February 01, 2011
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Obesity ups mortality risk for patients with H1N1

Louie J. Clin Infect Dis. 2011;52:300-311.

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Patients with 2009 pandemic influenza A who are extremely obese appear to be at higher risk for severe illness and death, according to new findings published in Clinical Infectious Diseases.

Janice K. Louie, MD, of the California Department of Public Health, and colleagues assessed BMI in California residents who were hospitalized with the 2009 pandemic influenza A (H1N1) to determine whether obesity (BMI ≥30) or extreme obesity (BMI ≥40) was an independent risk factor for death.

Researchers observed 534 patients with H1N1 aged 20 years and older during the first 4 months of the pandemic (April 20 to Aug. 11, 2009). Results indicated that 51% were obese and 19% were extremely obese. Further, of the 17% of patients who died from H1N1, 61% were obese and 30% were extremely obese.

“In addition, further subanalysis demonstrated that case patients with BMI ≥45 had a 4.2-fold increased odds of dying, with a case-fatality proportion of 34%,” the researchers wrote.

The independent, significant association between obesity and mortality due to 2009 H1N1 infection was present after the researchers adjusted for comorbidities and other risk factors.

“Everyone should be aware of their BMI,” Louie said in an interview. “Obese and extremely obese persons should see their physicians regularly and get vaccinated for influenza annually. Physicians should make an effort in obese persons to diagnose any underlying medical conditions that may put them at increased risk for influenza. Physicians should also be counseling their obese patients about weight loss, exercise, diet, risk of tobacco use, and make [patients] aware of the risk of severe influenza illness if they become infected.

“Obese persons should see their doctor right away if they develop respiratory symptoms during influenza season,” she said. “Physicians should test for influenza with polymerase chain reaction tests and consider starting treatment early with antivirals while awaiting test results.”

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