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15-05-2013 | Respiratory | Article

‘Obesity paradox’ holds true in COPD


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medwireNews: Obese patients with chronic obstructive pulmonary disease (COPD) are significantly less likely to die in hospital, or to be readmitted following an exacerbation than normal weight patients, show the results of Spanish research.

The nationwide study of over 300,000 COPD admissions also showed that, conversely, malnourished patients were at increased risk for these poor outcomes.

"Further studies are needed to show whether identifying and treating weight loss could act towards improving the prognosis for hospitalised COPD patients," authors Raquel Barba (Hospital Rey Juan Carlos, Madrid) and colleagues say.

They reviewed data of all patients admitted to hospital for COPD in Spain during 2006 and 2007. Of 313,233 patients, 22,582 (7.2%) were obese, and 6354 (2.0%) were diagnosed with malnutrition, according to their hospital chart.

After adjustment for confounders, patients diagnosed with obesity had the lowest risk for 30-day readmission or in-hospital mortality, with 13% and 51% lower odds for each outcome, respectively, compared with normal weight patients (14.1 vs 16.8%; 5.7 vs 12.3%).

Meanwhile, patients with malnutrition had a 29% greater odds for readmission, and a 77% greater odds for death than normal weight patients (22.0 vs 16.8%; 22.2 vs 12.3%).

Writing in the Journal of Human Nutrition and Dietetics, the authors say that their results highlight the importance of nutritional assessment, which should be included in both the initial evaluation and discharge reports for patients with COPD.

"Malnutrition is systematically underdiagnosed," they caution. "The work of nurses or dieticians is important in this field and could represent an invaluable tool for improving the quality of care given."

Barba and colleagues explain that the reasons behind the so-called "obesity paradox" are unresolved, but could involve the effects of obesity on lung capacity, increased fat-free skeletal muscle mass, and systemic inflammation.

"The obesity paradox is a complex phenomenon that requires additional investigation, and future studies should consider weight change when evaluating the longitudinal association among health, overweight/obesity and outcomes," they conclude.

medwireNews ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Kirsty Oswald, medwireNews Reporter

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