Action Points
- Body mass index was the least predictive risk factor for mortality over 10 years in obese patients who were eligible for bariatric surgery, a study found.
- Note that obese patients were more likely to be at risk for death for each year of age, if they were male, if they were smokers, or if they had diabetes.
Among predictors of mortality in obese patients, BMI was significantly predictive, but just barely (OR 1.03, 95% CI 1.01-1.05), according to Raj Padwal, MD, MSc, of the University of Alberta in Edmonton, and colleagues.
Obese patients were more likely to be at risk for death for each year of age (OR 1.09 per year, 95% CI 1.07-1.10), if they were male (OR 1.50, 95% CI 1.20-1.87), if they were smokers (OR 1.62, 95% CI 1.28-2.06), or if they had diabetes (OR 2.25, 95% CI 1.76-2.87), they wrote online in the Oct. 16 issue of JAMA Surgery.
The study adds to an already vast body of research on the effects of BMI on morbidity and mortality.
In past research, outcomes have been mixed where some studies haveassociated risks of death with BMI, especially low BMI, while other research has shown that a higher BMI was protective for hearts in some populations.
Other research has shown that a pregnant mother's obesity was tied to health problems and risks for early mortality for her child, while another study found that there were no extra risks of death tied to moderate obesity in particular.
However, distribution of weight, such as at the belly, has been tied to increased risks for cancer, heart disease, and death.
In the current study, the authors looked at mortality predictors among 15,394 obese English patients whose BMI made them eligible for bariatric surgery.
All participants were registered to the English General Practice Research Database, a database of anatomized, linked, longitudinal medical records in a population-representative sample of 6% of the English population. The records include patient demographics, health behaviors, physiological and laboratory data, clinician-assigned diagnoses, outpatient prescription medications, and disease registries for hypertension and diabetes.
Patients were ages 18 to 65 and had a BMI of 35 or greater, or a BMI of 30 to 34.9 and an obesity-related comorbidity, which included hypertension, dyslipidemia, heart failure, diabetes, sleep apnea, osteoarthritis, coronary artery disease, and cerebrovascular disease.
Cohort entry date was considered the first time a patient's record indicated that their BMI made them surgery-eligible.
The primary outcome was 10-year all-cause mortality in relation specifically to age, sex, BMI, smoking and alcohol intake, and chronic medical conditions.
Over the 10-year period, 2.1% of participants died, and "within-age strata did not differ significantly between BMI classes."
Among comorbidities, age, diabetes, male sex, smoking status, coronary artery disease, cerebrovascular disease, and BMI were predictive of 10-year mortality. Age, diabetes, smoking status, and male sex were the comorbidities with a P=0.99 overall goodness fit.
The authors noted in their conclusion that, although they were significant, "established cerebrovascular disease and BMI did not contribute materially to the mortality prediction in the primary analysis."
They added that the study was limited by lack of analysis of other clinically important end points separate from all-cause mortality, potential under-reporting of comorbidity prevalence, results that may not generalize outside of England, and use of BMI as recorded at a single point in time.
The study was supported by the Canadian Institutes of Health Research.
The authors received support from the Government of Alberta, the University of Alberta, Alberta Health Services Chair in Obesity Research and Management, the Alberta Heritage Foundation for Medical Research, Alberta Innovates-Health Solutions, Ethicon Endo-Surgery, Coviden, Gore, Johnson and Johnson, Bard, Baxter, and Olympus.
Primary source: JAMA Surgery
Source reference: Padwal RS, et al "A simple prediction rule for all-cause mortality in a cohort eligible for bariatric surgery" JAMA Surg 2013; DOI: 10.1001/jamasurg.2013.3953.
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