Key result
Obesity is linked to ~2-fold higher in-hospital mortality compared with normal weight.
Why the study?
Evidence regarding the association between overweight and obesity and in-hospital morbidity and mortality is inconsistent, and South Asian populations are underrepresented.
Does overweight or obesity increase in-hospital all-cause mortality and morbidity compared to normal weight in acutely hospitalized adult patients in Sri Lanka?
Cohort (n=2,128)
No
Does overweight or obesity increase in-hospital all-cause mortality and morbidity compared to normal weight in acutely hospitalized adult patients in Sri Lanka?
Among hospitalized South Asian adults in Sri Lanka, generalized or central obesity defined by international cut-offs is associated with higher rates of in-hospital mortality, acute kidney injury, and cardiovascular admissions, whereas lower Asian cut-offs increase obesity prevalence without identifying excess mortality risk.
Answers are grounded in this paper and cite their sources.
Obesity may identify higher-risk acute admissions for monitoring; leaves open whether targeted strategies improve outcomes in South Asian cohorts.
Background. Current evidence regarding the association between overweight and obesity and in-hospital morbidity and mortality is inconsistent and South Asian populations are underrepresented. Methods. Data relevant to anthropometry, hospital outcomes, complications, and medical diagnoses of all acute medical admissions to the National Hospital of Sri Lanka were collected over a period of 3 months. Analysis was performed with WHO international (ICs) and Asian obesity cut-offs (ACs). Results. Sample size was 2,128 (median age: 57 years [IQR: 42, 67], males: 49.7%). High prevalence of overweight (23.5%), generalized obesity (10.4%), central obesity (28.5%), and underweight (15.4%) was observed (ICs). Patients with either generalized or central obesity had significantly higher in-hospital mortality (4.8% versus 2.5%, <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>p</a:mi> <a:mo>=</a:mo> <a:mn>0.031</a:mn> </a:math> ) and acute kidney injury (AKI) (3.9% versus 1.2%) ( <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>p</c:mi> <c:mo>=</c:mo> <c:mn>0.001</c:mn> </c:math> ) compared to normal weight. With ACs, overweight and obesity prevalence increased, without any significant increment in morbidity and mortality, but median length of hospital stay was significantly reduced in patients with generalized obesity compared to normal (3 [IQR: 2, 5] versus 4 [IQR: 2, 6], <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mi>p</e:mi> <e:mo>=</e:mo> <e:mn>0.014</e:mn> </e:math> ). Infections (44.4%) and cardiovascular diseases (CVDs) (25.9%) were the most common causes of admission. Overweight and generalized obesity or central obesity were associated with increased prevalence of acute CVDs and CVD risk factors and lower prevalence of acute infections, whilst underweight showed an inverse association. Conclusion. A double burden of malnutrition and diseases were noted among hospital admissions, with obesity being a risk factor for in-hospital all-cause mortality and AKI. Overweight and obesity were associated with increased CVDs and reduced infections. Larger prospective studies are required to characterize these associations among South Asians.
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Dilrukshi et al. (2022) conducted a cohort in Acute medical illness admissions evaluated for overweight and obesity (n=2,128). Generalized or central obesity (WHO international cut-offs) vs. Normal weight (normal BMI or waist circumference) was evaluated on In-hospital all-cause mortality (p=0.031). Generalized or central obesity (by WHO international cut-offs) was associated with higher in-hospital mortality and acute kidney injury than normal weight.
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