Obesity paradox not observed in large cohort of critically ill patients on early enteral nutrition

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as presented at the Annual Congress of the Society of Critical Care Medicine

The obesity paradox in the intensive care unit (ICU) has been described as improved survival for obese critically ill patients compared to those with normal body mass index (BMI). But according to an oral presentation at SCCM, held in January in Phoenix, Arizona, the obesity paradox was not observed in a large cohort of critically ill patients on early enteral nutrition. These data suggest that early enteral nutrition modifies the relationship between BMI and mortality among the critically ill.

Investigators at the University of Maryland Medical Center, Baltimore, and colleagues, examined the Philips eICU Research Institute database, composed of patients in tele-ICU programs between 2004 and 2014 within the US. Adults with an APACHE IV score and BMI were included. A total of 1,163,234 ICU stays from 292 units were included with an average age of 63.3 years, APACHE IV score of 54.2, and hospital mortality of 8.6%.

According to the data, compared to patients within a normal range of BMI (18.5–24.9), hospital mortality was elevated among the underweight (BMI <18.5) (risk ratio [RR] 1.22) and reduced among BMI groups 25-29.9 (RR 0.89), 30-34.9 (RR 0.88), 35-39.9 (RR 0.88), and 40-49.9 (RR 0.91). However, among the 85,177 patients on early enteral nutrition, no reduction in mortality was observed among BMI groups 25-29.9 (RR 0.99), 30-34.9 (RR 0.96), 35-39.9 (RR 0.96), and 40-49.9 (RR 1.01) compared to the normal BMI group.

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