The obesity paradox in ICU patients
Abstract
Excessive weight is connected with an increased risk of certain life-threatening diseases. However, some evidence shows that among patients with chronic diseases such as heart failure (HF) chronic kidney disease (CKD) and COPD, increased weight is paradoxically associated with a decreased risk of mortality. This counterintuitive phenomenon is referred to as the obesity paradox. The obesity paradox has been mostly observed among certain cohorts of patients with HF, but not specific to patients in the Intensive Care Unit (ICU) setting. This paper studies the relationship between obesity and mortality of ICU patients with and without HF and presents evidence supporting the existence of this paradox. The results provide helpful insights for developing more patient-centric care in ICUs. Additionally, we use both the MIMIC-II and (recently available) MIMIC-III databases, for which few comparative studies exist to date. We demonstrate an aspect of consistency between the databases, providing a significant step towards validating the use of the newly announced MIMIC-III in broader studies.
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An earlier meta-analysis showed that early EN was associated with reduced mortality.
“An earlier meta-analysis [126] showed that early EN was associated with reduced mortality.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [126]
Cites
The relationship between obesity and mortality in patients with heart failure
Horwich, T. B., Fonarow, G. C., Hamilton, M. A., MacLellan, W. R., Woo, M. A., & Tillisch, J. H. (2001) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01448-6 · Cited by 867 · see citing works
Does obesity shorten life? The importance of well-defined interventions to answer causal questions
Hernán, M. A., & Taubman, S. L. (2008) · International Journal of Obesity · doi:10.1038/ijo.2008.82 · Cited by 384 · cited 1× · see citing works
“As Hernan [34] notes, obesity lacks many qualities of an ordinary treatment, such as a drug or surgical intervention.”
BackgroundLissin, L. W., Gauri, A. J., Froelicher, V. F., Ghayoumi, A., Myers, J., & Giacommini, J. (2002) · Journal of Cardiac Failure · doi:10.1054/jcaf.2002.126812 · Cited by 94 · see citing works
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ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
- Authors
- Pan, J., Shaffer, R., Sinno, Z., Tyler, M., & Ghosh, J.
- Affiliations
- The University of Texas at Austin (US)
- Venue
- 2017 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC)
- Publisher
- IEEE
- Published
- 2017-07
- Volume
- 2017
- Pages
- 3360-3364
- ISSN
- 2375-7477 (ISSN-L)
- OpenAlex
- W2755846328
- Cited by
- 20
- References
- 3
- Citations by year
- 2024: 1 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 7 · 2019: 5 · 2018: 2
- FWCI
- 6.79
- Type
- conference paper
- Language
- en
- Open access
- closed
- Locations
- Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity paradox, intensive care unit patients, mortality, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, MIMIC-II, MIMIC-III, database consistency, patient-centered care
- MeSH terms
- Critical Care, Heart Failure, Humans, Intensive Care Units, Obesity, Body Mass Index
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