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King P.,University of Texas Health Science Center at San Antonio | Mortensen E.M.,University of Texas Health Science Center at San Antonio | Mortensen E.M.,Dallas Medical Center General Internal Medicine 111E | Bollinger M.,VERDICT South Texas Veterans Health Care System | And 10 more authors.
European Respiratory Journal | Year: 2013

Obesity is an increasing problem in the USA, and research into the association between obesity and pneumonia has yielded conflicting results. Using Department of Veterans Affairs administrative data from fiscal years 2002-2006, we examined a cohort of patients hospitalised with a discharge diagnosis of pneumonia. Body mass index was categorised as underweight (<18.5 kg.m -2), normal (18.5-24.9 kg.m-2, reference group), overweight (25-29.9 kg.m-2), obese (30-39.9 kg.m-2) and morbidly obese (≥40 kg.m-2). Our primary analyses were multi level regression models with the outcomes of 90-day mortality, intensive care unit (ICU) admission, need for mechanical ventilation and vasopressor utilisation. The cohort comprised 18 746 subjects: 3% were underweight, 30% were normal, 36% were overweight, 27% were obese and 4% were morbidly obese. In the regression models, after adjusting for potential confounders, morbid obesity was not associated with mortality (OR 0.96, 95% CI 0.72-1.28), but obesity was associated with decreased mortality (OR 0.86, 95% CI 0.74- 0.99). Neither obesity nor morbid obesity was associated with ICU admission, use of mechanical ventilation or vasopressor utilisation. Underweight patients had increased 90-day mortality (OR 1.40, 95% CI 1.14-1.73). Although obesity is a growing health epidemic, it appears to have little impact on clinical outcomes and may reduce mortality for veterans hospitalised with pneumonia.

Noel P.H.,VERDICT South Texas Veterans Health Care System | Noel P.H.,University of Texas Health Science Center at San Antonio | Wang C.-P.,VERDICT South Texas Veterans Health Care System | Wang C.-P.,University of Texas Health Science Center at San Antonio | And 12 more authors.
Obesity | Year: 2012

We examined 5-year trends in BMI among obese primary care patients to determine whether obesity-related education such as nutrition counseling or a weight management program was associated with declines in BMI. Veterans with BMI 30 kg/m 2 and 1 primary care visits in fiscal year 2002 were identified from the Veterans Health Administration's (VHA) national databases. Outpatient visits from fiscal year 2002-2006 for nutrition counseling, exercise, or weight management were grouped into five categories varying in intensity and duration: (i) intense-and-sustained, (ii) intense-only, (iii) irregular, (iv) limited, and (v) no counseling. Generalized estimating equation assessed associations between obesity-related counseling and BMI trend (annual rate of BMI change fiscal year 2002-2006) among cohort members with complete race/ethnic data (N = 179,881). Multinomial logistic regression compared intensity and duration of counseling among patients whose net BMI increased or decreased by ≥10% vs. remained stable. Compared with patients receiving intense-and-sustained counseling, the BMI trend of those receiving intense-only or irregular counseling was not significantly different, but patients receiving no counseling or limited counseling had significantly higher rates of decreasing BMI (0.12 and 0.08 BMI per year; P<0.01, respectively). This was especially true for veterans in their 50-60s, compared with the oldest veterans who were most likely to lose weight. In contrast, younger veterans (18-35 years) were least likely to lose weight; their BMI tended to increase regardless of counseling intensity and duration. Enhanced efforts are needed to detect and combat increasing weight trajectories among veterans who are already obese, especially among those aged 18-35 who are at greatest risk. © 2011 The Obesity Society.

Noel P.H.,VERDICT South Texas Veterans Health Care System | Noel P.H.,University of Texas Health Science Center at San Antonio | Copeland L.A.,VERDICT South Texas Veterans Health Care System | Copeland L.A.,University of Texas Health Science Center at San Antonio | And 11 more authors.
Journal of General Internal Medicine | Year: 2010

Background: In response to dramatic increases in obesity prevalence, clinical guidelines urge health care providers to prevent and treat obesity more aggressively. OBJECTIVE: To describe the proportion of obese primary care patients receiving obesity care over a 5-year period and identify factors predicting receipt of care. DESIGN: Retrospective cohort study utilizing VHA administrative data from 6 of 21 VA administrative regions. PATIENTS: Veterans seen in primary care in FY2002 with a body mass index (BMI) ≥30 kg/m 2 based on heights and weights recorded in the electronic medical record (EMR), survival through FY2006, and active care (1 or more visits in at least 3 follow-up years FY2003-2006). MAIN MEASURES: Receipt of outpatient visits for individual or group education or instruction in nutrition, exercise, or weight management; receipt of prescriptions for any FDA-approved medications for weight reduction; and receipt of bariatric surgery. KEY Results: Of 933,084 (88.6%) of 1,053,228 primary care patients who had recorded heights and weights allowing calculation of BMI, 330,802 (35.5%) met criteria for obesity. Among obese patients who survived and received active care (N=264,667), 53.5% had a recorded obesity diagnosis, 34.1% received at least one outpatient visit for obesity-related education or counseling, 0.4% received weight-loss medications, and 0.2% had bariatric surgery between FY2002-FY2006. In multivariable analysis, patients older than 65 years (OR=0.62; 95% CI: 0.60-0.64) were less likely to receive obesity-related education, whereas those prescribed 5-7 or 8 or more medication classes (OR= 1.41; 1.38-1.45; OR=1.94; 1.88-2.00, respectively) or diagnosed with obesity (OR=4.0; 3.92-4.08) or diabetes (OR=2.23; 2.18-2.27) were more likely to receive obesity-related education. Conclusions: Substantial numbers of VHA primary care patients did not have sufficient height or weight data recorded to calculate BMI or have recorded obesity diagnoses when warranted. Receipt of obesity education varied by sociodemographic and clinical factors; providers may need to be cognizant of these when engaging patients in treatment. © 2010 Society of General Internal Medicine.

Perry T.W.,VERDICT South Texas Veterans Health Care System | Pugh M.J.V.,VERDICT South Texas Veterans Health Care System | Pugh M.J.V.,University of Texas Health Science Center at San Antonio | Waterer G.W.,University of Western Australia | And 11 more authors.
American Journal of Medicine | Year: 2011

Objective: Several studies have suggested an increased risk of cardiovascular events, primarily acute myocardial infarction, around the time of hospital admission for pneumonia. Therefore, we examined cardiovascular events, including myocardial infarction, congestive heart failure, unstable angina, stroke, and serious cardiac arrhythmias, within 90 days after hospitalization for pneumonia. Methods: By using data from the administrative databases of the Department of Veterans Affairs, we examined a cohort of subjects hospitalized with pneumonia between October 2001 and September 2007. Subjects were at least 65 years of age. We examined the incidence of myocardial infarction, congestive heart failure, cardiac arrhythmias, unstable angina, and stroke by International Classification of Diseases, Ninth Revision codes, excluding those with a diagnosis before the admission for pneumonia. Results: The cohort comprised 50,119 subjects with a mean age of 77.5 years (standard deviation 6.7 years), 98% of whom were male. The 90-day incidence of cardiovascular events was 1.5% for myocardial infarction, 10.2% for congestive heart failure, 9.5% for arrhythmia, 0.8% for unstable angina, and 0.2% for stroke. The majority of events occurred during the hospitalization for pneumonia. Conclusion: A clinically important number of subjects in this cohort had a cardiovascular event within 90 days of hospital admission, suggesting that such events may have an important role in post-pneumonia mortality. Additional research is needed to determine whether interventions may reduce the number of cardiovascular events after pneumonia. © 2011 Elsevier Inc. All rights reserved.

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