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Clin Infect Dis. 2017 May 16. doi: 10.1093/cid/cix437. [Epub ahead of print]

Obesity and Diabetes as Risk Factors for Severe Plasmodium falciparum Malaria: Results from a Swedish Nationwide Study.

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Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet; Stockholm, Sweden.
Department of Emergency Medicine, Karolinska University Hospital; Stockholm, Sweden.
Department of Infectious Diseases, Karolinska University Hospital; Stockholm, Sweden.
Department of Infectious Diseases, Västerås Central Hospital; Västerås, Sweden.
Unit of Biostatistics, Department of Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.



Noncommunicable diseases and obesity are increasing in prevalence globally, also in populations at risk of malaria. We sought to investigate if comorbidity, in terms of chronic diseases and obesity, is associated with severe Plasmodium falciparum malaria.


We performed a retrospective observational study in adults (≥18 years) diagnosed with malaria in Sweden between January 1995 and May 2015. We identified cases through the surveillance database at the Public Health Agency of Sweden and reviewed clinical data from 18 hospitals. Multivariable logistic regression was used to assess associations between comorbidities and severe malaria.


Among 937 adults (median age 37 years; 66.5% male), patients with severe malaria had higher prevalence of chronic diseases (28/92, 30.4%) compared to non-severe cases (151/845, 17.9%) (P=0.004). Charlson comorbidity score ≥1 was associated with severe malaria (adjusted odds ratio [aOR] 2.63, 95% confidence interval [CI] 1.45-4.77), as was diabetes among individual diagnoses (aOR 2.98, 95% CI 1.25-7.09). Median body mass index (BMI) was higher among severe (29.3) than non-severe cases (24.7) (P<0.001). Obesity was strongly associated with severe malaria, both independently (aOR 5.58, 95% CI 2.03-15.36), and in combination with an additional metabolic risk factor (hypertension, dyslipidemia or diabetes) (aOR 6.54, 95% CI 1.87-22.88). The associations were observed among non-immune travelers as well as immigrants from endemic areas.


Comorbidity, specifically obesity and diabetes, are previously unidentified risk factors for severe malaria in adults diagnosed with P. falciparum. Noncommunicable diseases should be considered in the acute management and prevention of malaria.


Severe malaria; comorbidity; diabetes; noncommunicable diseases; obesity

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