For a study, researchers sought to investigate whether this nonlinear relationship, known as the obesity paradox, extended to secondary outcomes in individuals with extreme obesity. The study was a retrospective cohort study that used data from the National Inpatient Sample from 2017 and 2018, which included individuals hospitalized with heart failure (HF). Patients whose codes indicated severe obesity, moderate obesity, or no obesity were compared with one another. The death rate was the most significant finding. The secondary outcomes were secondary outcomes of the length of stay (LOS), total costs, and cardiogenic shock (CS). To account for demographics and co-morbidities, multivariate regression was employed. Included are a total of 2,438,845 hospitalizations. Nonsevere obesity was associated with lower mortality (odds ratio 0.74, 95% CI 0.69 to 0.80, P=0.000), confirming the paradox of obesity. In contrast, extreme obesity was not associated with a decrease in mortality (odds ratio 1.01, 95% CI 0.94 to 1.04, P=0.766). Compared with non-obese individuals, severe and nonsevere obesity were also related to decreased CS and increased LOS. There was a correlation between extreme obesity and greater overall expenses. In conclusion, it was found that there was a nonlinear link that takes the shape of a U between obesity and mortality in patients who were hospitalized for HF. Those who fell into neither the obese nor the extremely obese categories had a mortality rate significantly greater than those who were merely fat. On the other hand, when it came to secondary outcomes like CS, LOS, and total charges, the relationship was linear and, as a result, did not contain any contradicting information. More data were required for the adiposity-based chronic illness model to accurately define the intricate connections between fat and mortality.

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