The obesity paradox and hypoglycemia in critically ill patients

Abstract Background A high body mass index (BMI) has been associated with decreased mortality in critically ill patients. This association may, in part, relate to the impact of BMI on glycemia. We aimed to study the relationship between BMI, glycemia and hospital mortality. Methods We included all p...

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Autores principales:	Drago Plečko, Nicolas Bennett, Johan Mårtensson, Rinaldo Bellomo
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Obesity Overweight Hypoglycemia Glucose Insulin Mortality Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
Acceso en línea:	https://doaj.org/article/70fa9128f6794d9a95a5b09d700a3d83
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spelling	oai:doaj.org-article:70fa9128f6794d9a95a5b09d700a3d832021-11-07T12:03:40ZThe obesity paradox and hypoglycemia in critically ill patients10.1186/s13054-021-03795-z1364-8535https://doaj.org/article/70fa9128f6794d9a95a5b09d700a3d832021-11-01T00:00:00Zhttps://doi.org/10.1186/s13054-021-03795-zhttps://doaj.org/toc/1364-8535Abstract Background A high body mass index (BMI) has been associated with decreased mortality in critically ill patients. This association may, in part, relate to the impact of BMI on glycemia. We aimed to study the relationship between BMI, glycemia and hospital mortality. Methods We included all patients with a recorded BMI from four large international clinical databases (n = 259,177). We investigated the unadjusted association of BMI with average glucose levels, mortality and hypoglycemia rate. We applied multivariate analysis to investigate the impact of BMI on hypoglycemia rate, after adjusting for glycemia-relevant treatments (insulin, dextrose, corticosteroids, enteral and parenteral nutrition) and key physiological parameters (previous blood glucose level, blood lactate, shock state, SOFA score). Results We analyzed 5,544,366 glucose measurements. On unadjusted analysis, increasing BMI was associated with increasing glucose levels (average increase of 5 and 10 mg/dL for the 25–30, 30–35 kg/m2 BMI groups compared to normal BMI (18.5–25 kg/m2) patients). Despite greater hyperglycemia, increasing BMI was associated with lower hospital mortality (average decrease of 2% and 3.25% for the 25–30, 30–35 kg/m2 groups compared to normal BMI patients) and lower hypoglycemia rate (average decrease of 2.5% and 3.5% for the 25–30, 30–35 kg/m2 groups compared to normal BMI patients). Increasing BMI was significantly independently associated with reduced hypoglycemia rate, with odds ratio (OR) 0.72 and 0.65, respectively (95% CIs 0.67–0.77 and 0.60–0.71, both p < 0.001) when compared with normal BMI. Low BMI patients showed greater hypoglycemia rate, with OR 1.6 (CI 1.43–1.79, p < 0.001). The association of high BMI and decreased mortality did not apply to diabetic patients. Although diabetic patients had higher rates of hypoglycemia overall and higher glucose variability (p < 0.001), they also had a reduced risk of hypoglycemia with higher BMI levels (p < 0.001). Conclusions Increasing BMI is independently associated with decreased risk of hypoglycemia. It is also associated with increasing hyperglycemia and yet with lower mortality. Lower risk of hypoglycemia might contribute to decreased mortality and might partly explain the obesity paradox. These associations, however, were markedly modified by the presence of diabetes. Graphical AbstractDrago PlečkoNicolas BennettJohan MårtenssonRinaldo BellomoBMCarticleObesityOverweightHypoglycemiaGlucoseInsulinMortalityMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENCritical Care, Vol 25, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Obesity Overweight Hypoglycemia Glucose Insulin Mortality Medical emergencies. Critical care. Intensive care. First aid RC86-88.9
spellingShingle	Obesity Overweight Hypoglycemia Glucose Insulin Mortality Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Drago Plečko Nicolas Bennett Johan Mårtensson Rinaldo Bellomo The obesity paradox and hypoglycemia in critically ill patients
description	Abstract Background A high body mass index (BMI) has been associated with decreased mortality in critically ill patients. This association may, in part, relate to the impact of BMI on glycemia. We aimed to study the relationship between BMI, glycemia and hospital mortality. Methods We included all patients with a recorded BMI from four large international clinical databases (n = 259,177). We investigated the unadjusted association of BMI with average glucose levels, mortality and hypoglycemia rate. We applied multivariate analysis to investigate the impact of BMI on hypoglycemia rate, after adjusting for glycemia-relevant treatments (insulin, dextrose, corticosteroids, enteral and parenteral nutrition) and key physiological parameters (previous blood glucose level, blood lactate, shock state, SOFA score). Results We analyzed 5,544,366 glucose measurements. On unadjusted analysis, increasing BMI was associated with increasing glucose levels (average increase of 5 and 10 mg/dL for the 25–30, 30–35 kg/m2 BMI groups compared to normal BMI (18.5–25 kg/m2) patients). Despite greater hyperglycemia, increasing BMI was associated with lower hospital mortality (average decrease of 2% and 3.25% for the 25–30, 30–35 kg/m2 groups compared to normal BMI patients) and lower hypoglycemia rate (average decrease of 2.5% and 3.5% for the 25–30, 30–35 kg/m2 groups compared to normal BMI patients). Increasing BMI was significantly independently associated with reduced hypoglycemia rate, with odds ratio (OR) 0.72 and 0.65, respectively (95% CIs 0.67–0.77 and 0.60–0.71, both p < 0.001) when compared with normal BMI. Low BMI patients showed greater hypoglycemia rate, with OR 1.6 (CI 1.43–1.79, p < 0.001). The association of high BMI and decreased mortality did not apply to diabetic patients. Although diabetic patients had higher rates of hypoglycemia overall and higher glucose variability (p < 0.001), they also had a reduced risk of hypoglycemia with higher BMI levels (p < 0.001). Conclusions Increasing BMI is independently associated with decreased risk of hypoglycemia. It is also associated with increasing hyperglycemia and yet with lower mortality. Lower risk of hypoglycemia might contribute to decreased mortality and might partly explain the obesity paradox. These associations, however, were markedly modified by the presence of diabetes. Graphical Abstract
format	article
author	Drago Plečko Nicolas Bennett Johan Mårtensson Rinaldo Bellomo
author_facet	Drago Plečko Nicolas Bennett Johan Mårtensson Rinaldo Bellomo
author_sort	Drago Plečko
title	The obesity paradox and hypoglycemia in critically ill patients
title_short	The obesity paradox and hypoglycemia in critically ill patients
title_full	The obesity paradox and hypoglycemia in critically ill patients
title_fullStr	The obesity paradox and hypoglycemia in critically ill patients
title_full_unstemmed	The obesity paradox and hypoglycemia in critically ill patients
title_sort	obesity paradox and hypoglycemia in critically ill patients
publisher	BMC
publishDate	2021
url	https://doaj.org/article/70fa9128f6794d9a95a5b09d700a3d83
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The obesity paradox and hypoglycemia in critically ill patients

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