Obesity is associated with reduced mortality in some patients hospitalized for heart
failure (HF). In this analysis, we determine if this nonlinear relation, referred
to as the obesity paradox, extends to secondary outcomes in patients diagnosed with
severe obesity. This is a retrospective cohort study using the 2017 and 2018 National
Inpatient Sample that includes adults hospitalized for HF. Patients with diagnosis
codes specifying severe obesity, nonsevere obesity, or without obesity are compared.
The primary outcome is mortality. Secondary outcomes include the length of stay (LOS),
total charges, and cardiogenic shock (CS). Multivariate regression is used to adjust
for demographics and co-morbidities. A total of 2,439,845 hospitalizations are included.
A decreased mortality is found in nonsevere obesity (odds ratio 0.74, 95% confidence
interval 0.69 to 0.80, p = 0.000), affirming the obesity paradox. However, this decreased
mortality is not found in severe obesity (odds ratio 1.01, 95% confidence interval
0.94 to 1.08, p = 0.766). Severe obesity and nonsevere obesity are also associated
with less CS and increased LOS compared with non-obese patients. Severe obesity is
associated with increased total charges. In conclusion, a nonlinear, U-shaped relation
between obesity and mortality in patients hospitalized for HF is demonstrated, where
those not obese and those severely obese experience greater mortality compared with
the nonseverely obese. However, for secondary outcomes of CS, LOS, and total charges,
the relation is linear and therefore not interpreted as paradoxical. More information
is needed using the adiposity-based chronic disease model to characterize complex
relations between obesity and mortality.
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Article Info
Publication History
Published online: June 12, 2022
Received in revised form:
April 24,
2022
Received:
March 13,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
