Effect of body mass index on the outcome of infections: a systematic review

Falagas, Matthew E.; Athanasoulia, AP; Peppas, George; Karageorgopoulos, Drosos E.

doi:10.1111/j.1467-789x.2008.00546.x

Cited by 118 publications

(87 citation statements)

References 74 publications

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“…Of note, a change in the CD4 count of 100 cells/mm 3 is of clinical significance and suggests HIV disease progression and a heightened risk of HIV-related diseases. Furthermore, it is possible that obesity may have additional adverse effects on immune cell functioning (10,11,19,21,32,36,41,48) not measured in our study.…”

Section: Discussionmentioning

confidence: 53%

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Crum-Cianflone

Roediger

Eberly

et al. 2011

Clin. Vaccine Immunol.

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Prior studies have shown that weight may impact immune cell counts. However, few data exist about the relationship of weight and immune cell counts among HIV-infected patients. We examined documented HIV seroconverters (mean window, 15.7 months) in a prospective U.S. Military HIV Natural History Study (1 January 1986 to 20 January 2010). We estimated the association of the time-updated body mass index (BMI) category with changes in immune cell counts from HIV diagnosis across time (mean follow-up of 5.1 years) using multiply adjusted longitudinal linear mixed-effects models. Of 1,097 HIV seroconverters, 448 (41%) were overweight and 93 (8%) were obese at HIV diagnosis. Immune cell counts at HIV diagnosis did not significantly differ by BMI category. In the longitudinal models for those diagnosed before the advent of the highly active antiretroviral therapy (HAART) era, mean postdiagnosis decreases in the white cell count, total lymphocyte count, CD4 count, CD4 percentage, and CD4/CD8 ratio were less as the BMI category increased (all with P values of <0.05). Among HIV seroconverters diagnosed in the HAART era, obese compared to normal-weight patients had significantly smaller increases in CD4 counts, CD4 percentages, and the CD4/CD8 ratio (all with P values of <0.05). Similar findings were also noted among underweight versus normal-weight patients. In conclusion, although BMI was not associated with immune cell levels at the time of HIV diagnosis, weight appears to affect immune cells counts over the course of infection. In the HAART era, being either underweight or obese was associated with smaller increases in several important immune cell levels, including the CD4/CD8 ratio.

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Section: Discussionmentioning

confidence: 53%

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Crum-Cianflone

Roediger

Eberly

et al. 2011

Clin. Vaccine Immunol.

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“…Specifically, obesity and morbid obesity seem to be associated with worse infection outcomes. 7 In this regard, adjustment for body weight was suggested for antimicrobial dosing in adult patients. 8 Linezolid is considered as a moderately lipophilic agent, thus its pharmacokinetic/pharmacodynamic aspects may be influenced by changes in body weight.…”

Section: Introductionmentioning

confidence: 99%

Immediate hematological toxicity of linezolid in healthy volunteers with different body weight: a phase I clinical trial

et al. 2012

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Linezolid is an important therapeutic option for infections from multi-drug resistant Gram-positive pathogens. However, prolonged linezolid treatment (414 days) is considered to increase the risk of hematological adverse events. We aimed to evaluate the hematological safety profile of an i.v. single dose of linezolid in healthy volunteers of different body weight. We conducted a phase I clinical trial involving 20 healthy male Chinese volunteers that received an i.v. single dose of linezolid (600 mg). The study participants were assigned to two groups: low-weight (LW) group: 50 kg obody weight p55 kg and high-weight (HW) group: X80 kg. A significant decrease in the hemoglobin (Hb) levels and red blood cell (RBC) count was observed at the end of administration of the study drug in both groups. White blood cell (WBC) count was simultaneously decreased in the HW group. In the LW group, Hb levels and RBC count were also significantly decreased at 5, 7 and 24 h. In the HW group, both values were significantly decreased at 5 h. At 48 h all values were normal. The observed decreases were numerically higher in the LW group compared with the HW group. Yet, no statistical significance was noted. No difference was observed in the platelet count in both the groups. Our findings suggest that linezolid-associated hematological toxicity may also occur shortly after the i.v. administration of the drug in both LW and HW healthy volunteers. Early initiated continuous monitoring of hematological values and linezolid dosage adjustment for body weight are recommended.

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“…Both PCM and obesity may predispose patients to infection (72) . Of the 11 studies representing 3159 hospitalized patients which were included in a systematic review, 64% describe worse outcome from infection in obese and PCM patients compared with other patient groups (72) .…”

Section: Antimicrobial Examplesmentioning

confidence: 99%

“…Of the 11 studies representing 3159 hospitalized patients which were included in a systematic review, 64% describe worse outcome from infection in obese and PCM patients compared with other patient groups (72) . The role of inappropriate antimicrobial dosing is a factor to be seriously considered.…”

Section: Antimicrobial Examplesmentioning

confidence: 99%

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Drug disposition in obesity and protein–energy malnutrition

Boullata

2010

Proc. Nutr. Soc.

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Clinical response to medication can differ between patients. Among the known sources of variability is an individual's nutrition status. This review defines some pharmacokinetic terms, provides relevant body size metrics and describes the physiologic influences of protein-energy malnutrition and obesity on drug disposition. Weight-based drug dosing, which presumes a healthy BMI, can be problematic in the protein-energy malnourished or obese patient. The use of total body weight, lean body weight, or an adjusted body weight depends on the drug and how it is differently handled in malnutrition or obesity. Most of the recognized influences are seen in drug distribution and drug elimination as a result of altered body composition and function. Distribution characteristics of each drug are determined by several drug-related factors (e.g. tissue affinity) in combination with body-related factors (e.g. composition). Drug elimination occurs through metabolic and excretory pathways that can also vary with body composition. The current data are limited to select drugs that have been reported in small studies or case reports. In the meantime, a rational approach to evaluate the potential influences of malnutrition and obesity can be used clinically based on available information. Antimicrobials are discussed as a useful example of this approach. Further advancement in this field would require collaboration between experts in body composition and those in drug disposition. Until more data are available, routine monitoring by the clinician of the protein-energy malnourished or obese patient receiving weight-based drug regimens is necessary.Drug: Obesity: Protein-energy malnutrition: Pharmacokinetics: Drug-nutrient interactionThe clinical variability that exists among patients is wellrecognized by most clinicians. This inter-individual variability includes the response to a drug which can be accounted for by a number of factors. Appropriate patient care requires an appreciation of the factors that influence the disposition and effect of medication. As used here, the term disposition refers to the absorption, distribution and elimination of a drug; while the term effect reflects the physiologic action of the drug at the target tissue or cell. The sources of variability that influence medication are numerous and include age, life stage, sex, genotype, disease state and nutrition status (1) . The latter is the focus of this review and encompasses primary protein-energy malnutrition (PCM) and obesity.The influence that nutrition status can have on drug disposition and effect is included as one of the five broad categories in the classification of drug-nutrient interactions (2,3)

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Effect of body mass index on the outcome of infections: a systematic review

Cited by 118 publications

References 74 publications

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Impact of Weight on Immune Cell Counts among HIV-Infected Persons

Immediate hematological toxicity of linezolid in healthy volunteers with different body weight: a phase I clinical trial

Drug disposition in obesity and protein–energy malnutrition

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