title: Lower short- and long-term mortality associated with overweight and obesity in a large cohort study of adult intensive care unit patients.
abstract: BACKGROUND
  Two thirds of United States adults are overweight or obese, which puts them at higher risk of developing chronic diseases and of death compared with normal-weight individuals. However, recent studies have found that overweight and obesity by themselves may be protective in some contexts, such as hospitalization in an intensive care unit (ICU). Our objective was to determine the relation between body mass index (BMI) and mortality at 30 days and 1 year after ICU admission.
  
  
  METHODS
  We performed a cohort analysis of 16,812 adult patients from MIMIC-II, a large database of ICU patients at a tertiary care hospital in Boston, Massachusetts. The data were originally collected during the course of clinical care, and we subsequently extracted our dataset independent of the study outcome.
  
  
  RESULTS
  Compared with normal-weight patients, obese patients had 26% and 43% lower mortality risk at 30 days and 1 year after ICU admission, respectively (odds ratio (OR), 0.74; 95% confidence interval (CI), 0.64 to 0.86) and 0.57 (95% CI, 0.49 to 0.67)); overweight patients had nearly 20% and 30% lower mortality risk (OR, 0.81; 95% CI, 0.70 to 0.93) and OR, 0.68 (95% CI, 0.59 to 0.79)). Severely obese patients (BMI ≥ 40 kg/m2) did not have a significant survival advantage at 30 days (OR, 0.94; 95% CI, 0.74 to 1.20), but did have 30% lower mortality risk at 1 year (OR, 0.70 (95% CI, 0.54 to 0.90)). No significant difference in admission acuity or ICU and hospital length of stay was found across BMI categories.
  
  
  CONCLUSIONS
  Our study supports the hypothesis that patients who are overweight or obese have improved survival both 30 days and 1 year after ICU admission.
authors.forename: Swapna
authors.initials: S
authors.lastname: Abhyankar
authors.forename: Kira
authors.initials: K
authors.lastname: Leishear
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Callaghan
authors.forename: Dina
authors.initials: D
authors.lastname: Demner-Fushman
authors.forename: Clement J
authors.initials: CJ
authors.lastname: McDonald
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality*; D050177:Overweight / Q000150:complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis