Obesity paradox in patients with community-acquired pneumonia: Is inflammation the missing link?
Abstract
Objective Positive associations between body mass index (BMI) and clinical outcomes have been found and are called "the obesity survival paradox." However, whether obesity has protective effects or if this paradox is because of confounding remains unclear. Herein, we analyzed the effects of weight on long-term mortality in a large cohort of patients with community-acquired pneumonia (CAP) and investigated whether the differential effects of obesity on inflammation pathways accounted for mortality differences. Methods For this secondary analysis, we followed prospectively for 6 y 763 CAP patients who were previously included in a multicenter trial (the ProHOSP Trial). To assess associations of BMI with mortality and with several inflammatory biomarker levels, we calculated three regression models adjusted for severity: the pneumonia severity index (PSI); fully adjusted for PSI, age, sex, metabolic factors, cardiovascular diseases, and other comorbidities; and fully adjusted including biomarker levels. Results Within the 763 patients studied, all-cause 6-y mortality was significantly lower in obese patients (BMI >30 kg/m 2 ) compared with normal-weight patients (BMI 18.5-25 kg/m 2 ), with a severity-adjusted hazard ratio of 0.641 (95% confidence interval 0.462-0.889) and robust results in fully adjusted and fully adjusted plus biomarker models. No associations of increased BMI and C-reactive protein, procalcitonin, or white blood cell count were found, but BMI > 30 kg/m 2 was a…
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Markers of inflammation (i.e., C-reactive protein) have been shown to correlate with disease-related anorexia, reduced food intake, and muscle catabolism, and to predict lack of response to nutritional treatment.
“Markers of inflammation (i.e.C-reactive protein [CRP]) have been shown to correlate with disease-related anorexia, reduced food intake and muscle catabolism, and at the same predict lack of response to nutritional treatment [147,190,191].”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [191]
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Merker, M., Felder, M., Gueissaz, L., Bolliger, R., Tribolet, P., Kägi-Braun, N., Gomes, F., Hoess, C., Pavlicek, V., Bilz, S., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.0663 · Cited by 262 · see citing works
Self-citationESPEN guideline on nutritional support for polymorbid medical inpatients
Wunderle, C., Gomes, F., Schuetz, P., Stumpf, F., Austin, P., Ballesteros-Pomar, M. D., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.06.023 · Cited by 105 · see citing works
“Markers of in fl ammation (i.e. C-reactive protein [CRP]) have been shown to correlate with disease-related anorexia, reduced food intake and muscle catabolism, and at the same predict lack of response to nutritional treatment [147,190,191].”
- Authors
- Braun, N., Hoess, C., Kutz, A., Christ-Crain, M., Thomann, R., Henzen, C., Zimmerli, W., Mueller, B., & Schuetz, P.
- Affiliations
- Kantonsspital Münsterlingen (CH)
- Kantonsspital Aarau (CH)
- Solothurner Spitäler (CH)
- Luzerner Kantonsspital (CH)
- Venue
- Nutrition
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 33
- Pages
- 304-310
- ISSN
- 0899-9007 (ISSN-L)
- OpenAlex
- W2484340948
- Cited by
- 49
- References
- 0
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 14 · 2021: 6 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 5
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nutrition (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
- Keywords
- obesity paradox, community-acquired pneumonia, body mass index, long-term mortality, inflammation, inflammatory markers, proadrenomedullin, C-reactive protein, procalcitonin, white blood cell count, Pneumonia Severity Index, confounding
- MeSH terms
- C-Reactive Protein, Calcitonin, Follow-Up Studies, Humans, Leukocyte Count, Mortality, Obesity, Pneumonia, Prospective Studies, Protein Precursors, Risk, Severity of Illness Index, Switzerland, Cohort Studies, Biomarkers, Comorbidity, Body Mass Index, Survival Analysis, Community-Acquired Infections, Models, Immunological, Inflammation Mediators, Adrenomedullin
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