O044 - OBESITY PHENOTYPES BEYOND BMI PREDICT HOSPITAL MORTALITY INDEPENDENTLY OF AGE, SEX AND DRG-DEFINED ADMISSION COMPLEXITY

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O044

OBESITY PHENOTYPES BEYOND BMI PREDICT HOSPITAL MORTALITY INDEPENDENTLY OF AGE, SEX AND DRG-DEFINED ADMISSION COMPLEXITY

M. Molina Ortega1,*, L. Dalla Rovere2,3, A. Guerrini4, R. Fernández-Jiménez2,3, C. Hardy Añón2, M. García Olivares2,3, C. Herola2, J. M. García-Almeida2,3

1Medicina y Cirugía, Universidad Autónoma de Madrid, Madrid, 2Endocrinology and Nutrition, Hospital QuironSalud de Málaga, 3Universidad de Málaga, Málaga, Spain, 4Science and Technology for Humans and the Environment , Università Campus Bio-medico di Roma, Rome, Italy

 

Rationale: Obesity is a heterogeneous condition whose clinical impact is poorly captured by BMI, leading to misclassification of risk in hospitalized patients. According to the Lancet Commission’s concept of clinical obesity, we evaluated multidimensional obesity phenotypes integrating body composition, muscle function and clinical staging and their association with 12‑month mortality independent of age, sex and admission complexity.

 

Methods: We performed a retrospective observational study of adult patients admitted to Hospital QuirónSalud Málaga (2019–2024). Body composition was assessed by bioelectrical impedance analysis and muscle function by handgrip strength. Obesity phenotypes were defined using BMI, excess adiposity and AACE/ACE staging as clinical, pre‑clinical, hidden and BMI‑misclassified obesity. Malnourished patients (GLIM criteria) were excluded. Admission complexity was measured using DRG relative weight. The primary outcome was 12‑month all‑cause mortality. Survival was analyzed using Kaplan–Meier curves and multivariable Cox regression adjusted for age, sex and DRG complexity.

 

Results: A total of 1,845 patients were included, with 246 deaths. Twelve‑month survival was lower in clinical obesity (84.5%) and hidden obesity (85.2%) compared with controls (93.4%), while pre‑clinical and BMI‑misclassified obesity showed similar survival. In adjusted Cox models, both clinical obesity (HR 1.67, 95% CI 1.09–2.58) and hidden obesity (HR 1.61, 95% CI 1.13–2.30) were independently associated with mortality.

 

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Conclusion: Clinical and hidden obesity were independently associated with increased 12‑month mortality, supporting the Lancet Commission’s functional definition of obesity and highlighting the limitations of BMI‑based classification in hospitalized patients.

 

Disclosure of Interest: None declared