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.     

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.     

Associations between obesity severity and medical comorbidities for children with obesity in low intensity hospital intervention

BackgroundChildhood obesity has increased dramatically in the United States. Most available research has followed obesity prevalence with little attention to medical comorbidities, which could guide prevention and intervention.MethodsA retrospective chart review examined 2038 children referred to a Pediatric Weight Management Clinic providing low intensity (<26 contact hours) intervention. Linear regression examined associations between obesity severity level (I, II, III) and blood pressure percentile scores (systolic, diastolic) while controlling for gender, age group, and ethnicity. Logistical regression examined associations between obesity severity level and five medical diagnoses (hypertension, type 2 diabetes, elevated ALT, hyperlipidemia, obstructive sleep apnea), again controlling for demographics.ResultsResults revealed that children with Class III obesity severity had significantly greater risk for five of the seven medical conditions examined, with higher systolic and diastolic blood pressure scores, and higher odds for hypertension, type 2 diabetes, and obstructive sleep apnea.ConclusionThe US Preventive Services Task Force has documented the effectiveness of intensive behavioral interventions (>26 contact hours for changes in diet, exercise, screen time) for reducing obesity severity in children. Additional research is required to determine whether more intensive behavioral approaches should be added before a child’s obesity reaches the Class III level of severity in order to prevent medical comorbidities.     

The role of adipokines in the improvement of diabetic and cardiovascular risk factors within a 52-week weight-loss programme for obesity

BackgroundObesity is an independent risk factor for cardiovascular disease and diabetes weight reduction not only reduces the risk for these diseases but leads to an alteration of the circulating adipokine levels. The aim of our study was to evaluate the effect of weight loss and lifestyle changes implemented in the form of the interdisciplinary weight management programme Optifast52® on cardiovascular and diabetic risk factors and on key adipokines.Methods72 morbidly obese patients were included in the programme, which consisted of a very low-calorie diet followed by incremental food introduction and dietary stabilisation, accompanied by medical surveillance, physical activity, dietary counselling and psychological support. At baseline, and after 14, 26 and 49 weeks, risk factor profiles and adipokine levels were evaluated.Results43 patients completed the programme with an average weight reduction of about 20%. Significant improvement was observed in the lipid and diabetic laboratory panels of all patients. In addition, adiponectin levels increased significantly (7.79 vs. 12.38 μg/ml, p < 0.001), while leptin levels decreased (7.29 vs 3.09 ng/ml, p < 0.001) during the course of the programme.ConclusionIn this study, Optifast52®, a multidisciplinary programme focusing on diet and lifestyle changes, was found not only to affect a decrease in parameters associated with diabetes and cardiovascular disease, but also to ameliorate in part the obesity-related imbalance of pro- and anti-inflammatory adipokines.     

Immunity to influenza: Impact of obesity

Obesity is a health concern that is recognized as a critical factor for vulnerability to influenza A/pdmH1N1 virus infection, with epidemiological and clinical impacts. In humans, obesity induces disturbances in inflammatory and immune responses to the influenza virus and in some cases, this leads to severe complications, with fatal outcomes. Obesity impairs immunity by altering the response of cytokines, resulting in a decrease in the cytotoxic cell response of immunocompetent cells which have a key anti-viral role. Additionally, obesity seems to disturb the balance of endocrine hormones, such as leptin, that affect the interplay between metabolic and immune systems. This contribution focuses on reviewing the current epidemiologic data for the immune response to immunity in obese humans and animal models. In doing so, we aim to provide potential mechanisms to enhance immunity to influenza A/pdmH1N1 virus infection and protective factors in obese people.     

含糖饮料摄入模式与儿童肥胖关联的纵向研究

目的 探讨童年期不同含糖饮料(sugar-sweetened beverages,SSBs)摄入模式对儿童肥胖的影响,旨在为预防和控制儿童超重或肥胖提供新的流行病学证据.方法 采用方便抽样方法,于2016年在安徽省蚌埠市2所小学建立儿童随访队列,每年随访1次,共随访3次.基线有1263名儿童参加调查,3次随访后最终有9...     

小儿单纯性肥胖与出生体重

目的:了解出生体重与小儿单纯性肥胖的关系。方法:回顾性研究6~10岁的50例巨大儿与小儿肥胖的关系,并与100例正常儿对照,对身长、体重定期随访,父母进行问卷调查。结果:6~10岁的50例巨大儿肥胖率为24%,高于对照组(7%),并且除外遗传、喂养、代谢性疾病等因素。结论:巨大儿与小儿肥胖有关。     

The association between obesity and pressure ulcer development in critically ill patients: A prospective cohort study

BackgroundPressure ulcers (PUs) are one of the leading potentially preventable adverse events in the hospital. Critically ill patients are at risk for the development of PUs. The primary aim of the study was to investigate the relation of PUs and obesity in critically ill ICU patients.MethodsA single center prospective cohort study was conducted on adult patients with obesity (defined as a body mass index BMI ≥ 30 kg/m²) and patients without obesity (BMI 18?25 kg/m²) admitted to the intensive care unit between May 2013 and July 2017 with an ICU length of stay of at least 3 days without pre-existing PUs at admission.Results851 of 1205 patients (70.6%) had a normal BMI and 354 (29.4%) had a BMI ≥ 30 kg/m² and were considered obese. Overall, 157 patients (13.0%) developed PUs; 112/851 (13.2%) of patients without obesity and 45/354 (12.7%) of patients with obesity (p = 0.907). There was no difference in the severity (p = 0.609) and PU location (p = 0.261). Mean days to PU development was 11.1; 11.7 days for patients without obesity and 9.5 days for patients with obesity (p = 0.270). Mean days to PU recovery was 13.2, which was 14.1 days for patients without obesity and 10.8 days for patients with obesity (p = 0.215). A multivariate logistic regression model showed no significant correlation between the occurrence of PUs in the ICU and obesity (OR 0.875 with 95% CI 0.528–1.448, p = 0.594). Subgroup analysis showed that patients with morbid obesity (BMI ≥ 40 kg/m²) developed PUs earlier during ICU admission when compared to patients without obesity (p = 0.004).ConclusionOur study demonstrates that obesity is not an independent risk factor for the development of PUs in the ICU. However, patients with morbid obesity might develop PUs earlier compared to patients without obesity.     

Postpartum weight retention in relation to gestational weight gain and pre-pregnancy body mass index: A prospective cohort study in Vietnam

BackgroundThe prevalence of maternal overweight and obesity is increasing in Asia. This study prospectively investigated the association between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and 12-month postpartum weight retention (PPWR) in a large cohort of Vietnamese mothers.MethodsOf the 2030 pregnant women recruited from three cities in Vietnam at 24–28 weeks of gestation, a total of 1666 mothers were followed up for 12 months after delivery and available for analysis. The outcome variable PPWR was determined by subtracting the pre-pregnancy weight from the 12-month postpartum measured weight, while GWG and pre-pregnancy BMI were classified according to the Institute of Medicine and WHO criteria for adults, respectively. Linear regression models were used to ascertain the association between pre-pregnancy BMI, GWG and PPWR accounting for the effects of plausible confounding factors.ResultsBoth pre-pregnancy BMI and GWG were significantly associated with PPWR (P < 0.001). The adjusted mean weight retention in underweight women before pregnancy (3.71 kg, 95% confidence interval (CI) 3.37–4.05) was significantly higher than that in those with normal pre-pregnancy weight (2.34 kg, 95% CI 2.13–2.54). Women with excessive GWG retained significantly more weight (5.07 kg, 95% CI 4.63–5.50) on average at 12 months, when compared to mothers with adequate GWG (2.92 kg, 95% CI 2.67–3.17).ConclusionsBeing underweight before pregnancy and excessive GWG contribute to greater weight retention twelve months after giving birth. Interventions to prevent postpartum maternal obesity should target at risk women at the first antenatal visit and control their weight gain during the course of pregnancy.     

儿童肥胖对高血压发病率影响的随访研究

目的 探讨儿童肥胖状态及肥胖状态的改变对其高血压发病率的影响.方法 采取前瞻队列研究的方法,抽取2004年北京市儿童青少年代谢综合征队列人群中2189名6～16岁血压正常儿童,于2010年12月对其随访,进行身高、腰围(WC)、体重和血压的测量.分别以体质指数(BMI)和WC作为评价超重、肥胖、腹型肥胖的指标.以不同肥胖状态组设置哑变量,以随访时点是否高血压作为结局变量,进行非条件logistic回归分析,分析基线肥胖状态及肥胖状态的改变与高血压发病率之间的关系,并计算相应的OR值及95%CI值.结果 共完成了1184名在校学生的随访,6年间高血压累积发病率为19.9%(236/1184).男性高血压发病率(23.2%,149/643)高于女性(16.1%,87/541) (χ2=9.257,P=0.002).基线非超重组、超重组、肥胖组随访期间高血压累积发病率分别为8.7%(45/519)、19.3%(35/181)、32.4%(156/484)(χ2=9.332,P<0.001),基线非肥胖组与腹型肥胖组随访期间高血压累积发病率分别为10.3%(63/613)、30.7%(173/567) (χ2=77.753,P<0.001).基线肥胖组的高血压发病危险高于基线非超重组(BMI:OR=4.9,95%CI:3.4～7.0)和基线非肥胖组(WC:OR=3.9,95%CI:2.8～5.3);基线时BMI、WC水平相同时,随访时BMI、WC水平增加,高血压发病危险增加.控制年龄、性别,基线BMI和WC每增加1 kg/m2和1 cm,高血压发病风险分别增加0.21和0.07倍,OR(95%CI)值分别为1.21(1.16～1.26)和1.07(1.05～1.09);随访时BMI和WC改变量每增加1 kg/m2和1 cm,高血压发病风险分别增加0.16和0.05倍,OR(95%CI)值分别为1.16(1.11～1.22) 和1.05(1.03～1.07).结论 儿童肥胖及肥胖水平升高的改变会增加其高血压发病风险.

Abstract：

Objective To explore the impact of obesity level and the level change in childhood on hypertension incidence.Methods A perspective cohort study was conducted.As part of Beijing Child and Adolescent Metabolic Syndrome Study,2189 aged 6-16 year non-hypertensive children was followed up in December,2010.In this study,height,weight,waist circumference (WC) and blood pressure was measured at follow-up,and body mass index (BMI) and WC was respectively used to assess overweight,obesity and abdominal obesity.Non-conditional logistic regression was used to evaluate the association between baseline obesity status, change of obesity status and hypertension incidence. OR and 95%CI were computed in the model using obese status as dummy variable and hypertension at follow up visit as dependent variable.Results The total hypertension incidence of 1184 subjects during 6 years follow-up was 19.9%(236/1184).The hypertension incidence in male (23.2%,149/643) was higher than that in female (16.1%,87/541) (χ2=9.257,P=0.002).The hypertension incidence of non-overweight,overweight and obese children at baseline was 8.7%(45/519),19.3%(35/181) and 32.4%(156/484)respectively (χ2=9.332,P<0.001),and the incidence of non-obese and abdominal obese children at baseline was respectively 10.3%(63/613) and 30.7%(173/567) (χ2=77.753,P<0.001).Hypertension incidence in the baseline obesity group was higher than the non-overweight (BMI:OR=4.9,95%CI:3.4-7.0) and non-obese group (WC:OR=3.9,95%CI: 2.8-5.3).The hypertension incidence increased with the follow-up BMI/WC level,based on the same baseline level of BMI and WC.The hypertension risk increased to 0.21 and 0.07 times respectively with elevation of baseline BMI level by 1 kg/m2 and WC level by 1 cm,and OR(95%CI) were 1.21(1.16-1.26) and 1.07(1.05-1.09),respectively.Similarly,the hypertension risk increased 0.16 and 0.05 times respectively with the elevation of BMI level change by 1 kg/m2 and 1 cm,and OR (95%CI) were 1.16(1.11-1.22) and 1.05(1.03-1.07),respectively.Conclusion Obesity and increased obesity level change in childhood can increase the risk of incident hypertension.     

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.     

巨大儿与单纯性肥胖症的相关性分析

[目的 ]　探讨巨大儿与婴幼儿、青少年单纯性肥胖的关系。　 [方法 ]　对 6～ 14岁的 132例巨大儿、5 0 0例正常对照儿及其双亲作了身高和体重的人体测量学检查 ,并对以往超重肥胖情况采用了回顾性问卷调查 ;对婴儿期 5 0例巨大儿 ,15 0例对照儿于 1岁内作了身长体重测量的定期随访。　 [结果 ]　 6～ 14岁时巨大儿组肥胖率 16 .3% ,高于对照组的 8.6 % (P <0 .0 5 ) ,巨大儿组超重率 10 .9% ,略高于对照组的 9.8% ,且与遗传因素无明显的相关性。肥胖和超重在婴儿期最多 ,在学龄前期 ,随着年龄的增加 ,人数逐渐减少 ,但在各年龄段巨大儿组和对照组的肥胖和超重率差异均有显著性。　 [结论 ]　胎儿期肥胖易导致婴幼儿期肥胖 ,与青少年肥胖有一定的相关性     

上海市成年双生子健康生活方式与肥胖的关联研究

目的分析上海市成年双生子健康生活方式的数量与超重/肥胖及腹型肥胖的关联。方法使用2017-2018年上海市双生子项目第二轮调查数据, 通过病例对照的研究设计分析健康生活方式与肥胖的关联, 并进一步利用双生子配对控制遗传等混杂因素。结果共纳入7 864名(3 932对)成年双生子。同卵双生子配对病例对照分析显示, 与0～2种健康生活方式者相比, 有3种和4～5种健康生活方式者患超重/肥胖的风险分别降低49%(OR=0.51, 95%CI:0.28～0.93)和70%(OR=0.30, 95%CI:0.13～0.69), 患腹型肥胖的风险分别降低17%(OR=0.83, 95%CI:0.44～1.57)和66%(OR=0.34, 95%CI:0.14～0.80);并且每增加1种健康生活方式, 患超重/肥胖的风险降低41%(OR=0.59, 95%CI:0.42～0.85), 患腹型肥胖的风险降低37%(OR=0.63, 95%CI:0.44～0.90)。结论健康生活方式的数量与超重/肥胖及腹型肥胖均相关, 数量越多, 患病风险越低。