Heterogeneous effects of obesity on all‐cause mortality: A causal forest analysis of hospitalized patients in China
Main finding · All-cause mortality, subgroup 3 (good renal function, well-controlled blood glucose, favourable nutritional status)Result — go to the resultHazard ratio 2.12 95% CI 1.06–4.22Authors' conclusion
The association between obesity and all-cause mortality is heterogeneous, as individuals with good renal function, well-controlled blood glucose and favourable nutritional status may experience a higher mortality risk. These findings emphasize the need for personalized management strategies in clinical practice to address the varying effects of obesity across different health conditions.
Study context
- Population
- Hospitalized patients in China from the RED-CARPET study1:1 matched
- Participants
- 5,967 patients
- Exposure
- Obesity vs normal weight
- Obesityn = 911
- Normal weightn = 911reference
- Outcome
- All-cause mortality
- Follow-up
- Median 63.8 months
Methodological details1:1 k-nearest neighbours matching, causal forest model, external validation in Atherosclerosis Risk in Communities (ARIC) cohort
- 1:1 k-nearest neighbours matching
- Causal forest model
- External validation in ARIC cohort
Main finding
As reported in the abstract
All-cause mortality, subgroup 3 (good renal function, well-controlled blood glucose, favourable nutritional status)
Hazard ratio
2.12
95% CI 1.06–4.22
P = 0.033
Obesityvs Normal weight
HR 2.12 (95% CI 1.06–4.22); P = 0.033
- No significant association in the other subgroups
- P > 0.05
Observational data: associations, not effects.
Further findings
Deaths during follow-up (whole cohort) · median 63.8 months
- Deaths
- 919 (15.4%)
- U-shaped association between body mass index (BMI) and all-cause mortality ('obesity paradox'); highest mortality in normal weight group
- 18.5%
External validation
- Similar results verified in the ARIC study cohort
Original publication
Heterogeneous effects of obesity on all‐cause mortality: A causal forest analysis of hospitalized patients in China. Diabetes Obes Metab. Published 4 April 2025. doi:10.
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