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Obesity rising among hospitalized Crohn’s patients

Journal of Clinical Gastroenterology
Reuters Health - 25/09/2020 - The percentage of hospitalized Crohn's disease (CD) patients with obesity rose sharply over the past two decades, while the proportion of malnourished patients also increased, new findings show.

Obese CD patients did not have increased mortality, but their hospital stays were longer, the costs were higher, and they were more likely to develop sepsis and deep vein thrombosis (DVT), Dr. Joseph D. Feuerstein of Beth Israel Deaconess Medical Center in Boston and colleagues found.

"Prospective studies are needed to optimize care for the population of patients with both CD and obesity and reduce hospital-associated morbidity," they write in the Journal of Clinical Gastroenterology.

Obesity contributes to inflammation, but studies of the effect of obesity on CD outcomes have had mixed results, the authors say. To investigate, they looked at data from the National Inpatient Sample (NIS) on more than 176,000 patients admitted for CD in 2016-2017, including 132,970 normal-weight patients, 27,915 with malnutrition and 15,695 who were obese. They also looked at trends in obesity and malnutrition in CD from 2002-2017 using NIS data.

In 2002, 1.8% of CD inpatients were obese, compared to 9.5% in 2017 (P<0.001). During the same period, the percentage of malnourished CD inpatients rose from 5.6% to 16.5% (P<0.001).

Mortality was similar for the obese and normal-weight patients, but significantly higher in malnourished patients (odds ratio, 2.16).

Length of stay was 5.7 days for the obese patients, compared to 4.4 days for the normal-weight patients (P<0.001), while mean total costs were $51,975 and $41,143 (P<0.001), respectively.

Obese patients were at significantly increased risk of DVT (OR, 1.67), gastrointestinal bleeding (13.4% vs. 11.6%), and sepsis (22.8% vs. 14.8%). However, they were at significantly lower risk of bowel obstruction (28.9% vs. 35.0%) and abscesses (9.3% vs. 10.3%).

In addition to having higher mortality rates, malnourished patients also had longer hospital stays (by 3.62 days) and a $31,044 increase in total charges compared to normal-weight patients. Malnourished patients had four-fold increased odds of DVT.

"These data confirm the important predictive role of malnutrition in predicting mortality. However, the role of obesity in increasing length of stay, total hospitalization charges, and the rate of DVT is novel," the authors write. "Furthermore, the notable increased rate of sepsis raises concerns about the optimal approach to the treatment of CD with immune modulation."

Dr. Feuerstein was not available for an interview by press time.

By Reuters Staff

SOURCE: https://bit.ly/3mNuKnv Journal of Clinical Gastroenterology, online September 17, 2020.

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