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Cited by 318Sepsis Diagnosis and TreatmentObesity, Physical Activity, DietClinical Nutrition and Gastroenterology

Impact of Body Mass Index on Outcomes Following Critical Care

Tremblay, Alain, Bandi, Venkata·2003·Chest
DOI 10.1378/chest.123.4.1202
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Abstract

Study objectives To determine the impact of body mass index (BMI) on outcomes in critically ill patients.Design Retrospective analysis of a large multi-institutional ICU database.Measurements The influence of BMI classification (underweight, < 20 kg/m(2); normal [control subjects], 20 to 25 kg/m(2); overweight, 25 to 30 kg/m(2); obese, 30 to 40 kg/m(2); severe obesity, > 40 kg/m(2)) on hospital survival, functional status at hospital discharge, and ICU/hospital length of stay (LOS) was analyzed via multivariate analysis, adjusting for age, gender, type of hospital admission, and severity score (ie, simplified acute physiologic score [SAPS] II and mortality prediction model [MPM] at time zero). Univariate analysis also was performed according to the quartile of the severity score. All comparisons were to the normal BMI group.Results Of 63,646 patient datasets, 41,011 were complete for height, weight, and at least one of the two severity scores. We found increased mortality in underweight patients (odds ratio [OR] of death: SAPS group, 1.19; MPM group, 1.26) but not in overweight, obese, or severely obese patients. ICU and hospital LOS were increased in both the severely obese (OR of discharge: ICU, 0.81 and 0.84, respectively; hospital, 0.83 and 0.87, respectively) and underweight groups (OR of discharge: ICU, 0.96 and 0.94, respectively; hospital, 0.91 and 0.90, respectively). Only in the SAPS group did the obese group have increased ICU LOS (OR, 0.96) and hospital LOS (OR, 0.96). Functional status at discharge was impaired in underweight patients (OR of disability: ICU, 1.11; hospital, 1.19). Overweight patients had decreased discharge disability (OR of disability: SAPS, 0.93; MPM, 0.94), while the results in the obese group were discordant between the two severity score groups (SAPS, not significant; MPM, 0.91; p < 0.05 for all ORs).Conclusions Low BMI, but not high BMI, is associated with increased mortality and worsened hospital discharge functional status. LOS is increased in severely obese patients and, to a lesser extent, in underweight patients. Patients in the overweight and obese BMI groups may have improved mortality and discharge functional status.

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  • Lower rates of obesity in active subjects suggest that leisure-time activity had a positive effect on BMI and weight, and support a relationship between physical inactivity and the development of overweight and obesity.

    “The lower rates of obesity in the active subjects also suggest that leisure-time activity had a positive effect on BMI and weight, and support a relationship between physical inactivity and the development of overweight and obesity 34 .”

    From Overweight and obesity in a Swiss city: 10-year trends (2007) · cites this paper as [34]

  • Haapanen et al. found that increased physical activity was associated with small body mass gain and low physical activity, and decreasing activity during 10-year follow-up was strongly associated with large body mass gain.

    “Haapanen et al. 34 found that increased physical activity was associated with small body mass gain and low physical activity, and, in particular, decreasing levels of activity during a 10-year follow-up period was strongly associated with large body mass gain.”

    From Overweight and obesity in a Swiss city: 10-year trends (2007) · cites this paper as [34]

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Authors
Tremblay, A., & Bandi, V.
Affiliations
Baylor College of Medicine (US)
ORCID
Tremblay, Alain
Venue
Chest
Publisher
Elsevier BV
Published
2003-04
Volume
123
Issue
4
Pages
1202-1207
ISSN
0012-3692 (ISSN-L)
DOI
10.1378/chest.123.4.1202
OpenAlex
W2137566276
Cited by
318
References
25
Citations by year
2026: 1 · 2025: 5 · 2024: 11 · 2023: 8 · 2022: 11 · 2021: 18 · 2020: 10 · 2019: 10 · 2018: 7 · 2017: 8 · 2016: 20 · 2015: 18 · 2014: 25 · 2013: 18 · 2012: 21
FWCI
10.16
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • CHEST Journal (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Keywords
body mass index, obesity, underweight, critically ill patients, intensive care unit outcomes, mortality, length of hospital stay, functional status at discharge, severity scoring, SAPS II, mortality prediction model
MeSH terms
Adult, Body Weight, Female, Health Status Indicators, Humans, Length of Stay, Male, Middle Aged, Retrospective Studies, Severity of Illness Index, Body Mass Index, Multivariate Analysis, Logistic Models, Critical Illness, Hospital Mortality

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