Obesity and Mortality in Critically Ill Adults: A Systematic Review and Meta‐analysis

Oliveros, Henry; Villamor, Eduardo

doi:10.1038/oby.2007.102

Cited by 244 publications

(203 citation statements)

References 34 publications

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“…Similar to inconsistent relationship mortality and MV, the data for ICU and hospital LOS varies as well. Some studies reports a higher ICU and hospital LOS across all BMI groups [20,23] while others reports no correlation [17]. In our study although the Hospital LOS were similar between BMI groups, The ICU LOS was higher in severely obese patients.…”

Section: Icu Los (Mean ± Sd)contrasting

confidence: 52%

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Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

Venkatram¹,

Rapaka²,

Anwer³

et al. 2013

Intern Med Inside

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Background: The relationship between body mass index and outcome in the intensive care unit is controversial. The objective was to evaluate the incidence and effect of different body mass indexes on mortality, duration of mechanical ventilation, intensive care unit and hospital length of stay among critically ill medical patients. Methods: Retrospective, single center study in a medical intensive care unit of an inner city teaching hospital. All patients with available BMI levels on admission were included. Results: There were 1,988 patients admitted to the intensive care unit between January to December 2008; 1,797 (90.3%) were analyzed. Based in body mass index, 162 (9%) patients were underweight, 598 (33%) normal, 774 (43%) overweight/ obese and 263 (14.6%) severe obesity. Patients with obesity/severe obesity were more likely to be female (p<0.0001); to have hypertension (p=<0.0001), diabetes mellitus (p=<0.0001) and obstructive sleep apnea (p=<0.0001) as comorbid conditions. Severely obese patients had lower APACHE IV scores (66 ± 33 vs. 71 ± 32, p=0.035) and higher like hood of mechanical ventilation (105 (40%) vs. 180 (28%), p=<0.0007) when compared to normal. Underweight patients were sicker (APACHE IV 80 ± 32 vs. 71 ± 32, p=0.002) and more likely to have HIV infection (55 (36.6%) vs. 164 (26%), p=0.008) and cancer (22 vs. 51, p=0.017) compared to normal. Neither underweight, obesity nor severe obesity were associated with an increased risk of hospital mortality, (odd ratio=1.162; 95% confidence interval, 0.57-2.34 for underweight, odd ratio=1.04; 95% confidence interval, 0.62-1.75 for overweight/obese, odd ratio=1.23; 95% confidence interval, 0.64-2.39 for severe obesity). There were no differences in hospital length of stay or days on mechanical ventilation between the different body mass index groups. However, intensive care unit length of stay were significantly longer in the severe obese group by 1.2 days (95% confidence interval, 1.00-1.09; p=0.0015) compared with all the other groups. Conclusion: Body mass index in critically ill inner city patients is not associated with increased mortality. Severely obese patients have a longer intensive care unit length of stay, but not hospital stay. In our inner city MICU population, the prevalence of obesity and severe obesity is higher than reported.

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Section: Icu Los (Mean ± Sd)contrasting

confidence: 52%

“…The association of BMI with mortality in the intensive care unit (ICU) is controversial with reports suggesting no relation [11][12][13], increased [14][15][16] or decreased hospital mortality [17]. The role of BMI for length of stay (LOS) on mechanical ventilation (MV) and ICU LOS is equally inconsistent [11,[18][19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

Venkatram¹,

Rapaka²,

Anwer³

et al. 2013

Intern Med Inside

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“…Similarly, dyslipidaemia, often encountered in obesity and an essential part of the metabolic syndrome, is also known to be an independent risk factor for the development of sepsis and increased mortality (12) . Indeed the risk of death from multiorgan failure was shown to be greater in obese patients than in patients with normal weight (13,14) . A study on obese women clearly showed that a reduction in adipose tissue mass, achieved by consuming 2520 kJ/day for 10 weeks, substantially reduced the ability of adipose tissue to produce TNFa, IL-6, IL-8 and leptin (15) .…”

Section: Influence Of Adipose Tissue Mass On Inflammatory Stressmentioning

confidence: 99%

The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity

Grimble

2010

Proc. Nutr. Soc.

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The objective of the present review is to provide an overview of the metabolic effects of pro-inflammatory cytokine production during infection and injury; to highlight the disadvantages of pro-inflammatory cytokine production and inflammatory stress on morbidity and mortality of patients; to identify the influence of genetics and adiposity on inflammatory stress in patients and to indicate how nutrients may modulate the inflammatory response in patients. Recent research has shown clearly that adipose tissue actively secretes a wide range of pro- and anti-inflammatory cytokines. Paradoxically, although inflammation is an essential part of the response of the body to infection, surgery and trauma, it can adversely affect patient outcome. The metabolic effects of inflammation are mediated by pro-inflammatory cytokines. Metabolic effects include insulin insensitivity, hyperlipidaemia, muscle protein loss and oxidant stress. These effects, as well as being present during infective disease, are also present in diseases with a covert inflammatory basis. These latter diseases include obesity and type 2 diabetes mellitus. Inflammatory stress also increases during aging. The level of cytokine production, within individuals, is influenced by single nucleotide polymorphisms (SNP) in cytokine genes. The combination of SNP controls the relative level of inflammatory stress in both overt and covert inflammatory diseases. The impact of cytokine genotype on the intensity of inflammatory stress derived from an obese state is unknown. While studies remain to be done in the latter context, evidence shows that these genomic characteristics influence morbidity and mortality in infectious disease and diseases with an underlying inflammatory basis and thereby influence the cost of in-patient obesity. Antioxidants andn-3 PUFA alter the intensity of the inflammatory process. Recent studies show that genotypic factors influence the effectiveness of immunonutrients. A better understanding of this aspect of nutrient–gene interactions and of the genomic factors that influence the intensity of inflammation during disease will help in the more effective targeting of nutritional therapy.

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“…9 Others question whether obese patients receive higher levels of care because of a perceived poor prognosis. 5 Future studies should differentiate extremes of weight (underweight, super obese) into separate categories to understand whether results are influenced by these potential confounders. A final question to raise is whether BMI is the correct variable to study in the first place.…”

Section: See the Original Study On Page 983mentioning

confidence: 99%

“…Data from the medical literature is inconsistent. Multiple meta-analyses suggest a lower mortality rate among critically ill obese subjects, [5][6][7] known as the obesity paradox. Oliveros and Villamor 5 showed a lower risk of mortality among medical and surgical ICU subjects with a body mass index (BMI) between 18.5 and 24.9 kg/m 2 compared with those with a BMI between 30 and 39.9 kg/m 2 .…”

mentioning

confidence: 99%

A Paradox Defined?

Shipe

2015

Respir Care

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Obesity and Mortality in Critically Ill Adults: A Systematic Review and Meta‐analysis

Cited by 244 publications

References 34 publications

Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

Body mass index have no effect in hospital mortality or intensive care outcomes in an inner city population

The true cost of in-patient obesity: impact of obesity on inflammatory stress and morbidity

A Paradox Defined?

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