Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Basel Hospital, Basel, Switzerland.
Department of Endocrinology and Medical Oncology, Fondazione Maugeri, Pavia, Italy.
Nutr Diabetes. 2022 Mar 23;12(1):12. doi: 10.1038/s41387-022-00190-7.
Obesity is associated with an increased risk for several chronic conditions and mortality. However, there are data in support of beneficial outcome in acute medical conditions such as community-acquired pneumonia (CAP), termed "obesity paradox". The aim of this study was to test the association of BMI with clinical outcomes in a large randomized clinical trial of patients hospitalized with CAP.
In total, 773 patients hospitalized with CAP were included in this study. Patients were stratified into four groups according to their baseline BMI (underweight <18.5, normal weight 18.5-25, overweight 25-30, and obese >30 kg/m). The primary endpoint was time to clinical stability (TTCS). Secondary endpoints included 30-day mortality, ICU admission rate, CAP complications, and duration of antibiotic treatment.
BMI and TTCS had a U-shaped association with shortest TTCS among patients at an overweight BMI of 28 kg/m. In patients with obesity, there was a trend towards reduced hazards to reach clinical stability when compared to patients with normal weight (HR 0.82; 95%CI, 0.67-1.02; p = 0.07). In underweight BMI group TTCS was prolonged by 1 day (HR 0.63; 95%CI, 0.45-0.89; p = 0.008). There was no difference in mortality or ICU admission rates between BMI groups (p > 0.05). While in the underweight BMI group the total duration of antibiotic treatment was prolonged by 2.5 days (95%CI, 0.88-4.20, p = 0.003), there was no difference in patients with obesity.
The overweight BMI group had shortest time to clinical stability. While underweight patients face adverse clinical outcomes, there is neither beneficial, nor adverse outcome in patients with obesity hospitalized for CAP.
gov (registration no. NCT00973154).
肥胖与多种慢性疾病和死亡率增加有关。然而，有数据支持肥胖在急性医疗状况下的有益结果，例如社区获得性肺炎（CAP），称为“肥胖悖论”。本研究的目的是在一项大型 CAP 住院患者的随机临床试验中检验 BMI 与临床结局的相关性。
共有 773 例 CAP 住院患者纳入本研究。根据基线 BMI（体重不足<18.5、正常体重 18.5-25、超重 25-30、肥胖>30kg/m）将患者分为四组。主要终点是临床稳定时间（TTCS）。次要终点包括 30 天死亡率、ICU 入院率、CAP 并发症和抗生素治疗持续时间。
BMI 和 TTCS 呈 U 形关联，超重 BMI 为 28kg/m 的患者 TTCS 最短。与正常体重患者相比，肥胖患者达到临床稳定的风险降低（HR 0.82；95%CI，0.67-1.02；p=0.07）。体重不足 BMI 组 TTCS 延长 1 天（HR 0.63；95%CI，0.45-0.89；p=0.008）。BMI 组之间死亡率或 ICU 入院率无差异（p>0.05）。虽然体重不足 BMI 组抗生素治疗总持续时间延长 2.5 天（95%CI，0.88-4.20，p=0.003），但肥胖患者无差异。
超重 BMI 组达到临床稳定的时间最短。虽然体重不足的患者面临不良临床结局，但 CAP 住院肥胖患者既无获益，也无不良结局。
gov（注册号 NCT00973154）。
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