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Obesity associated with higher risk for death in patients with H1N1

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

Issue: February 2011

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Patients with 2009 pandemic influenza A who are extremely obese had a 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 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 among this patient population.

Researchers observed 534 H1N1 patients 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.

“After adjusting for comorbidities and other risk factors, extreme obesity was independently and significantly associated with death due to 2009 H1N1 infection,” the researchers wrote. “In addition, further sub-analysis demonstrated that case patients with BMI>45 had a 4.2-fold increased odds of dying, with a case-fatality proportion of 34%.”

“Everyone should be aware of their BMI,” Louie told Infectious Disease News. “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 them 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 PCR tests and consider starting treatment early with antivirals while awaiting test results.”

According to Louie, further research is needed to determine why people who are extremely obese are more likely to die of H1N1.

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