-effect model or random-effect model according to the heterogeneity of the selected studies.ResultsTotally, 16 studies contributed to the present meta-analysis. Fifteen of them provided absolute numbers of non-responders in obese group and non-obese group. Overall, we found that the obese population was significantly associated with non-response to hepatitis B vaccination (adjusted OR: 2.46, 95% CI: 1.50–4.03). Significant heterogeneity was present in most of the pooled analyses, but was markedly reduced when analyses were restricted to study reports with uniform criteria of obesity and restricted to study in adults. No publication bias was observed in the present analysis.ConclusionsThe present meta-analysis suggested that obesity is significantly associated with the decreased response to hepatitis B vaccines. Future studies should be performed to unravel this relationship in order to prevent HBV infection and transmission.     

Contraceptive choices of overweight and obese women in a publically funded hospital: possible clinical implications

BackgroundDespite the growing obesity epidemic in the United States, family planning for overweight and obese women has been understudied. The aim of this study was to describe the contraception methods selected by normal weight, overweight and obese women.Study DesignWe retrospectively reviewed 7262 charts of women who underwent first trimester surgical termination of pregnancy at the John H. Stroger, Jr. Hospital of Cook County between January 1, 2008, and January 1, 2010. We analyzed the relationship between body mass index (BMI) and choice of contraceptive method, after adjusting for age, race, smoking and level of education.ResultsWhen compared to patients with BMI <25 kg/m², overweight (BMI 25–29.9 kg/m²) and obese patients (BMI ≥30 kg/m²) were more likely to select the intrauterine device (OR 1.3, 95% CI 1.28–1.32 for overweight; OR 1.6, 95% CI 1.59–1.61 for obese), contraceptive ring (OR 1.4, 95% CI 1.28–1.52 for overweight; OR 1.6, 95% CI 1.57–1.63 for obese) and tubal ligation (OR 1.5 95% CI 1.44–1.62 for overweight; OR 2.9, 95% CI 2.79–3.01 for obese). They were less likely to choose injectable contraception (OR 0.7, 95% CI 0.59–0.81 for overweight; OR 0.52, 95% CI 0.48–0.56 for obese). There was no relationship between BMI and choice of condoms, oral contraceptive pills and implantable methods.ConclusionIn our population, the contraceptive choices of overweight and obese women differed from those of normal weight women. These differences in contraceptive selection are important to recognize in light of the potential effect of BMI on the safety and efficacy of different contraceptive methods. Further research is needed to evaluate the contraceptive preferences, risks and benefits for overweight and obese women.     

Depression and Health Service Utilization From Age 70 to 85: The Jerusalem Longitudinal Study

BackgroundHealth service utilization rises with age, and yet, its determinants are poorly understood. Our objective was to examine the association between depression and health service utilization from age 70–85.MethodsA representative sample (born 1920–1921) from the Jerusalem Longitudinal Cohort Study (1990–2010) was assessed at age 70, 78, and 85 for depression (using the Brief Symptoms Inventory); emergency room (ER) visits, and hospitalization in the previous year; social, functional, and medical domains.ResultsWe examined 414, 674, and 1118 subjects at ages 70, 78, and 85, among whom prevalence of depression was 16.2%, 21.1%, and 36.7%, respectively. ER visits and hospitalization were higher among depressed subjects. We adjusted for sex as well as financial status (social model); physical activity, going outdoors, functional status (functional model); and diabetes, ischemic heart disease, hypertension, cancer, dementia, chronic pain, and smoking (medical model). Depressed subjects were more likely to report increased ER visits, after adjustment in social, functional or medical models at age 78 (odds ratio [OR], 2.1, 95% confidence interval [CI], 1.3–3.3; OR, 1.8, 95% CI, 1.1–2.9; OR, 2.0, 95% CI, 1.26–3.26), and at age 85 (OR, 1.7, 95% CI, 1.33–2.3; OR, 1.4, 95% CI, 1.04–1.81; and OR, 1.4, 95% CI, 1.1–1.94), respectively. Aside from the social model at age 85 (OR, 1.5, 95% CI, 1.1–2.0), depression was not associated with increased likelihood of hospitalization.ConclusionsDepression at ages 78 and 85 is consistently associated with increased ER visits and should be considered among older people presenting to the ER.     

The association between maternal serious psychological distress and child obesity at 3 years: a cross-sectional analysis of the UK Millennium Cohort Data

Background The prevalence of child obesity is increasing rapidly worldwide. Early childhood has been identified as a critical time period for the development of obesity. Maternal mental health and early life environment are crucial factors and have been linked to adverse child outcomes. The objective of the study was to examine the relationship between maternal serious psychological distress and obesity in early childhood. Methods A cross‐sectional analysis of data from the Millennium Cohort Study was conducted. Subjects consisted of all natural mothers (n= 10 465) who had complete and plausible data for Kessler‐6 scores, socio‐demographic and anthropometric variables, and their children for whom anthropometric measurements were completed at age 3. Maternal serious psychological distress was defined as a score of 13 or more on the Kessler‐6 scale. Obesity was defined as body mass index ≥95th centile of the 1990 reference chart for age and sex in children. The data were analysed using spss 16. Maternal socio‐demographic factors that are known to influence maternal mental health and child obesity were identified and adjusted using multivariate logistic regression. Results Of the 10 465 mother–child dyads, 3.5% of mothers had serious psychological distress and 5.5% of children were obese at 3 years of age. Logistic regression analysis showed that maternal serious psychological distress was associated with early childhood obesity (P= 0.01; OR 1.62, 95% CI 1.11, 2.37). After adjusting for potential confounding factors using multivariate logistic regression, maternal serious psychological distress remained significantly associated with early childhood obesity (P= 0.01; OR 1.59, 95% CI 1.08, 2.34). Conclusions The results show that maternal serious psychological distress is independently associated with early childhood obesity.     

Interleukin-10 as a potential regulator of hepcidin homeostasis in overweight and obese children: A cross-sectional study in Taiwan

ObjectiveA sharp increase in the prevalence of obesity and a decline in iron deficiency in children was observed between the two consecutive Nutrition and Health Surveys in Taiwan. The aim of this study was to evaluate the distribution of hepcidin in relation to nutritional status in children.Methods648 children ages 7 to 13 y living in Taipei and New Taipei City were enrolled in this study. Parameters for obesity, iron status, and inflammatory markers were evaluated.ResultsThere were no differences in the prevalence of iron deficiency and iron depletion between normal and overweight/obese children. A V-sharp hepcidin distribution curve was seen in normal weight children and overweight/obese boys. Serum hepcidin levels remained stable in overweight/obese girls during transition from childhood to teenager. Overweight/obese children had increased serum nitric oxide (NO) and interleukin (IL)-1β but decreased IL-10 concentration compared with normal weight children. A strong inverse relationship was found between IL-10 and body mass index (BMI; odds ratio (OR), 0.86, 95% confidence interval [CI], 0.83–0.89). By contrast, positive correlations were observed between BMI and IL-1β (OR, 1.60; 95% CI, 1.29–1.98); and between BMI and NO (OR, 1.04, 95% CI, 1.02–1.07). Multivariate linear regression analysis showed serum hepcidin was significantly correlated with IL-10 (β = 0.26, P < 0.0001).ConclusionsOur results raise the possibility that IL-10 may play a role in iron homeostasis. Decreased circulating IL-10 concentration may temporary protect young overweight/obese girls against the development of iron deficiency. However, long-term decrease in hepcidin concentration may increase the risk for iron overload in overweight/obese children.     

Intelligence quotient in childhood and the risk of illegal drug use in middle-age: the 1958 National Child Development Survey

PurposeHigh childhood IQ test scores have been associated with increased alcohol dependency and use in adult life, but the relationship between childhood IQ and illegal drug use in later life is unclear.MethodsParticipants were 6713 members of the 1958 National Child Development Survey whose IQ was assessed at 11 years and had their lifetime illegal drug use measured at 42 years of age.ResultsIn analyses adjusted for a range of covariates, a 1 SD (15-point) increase in IQ scores was associated with an increased risk of illegal drug use in women: ever using cannabis (odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.16–1.45), cocaine (OR, 1.66; 95% CI, 1.21–2.27), amphetamines (OR, 1.50; 95% CI, 1.22–1.83), amyl nitrate (OR, 1.79; 95% CI, 1.30–2.46) and “magic mushrooms” (OR, 1.52; 95% CI, 1.18–1.98). Associations were of lower magnitude in men.ConclusionsIn this cohort, high childhood IQ was related to illegal drug use in adulthood.     

Physical Activity and Health Service Utilization Among Older People

BackgroundRising health care use among older people presents a challenge to medical care. Physical activity (PA) is beneficial; however, it is unknown if initiating PA among the very old reduces health service use. We examined the effects of changing PA levels on emergency room (ER) visits and hospitalization at ages 78 and 85.MethodsA representative sample (born 1920–1921) from the Jerusalem Longitudinal Cohort Study (1990–2010) were assessed at ages 78 and 85 for self-reported PA; ER visits and hospitalization; and social, functional, and medical domains.ResultsWe examined 896 and 1173 subjects at ages 78 and 85, respectively. ER usage at ages 78 and 85 respectively was lower among active subjects (15.8% vs 37.4%, P < .0001; 30.6% vs 50.8%, P < .0001), as was hospitalization (10.5% vs 16.7%, P < .05; 22.1% vs 37.8%, P < .0001). We adjusted for gender, education, loneliness, functional dependence, cognitive impairment, depression, diabetes, heart disease, hypertension, neoplasm, renal disease, self-rated health, body mass index, and smoking. PA at age 78 was associated with a reduced likelihood of ER visits (odds ratio [OR] 0.49, 95% confidence interval [CI] 0.27–0.89), but not hospitalization (OR 1.14, 95% CI 0.54–2.42); at age 85 with a reduced likelihood for ER visits (OR 0.72, 95% CI 0.52–0.99) and hospitalization (OR 0.68, 95% CI 0.48–0.98). Compared with subjects consistently active at ages 78 and 85, initiating PA between ages 78 and 85 resulted in similar lower likelihood of ER visits (OR 0.6, 95% CI 0.23–1.56) and hospitalization (OR 1.20, 95% CI 0.48–3.02); stopping PA and never being active between 78 and 85 were respectively associated with increased ER visits (OR 1.72, 95% CI 1.02–2.88; OR 2.18, 95% CI 1.04–4.57) and hospitalization (OR 1.85, 95% CI 1.06–3.23; OR 2.01, 95% CI 0.92–4.4).ConclusionsAmong the oldest old, not only continuing but also becoming physically active is associated with reduced health service use. Initiating PA among the very old should be encouraged.     

Family Meals and Diet Quality Among Children and Adolescents in North Carolina

ObjectiveTo examine the relationship between diet quality and frequency of family meals throughout childhood and adolescence.MethodsCross-sectional study of children ages birth through 17 years (n = 1,992) using data from the 2010 North Carolina Child Health and Monitoring Program. Multiple logistic regression was used to estimate the associations between family meals and fruit intake, vegetable intake, and sugar-sweetened beverage intake among younger children, older children, and adolescents.ResultsIn adjusted analyses, participating in ≥ 5 family meals/wk was associated with less sugar-sweetened beverage intake among younger (OR 2.04; CI 1.06–3.93) and older children (OR 2.12; 95% CI 1.27–3.55), greater vegetable intake among older children (OR 1.87; 95% CI 1.08–3.24) and adolescents (OR 1.81; 95% CI 1.14–2.88), and greater fruit intake among adolescents (OR 2.11; 95% CI 1.40–3.19).Conclusions and ImplicationsStrategies to encourage families to establish regular family meals early in life and continue them throughout childhood and adolescence is warranted.     

Self-reported prenatal influenza vaccination and early childhood vaccine series completion

BackgroundNo studies have examined associations between prenatal vaccination and childhood vaccination. Mothers who refuse influenza vaccinations during pregnancy report similar attitudes and beliefs to those who refuse vaccinations for their children. The objective of this study was to examine the association between self-reported prenatal influenza vaccination and early childhood vaccination.MethodsA retrospective cohort study was conducted with existing surveillance data from 4022 mothers who responded to the 2009–2011 Minnesota Pregnancy Risk Assessment Monitoring System survey and child vaccination records from the Minnesota Immunization Information Connection database. The childhood vaccine series outcome included the following vaccines: diphtheria, tetanus, and pertussis; poliovirus; measles, mumps, and rubella; Haemophilus influenzae type b (Hib); hepatitis B; varicella; and pneumococcal conjugate. To evaluate the association between self-reported prenatal influenza vaccination and early childhood vaccination, unadjusted and adjusted logistic regression was used to estimate log odds for childhood vaccination status, while margins post-estimation commands were used to obtain predicted probabilities and risk differences.ResultsVaccine series completion was 10.86% higher (95% confidence interval (CI) 7.33%–14.40%, adjusted and weighted model) in children of mothers who had a prenatal influenza vaccine compared to those who did not. For individual vaccines in the recommended series, risk differences ranged from 7.83% (95% CI 5.37%, 10.30%) for the Hib vaccine to 10.06% (95% CI 7.29%, 12.83%) for the hepatitis B vaccine.ConclusionSelf-reported prenatal influenza vaccination was associated with increased early childhood vaccination. More research is needed to confirm these results and identify potential intervention strategies.     

Early-life exposure to antibiotics and excess body weight in childhood and adolescence: A systematic review and meta-analysis

BackgroundThe association between early-life exposure to antibiotics and overweight/obesity is unclear. We conducted a systematic review and meta-analysis to address this issue.MethodsWe searched PubMed, Web of Science, Scopus, and grey literature from inception to August 10, 2022, for cohort studies investigating the association between early-life exposure to antibiotics and weight outcomes. Two independent reviewers screened studies for eligibility, extracted data, assessed risk of bias, and examined the certainty of the evidence. Random-effects meta-analyses was used for pooling the data. The review was registered in PROSPERO, CRD42021265417.ResultsWe included 42 studies and data from 28 of them were pooled in the quantitative synthesis. Overall antenatal (OR 1.10, 95% CI 1.04–1.16; 518,095 children, very low certainty) and second trimester (OR 1.11, 95% CI 1.08–1.14, 248,469 children, low certainty) exposure to antibiotics were associated with increased risk of overweight/obesity in childhood/adolescence. Overall early postnatal antibiotic exposure was also associated with increased likelihood of overweight/obesity in childhood/adolescence (OR 1.09, 95% CI 1.05–1.12, 1,488,316 children, very low certainty). The magnitude of the association increased from exposure to one (OR 1.07, 95% CI 1.00–1.15, 512,954 children) to four or more courses of antibiotics (OR 1.31, 95% CI 1.17–1.46, 543,627 children).ConclusionAntenatal and early postnatal exposure to antibiotics is associated increased likelihood of overweight/obesity, although the findings are limited by the very low certainty of evidence. We highlight the need for homogeneous prospective studies addressing potential confounding factors to further explore the link between exposure to antibiotics and the risk of excess body weight.     

Impact of obesity on influenza compared to pneumonia hospitalization outcomes

ObjectivesPrevious literature has suggested that obesity impacts mortality risk differently in bacterial versus viral infections. This study sought to further elucidate this association in pneumonia versus influenza.DesignRetrospective cohort study.Setting and participantsData were collected from the US Nationwide Readmission Database from 2013 to 2014.MethodsPatients were categorized into three weight groups: normal weight (BMI 18.5–25.0 kg/m²), obese (BMI 30–40.0 kg/m²), and morbidly obese (BMI ≥ 40 kg/m²). To minimize confounding, we excluded patients with a history of smoking, alcoholism, or chronic wasting conditions, as suggested by the Global BMI Mortality Collaboration. To further isolate obesity from baseline differences across cohorts, we performed a three-way propensity matching analysis. The association between body weight and in-hospital all-cause 30-day mortality was assessed using Cox proportional hazard regression analysis.Results132,965 influenza and 34,177 pneumonia hospitalizations were identified. For patients with influenza, obesity (hazard ratio [HR]: 1.51; 95% CI: 1.01–2.26) and morbid obesity (HR: 1.64; 95% CI: 1.10–2.44) were associated with higher in-hospital 30-day mortality compared to normal weight. For pneumonia, obesity (HR, 0.41; 95% CI, 0.20–0.84) and morbid obesity (HR, 0.49; 95% CI, 0.25–0.96) were associated with reduced 30-day mortality compared to normal weight.Conclusions and implicationsObesity may increase 30-day mortality risk during influenza hospitalization but provide mortality benefit in pneumonia, a divergent effect not adequately explained by lower admission threshold.     

Risk factors for infection/colonization caused by resistant Gram negative bacilli in critically ill patients (An observational study of 1633 critically ill patients)

ObjectiveThe objective of this study is to identify risk factors associated with multi-resistant Gram negative (RGNB) infection and colonization among critically ill patients.MethodsA prospective cohort study of all patients aged 21–90 admitted for more than 24 hours in Medical and Surgical intensive care units (ICU) at a large teaching hospital in Singapore for the period of Aug '07–Dec '09 was conducted. Patient demographics, comorbidities, antibiotics, invasive devices, and culture results were collected. Forward stepwise logistic regression analyses were done to identify risk factors associated with RGNB infection and colonization.ResultsOf the 1373 patients included in the analysis, 13.5% developed RGNB infection. A logistic regression analysis including variables with a p value of < 0.2 in the univariate analysis showed that recent surgery (OR 2.1, 95% CI 1.2–3.6), renal impairment (OR 2.9, 95% CI 1.5–5.4), liver disease (OR: 3.8, 95% CI 1.7–8.8), central line (OR 1.8, 95% CI 1.01–3.4) were independently associated with RGNB infection in the ICU. Surgery (OR 3.9, 95% CI 2.7–5.7), third-line antibiotics (carbapenem, vancomycin, linezolid) (OR 1.8, 95% CI 1.2–2.9) were independently associated with RGNB infection during their hospitalization.ConclusionThe major risk factors identified for RGNB infection and colonization in the ICU were mainly patient dependent. However, broad spectrum initial antibiotic treatment remains an important independent modifiable risk factor. Interventions aimed at reducing initial broad spectrum antibiotics are clearly needed to help control the spread of these difficult to treat infections.     

Metabolically healthy overweight/obesity and cancer risk: A representative cohort study in Taiwan

ObjectiveMany cancers are caused by overweight; however, cancer risk varies among individuals with obesity. Few studies are addressing the relationship between metabolic obesity phenotypes and cancer. This study investigates the association between metabolically healthy overweight (MHOW) or metabolically healthy obesity (MHO) and cancer incidence.MethodsIn a nationwide, representative community-based prospective cohort study, 5734 Taiwanese adults were classified into eight phenotypes according to body mass index (underweight <18.5; normal weight 18.5–23.9; overweight 24–26.9; and obese ≥27 kg/m²) and metabolic status (healthy/unhealthy). Participants with healthy cardiometabolic blood profiles included in the metabolic syndrome criteria and an absence of hypertension, diabetes, and hyperlipidemia were considered metabolically healthy. We used the Cox proportional hazards models to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (95% CI).ResultsDuring 73,389 person-years of follow-up, 428 incident cancers were identified. Compared to the participants with metabolically healthy normal weight, participants with MHOW (adjusted HR 1.39, 95% CI, 0.90–2.13) or MHO (adjusted HR 1.07, 95% CI, 0.51–2.22) had a tendency toward a higher risk of cancer. These associations were stronger in MHOW (adjusted HR 1.77, 95% CI, 1.09–2.86) or MHO (adjusted HR 1.39, 95% CI, 0.66–2.93) participants younger than 65 years.ConclusionsThis study was the first to investigate the impact of metabolic obesity phenotype on the incidence of cancer in the Taiwanese population. Even in the absence of metabolic abnormalities, overweight, and obesity may cause a modest increase in the risk of developing cancer.     

Association between underweight and overweight/obesity with oral health among independently living Brazilian elderly

ObjectivePoor oral status, represented by partial/complete tooth loss, may lead to changes in food choice, which may ultimately lead to underweight, overweight, or obesity. The aim of this study is to evaluate whether poor oral status is associated with underweight or overweight/obesity, regardless of physical activity.MethodsThis cross-sectional study is part of a major project, The Frailty in Brazilian Elderly Study, carried out in Campinas, Brazil (2008–2009). The sample was composed of 900 independent-living older adults. Complete data were available for 875 individuals including sociodemographic, self-reported amount of medications used and eating difficulty questionnaire, smoking habit, depressive symptoms, physical activity, oral examination, and anthropometric assessments according to the WHO criteria. Body mass index was used as an outcome. Multinomial logistic regression was adjusted for confounding variables.ResultsThe mean age of the sample was 72.7 y (±5.81) and the prevalence of edentulism was 47.7%. Edentate individuals not wearing dentures were more likely to be underweight [odds ratio (OR) = 3.94, 95% confidence interval (CI) 1.14–13.64] and overweight/obese (OR = 2.88, 95%CI 1.12–7.40). Males (OR = 0.56, 95%CI 0.36–0.85) and those not using medications (OR = 0.41 95%CI 0.24–0.70) were less likely to be overweight/obese. Individuals who smoke (OR = 2.62, 95%CI 1.26–5.44) were more likely to be underweight. Older individuals with family income between 3.1 and 5 minimum wage (OR = 1.69, 95%CI 1.00–2.87) were more likely to be overweight/obese.ConclusionTo our knowledge, this is one of the first studies associating poor oral health, represented by edentulism not rehabilitated with dentures, with unfavorable body mass, regardless of the two major confounders, physical activity and depression symptoms.     

Weight status and weight-related behaviors of children commencing school

ObjectiveTo describe the weight status and weight-related behaviors of children commencing school.MethodsThis study is a representative cross-sectional survey of Australian children in their first year of schooling (n = 1141) in 2010. Height and weight were measured, and parents reported their child's diet, physical activity and screen-time.Results18.7% of children were overweight/obese. Compared with non-overweight/obese peers, overweight/obese boys were 1.73 times (95% CI 1.08, 2.79) as likely to exceed recommended screen time and 2.07 times (95% CI 1.11, 3.87) as likely to eat dinner three or more times/week in front of the TV. Overweight/obese girls were twice as likely to have a TV in their bedroom (OR 2.00, 95% CI 1.12, 3.59) and usually be rewarded with sweets for good behavior (OR 1.96, 95% CI 1.09, 3.51) and were 1.65 times as likely to be inactive (95% CI 1.08, 2.55).ConclusionWe showed that many children begin school with established weight-related behaviors that occur in the home environment. The inclusion of parents and the home environment in intervention strategies will be important to support changes to reduce childhood obesity. The weight status and weight-related behaviors of children entering school may potentially be a general indicator of the overall effectiveness of obesity prevention interventions among preschool-aged children.     

Association of obesity with illness severity in hospitalized patients with COVID-19: A retrospective cohort study

BackgroundAlthough recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients.MethodsWe performed a retrospective study at a tertiary care health system of adult patients with COVID-19 who were admitted between March 1 and April 30, 2020. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m 2) and non-obese (BMI < 30 kg/m 2) cohorts. Primary outcomes were mortality, intensive care unit (ICU) admission, intubation, and 30-day readmission.ResultsA total of 1983 patients were included of whom 1031 (51.9%) had obesity and 952 (48.9%) did not have obesity. Patients with obesity were younger (P < 0.001), more likely to be female (P < 0.001) and African American (P < 0.001) compared to patients without obesity. Multivariable logistic models adjusting for differences in age, sex, race, medical comorbidities, and treatment modalities revealed no difference in 60-day mortality and 30-day readmission between obese and non-obese groups. In these models, patients with obesity had increased odds of ICU admission (adjusted OR, 1.37; 95% CI, 1.07?1.76; P = 0.012) and intubation (adjusted OR, 1.37; 95% CI, 1.04?1.80; P = 0.026).ConclusionsObesity in patients with COVID-19 is independently associated with increased risk for ICU admission and intubation. Recognizing that obesity impacts morbidity in this manner is crucial for appropriate management of COVID-19 patients.     

Mortality association between obesity and pneumonia using a dual restricted cohort model

BackgroundAn obesity survival paradox has been reported among obese patients with pneumonia.AimsTo determine the impact of obesity on pneumonia outcomes and analyze the correlation between in-hospital all-cause mortality and obesity among patients with pneumonia.MethodsThe United States Nationwide Readmissions Database (NRD) was retrospectively analyzed for patients with pneumonia from 2013 to 2014. We used a step-wise restricted and propensity score matching cohort model (dual model) to compare mortality rates and other outcomes among pneumonia patients based on BMI. Mortality was calculated by a Cox proportional hazard model, adjusted for potential confounders with propensity score matched analysis.ResultsA total of 70,886,775 patients were registered in NRD during the study period. Of these, 7,786,913 patients (11.0%) were considered obese and 1,652,456 patients (2.3%) were admitted to the hospital with pneumonia. Based on the step-wise restricted cohort model, the hazard ratio comparing the mortality rates among obese pneumonia patients to mortality rates among normal BMI pneumonia patients was 0.75 (95% CI 0.60–0.94). The propensity score matched analysis estimated a hazard rate of 0.84 (95% CI 0.79–0.90) and the hazard ratio estimated from the dual model was 0.82 (95% CI 0.63–1.07).ConclusionsWith the application of a dual model, there appears to be no significant difference in mortality of obese patients with pneumonia compared to normal BMI patients with pneumonia.