In:
PLOS Medicine, Public Library of Science (PLoS), Vol. 17, No. 11 ( 2020-11-16), p. e1003413-
Abstract:
In observational studies of the general population, higher body mass index (BMI) has been associated with increased incidence of and mortality from bloodstream infection (BSI) and sepsis. On the other hand, higher BMI has been observed to be apparently protective among patients with infection and sepsis. We aimed to evaluate the causal association of BMI with risk of and mortality from BSI. Methods and findings We used a population-based cohort in Norway followed from 1995 to 2017 (the Trøndelag Health Study [HUNT]), and carried out linear and nonlinear Mendelian randomization analyses. Among 55,908 participants, the mean age at enrollment was 48.3 years, 26,324 (47.1%) were men, and mean BMI was 26.3 kg/m 2 . During a median 21 years of follow-up, 2,547 (4.6%) participants experienced a BSI, and 451 (0.8%) died from BSI. Compared with a genetically predicted BMI of 25 kg/m 2 , a genetically predicted BMI of 30 kg/m 2 was associated with a hazard ratio for BSI incidence of 1.78 (95% CI: 1.40 to 2.27; p 〈 0.001) and for BSI mortality of 2.56 (95% CI: 1.31 to 4.99; p = 0.006) in the general population, and a hazard ratio for BSI mortality of 2.34 (95% CI: 1.11 to 4.94; p = 0.025) in an inverse-probability-weighted analysis of patients with BSI. Limitations of this study include a risk of pleiotropic effects that may affect causal inference, and that only participants of European ancestry were considered. Conclusions Supportive of a causal relationship, genetically predicted BMI was positively associated with BSI incidence and mortality in this cohort. Our findings contradict the “obesity paradox,” where previous traditional epidemiological studies have found increased BMI to be apparently protective in terms of mortality for patients with BSI or sepsis.
Type of Medium:
Online Resource
ISSN:
1549-1676
DOI:
10.1371/journal.pmed.1003413
DOI:
10.1371/journal.pmed.1003413.g001
DOI:
10.1371/journal.pmed.1003413.g002
DOI:
10.1371/journal.pmed.1003413.g003
DOI:
10.1371/journal.pmed.1003413.t001
DOI:
10.1371/journal.pmed.1003413.s001
DOI:
10.1371/journal.pmed.1003413.s002
DOI:
10.1371/journal.pmed.1003413.s003
DOI:
10.1371/journal.pmed.1003413.s004
DOI:
10.1371/journal.pmed.1003413.s005
DOI:
10.1371/journal.pmed.1003413.s006
DOI:
10.1371/journal.pmed.1003413.s007
DOI:
10.1371/journal.pmed.1003413.s008
DOI:
10.1371/journal.pmed.1003413.s009
DOI:
10.1371/journal.pmed.1003413.s010
DOI:
10.1371/journal.pmed.1003413.s011
DOI:
10.1371/journal.pmed.1003413.s012
DOI:
10.1371/journal.pmed.1003413.s013
DOI:
10.1371/journal.pmed.1003413.s014
DOI:
10.1371/journal.pmed.1003413.s015
DOI:
10.1371/journal.pmed.1003413.s016
DOI:
10.1371/journal.pmed.1003413.s017
DOI:
10.1371/journal.pmed.1003413.s018
DOI:
10.1371/journal.pmed.1003413.r001
DOI:
10.1371/journal.pmed.1003413.r002
DOI:
10.1371/journal.pmed.1003413.r003
DOI:
10.1371/journal.pmed.1003413.r004
DOI:
10.1371/journal.pmed.1003413.r005
DOI:
10.1371/journal.pmed.1003413.r006
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2020
detail.hit.zdb_id:
2164823-2
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