Does the “Obesity Paradox” Have an Expiration Date? A Retrospective Cohort Study

Author:

Elkan Matan1ORCID,Kofman Natalia23,Minha Sa’ar23ORCID,Rappoport Nadav45ORCID,Zaidenstein Ronit13,Koren Ronit13

Affiliation:

1. Department of Internal Medicine A, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel

2. Department of Cardiology, Shamir Medical Center (Assaf Harofeh), Zerifin 7030000, Israel

3. Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel

4. Department of Software and Information Systems Engineering, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel

5. Division of Government Medical Centers, Israeli Ministry of Health, Jerusalem 9101002, Israel

Abstract

(1) Background: The “obesity paradox” refers to a protective effect of higher body mass index (BMI) on mortality in acute infectious disease patients. However, the long-term impact of this paradox remains uncertain. (2) Methods: A retrospective study of patients diagnosed with community-acquired acute infectious diseases at Shamir Medical Center, Israel (2010–2020) was conducted. Patients were grouped by BMI: underweight, normal weight, overweight, and obesity classes I–III. Short- and long-term mortality rates were compared across these groups. (3) Results: Of the 25,226 patients, diverse demographics and comorbidities were observed across BMI categories. Short-term (90-day) and long-term (one-year) mortality rates were notably higher in underweight and normal-weight groups compared to others. Specifically, 90-day mortality was 22% and 13.2% for underweight and normal weight respectively, versus 7–9% for others (p < 0.001). Multivariate time series analysis revealed underweight individuals had a significantly higher 5-year mortality risk (HR 1.41 (95% CI 1.27–1.58, p < 0.001)), while overweight and obese categories had a reduced risk (overweight—HR 0.76 (95% CI 0.72–0.80, p < 0.001), obesity class I—HR 0.71 (95% CI 0.66–0.76, p < 0.001), obesity class II—HR 0.77 (95% CI 0.70–0.85, p < 0.001), and obesity class III—HR 0.79 (95% CI 0.67–0.92, p = 0.003)). (4) Conclusions: In this comprehensive study, obesity was independently associated with decreased short- and long-term mortality. These unexpected results prompt further exploration of this counterintuitive phenomenon.

Publisher

MDPI AG

Subject

General Medicine

Reference50 articles.

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