CHEST Guidelines-Is-It-a-Real-Obesity-Paradox-

Is-It-a-Real-Obesity-Paradox-_chest

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The document addresses a study exploring the relationship between obesity and ventilator-associated pneumonia (VAP) in ICU patients, analyzed through a post hoc examination of the NUTRIREA2 trial. Concerns about the study's validity are raised in a correspondence by a group of Japanese doctors, highlighting issues relating to potential misclassification of Body Mass Index (BMI) groups and the external validity of the findings.<br /><br />The Japanese doctors argue that classifying overweight, normal weight, and underweight individuals as non-obese could underestimate the association between obesity and the risk of pneumonia, suggesting the use of World Health Organization's specific weight categories for more accurate classification. They also point out that due to the nature of post hoc analyses of randomized controlled trials, the selected ICU patients might not be representative of the broader population, potentially affecting the study’s external validity.<br /><br />The study’s authors responded by defending their use of the WHO definition of obesity, explaining that this was correctly applied in their analysis. They note that the incidence of VAP was delineated through a rigorous process involving an independent committee to ensure accurate diagnosis. The analysis included adjustments for variables at ICU admission to minimize bias.<br /><br />Furthermore, the authors acknowledge that their findings may not be applicable to every ICU patient, particularly those not requiring vasopressor support. However, they argue that their findings align with current French epidemiological data, underscoring the strict criteria used for VAP diagnosis in the study as a reason for the low reported incidence rate.<br /><br />In conclusion, while the study appears to offer valuable insights into the potential link between obesity and VAP, careful consideration of the methodological constraints and demographic limitations is necessary when interpreting the findings.

Keywords

obesity

ventilator-associated pneumonia

ICU patients

NUTRIREA2 trial

Body Mass Index

post hoc analysis

external validity

World Health Organization

randomized controlled trials

epidemiological data