Department of General, Gastrointestinal, Colorectal and Oncological Surgery, Faculty of Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
Department of Vascular and Internal Diseases, Faculty of Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Poland.
Clin Nutr. 2019 Feb;38(1):412-421. doi: 10.1016/j.clnu.2017.12.005. Epub 2017 Dec 20.
Overweight and obesity are, on the one hand, recognized as risk factors for many health-related disorders, and, on the other, as favorable prognostic factors in various patients treated for several different conditions; what is called the "obesity paradox". Until now, the existence of this phenomenon among a general population of consecutive inpatients has not been evaluated. We decided, therefore, to perform an evaluation.
Historical prospective analysis of the medical documentation of 23 603 hospitalizations during two consecutive years in one center was performed. The outcomes measured were as follows: length of stay, in-hospital all-cause mortality, and non-scheduled readmission in the 14-day, 30-day and one-year periods following discharge.
Overweight and obese patients had a lower or similar prevalence of the measured outcomes than malnourished patients and those of normal weight. Adjustment of the standard WHO BMI ranges for patients aged ≥65 y (normal weight BMI range 23-33 kg/m) made these differences more apparent. In logistic regression, the ratio of fat to fat-free body mass was a stronger and unfavorable risk factor compared with BMI for the measured outcomes.
The greatest risk of all-cause in-hospital death and readmission concerned malnourished inpatients. Compared to patients with a normal BMI range, overweight and obesity had a lower or similar (but not greater) risk of the outcomes measured. However, due to several BMI limitations, our observations should be interpreted as suggesting a "BMI paradox", rather than an "obesity paradox".
超重和肥胖一方面被认为是许多与健康相关的疾病的危险因素，另一方面在治疗各种不同疾病的患者中被认为是有利的预后因素；这就是所谓的“肥胖悖论”。到目前为止，尚未评估这种现象在连续住院的一般人群中是否存在。因此，我们决定进行评估。
对一个中心连续两年的 23603 例住院患者的医疗记录进行了历史前瞻性分析。测量的结果如下：住院时间、院内全因死亡率以及出院后 14 天、30 天和 1 年的非计划再入院。
超重和肥胖患者的测量结果的发生率低于或与营养不良患者和体重正常患者相似。对年龄≥65 岁的患者进行标准 WHO BMI 范围调整（正常体重 BMI 范围为 23-33kg/m）后，这些差异更为明显。在逻辑回归中，与 BMI 相比，体脂与去脂体质量的比值是更强烈和不利的预后因素。
所有院内死亡和再入院的最大风险都与营养不良的住院患者有关。与正常 BMI 范围的患者相比，超重和肥胖患者的测量结果的风险较低或相似（但不是更高）。然而，由于 BMI 存在几个局限性，我们的观察结果应被解释为提示“BMI 悖论”，而不是“肥胖悖论”。
