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Mortality risk

“Obesity paradox” protects against pneumonia

Obese patients are significantly more likely to survive a pneumonia hospitalisation than normal weight patients. Photo: Flickr / scottfeldstein
4% of obese patients hospitalised with pneumonia died from condition, compared with 10% of normal weight patients
Researcher suggests inflammatory mechanism protects patients against pneumonia

Obese patients are more likely to survive being hospitalised with pneumonia, according to new research published in Clinical Microbiology and Infection.

Studying patients who were admitted over a two-year period to hospitals in Edmonton, Canada, the study found that those who were obese had a lower in-hospital mortality rates due to pneumonia.

While 10% of normal weight patients hospitalised with pneumonia died of the condition, only 4% of the obese patients did, meaning there was a 54% reduction in mortality associated with obesity.

Sharry Kahlon, Faculty of Medicine researcher at the University of Alberta, said that the results described one of the first examples of the obesity paradox - the idea that overweight can confer health benefits in some areas, while being damaging in others - being expressed in an acute, rather than a chronic condition.

"The thinking usually is obesity equals bad and this research demonstrated something different,” said Kahlon. “It shows that perhaps we're not looking at obesity in the right way. Is all fat bad? Is all fat equal? For acute illnesses, maybe we're not looking at the right indicators for body mass index and obesity."

The results led Kahlon to suggest that there may be a protective influence of higher BMIs that required further study and understanding.

"It might be a misregulation of the inflammatory system that allows these individuals to do better," she said. "These mechanisms still need to be better studied."

A total of 907 patients who were admitted with pneumonia and had their BMI measured were identified for the study. 9% were underweight, 39% were normal weight, 25% were overweight and 25% were obese.

In total, 9% of patients who were admitted later died from pneumonia: 14% of the underweight patients, 10% of the normal weight patients, 9% of the overweight patients, and 4% of the obese patients.

The adjusted odds ratio for obese patients dying of pneumonia, compared to normal weight patients, was 0.46 (95% confidence interval, 0.22-0.94; p=0.04).

Neither underweight (OR 1.13, 95% CI 0.54-2.4; p=0.7) nor overweight (OR 0.94, 95% CI 0.52-1.69; p=0.8) were associated with a significantly altered in-hospital mortality.

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