Higher BMI in heart failure patients is associated with longer survival only in the absence of diabetes

Pinho, Eva; Lourenço, Patrícia; Silva, Sérgio; Laszczyńska, Olga; Leite, Ana Bento; Gomes, Filipa; Pimenta, Joana; Azevedo, Ana; Bettencourt, Paulo

doi:10.2459/jcm.0b013e328364be3c

Cited by 19 publications

(18 citation statements)

References 34 publications

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“…We now reach a similar conclusion, albeit with a larger patient cohort and longer follow‐up, but using similar definitions of diabetes. One point of departure between our study and that of Pinho et al . is our more extensive categorization of BMI, as opposed to the split of either above or below 25 kg/m 2 (i.e.…”

Section: Discussioncontrasting

confidence: 86%

“…The authors found that once HF was established, overweight and obese patients fared better than normal weight patients, but this was irrespective of diabetes status. More recently, Pinho et al . evaluated BMI and diabetes in 503 ambulatory HF patients.…”

Section: Discussionmentioning

confidence: 99%

“…The Pinho et al . study included only patients with depressed LVEF and in the DIG retrospective subanalysis the majority of patients had also depressed systolic function.…”

Section: Discussionmentioning

confidence: 99%

“…The links between obesity and diabetes are evident, but the basis for obese protection in diabetic patients is debatable . Few reports have evaluated the impact of body mass index (BMI) in diabetic patients with HF, and it has been suggested that obesity may confer no advantage at all to this patient group . Nevertheless, comparison of the published datasets shows relevant disparities in study design, patient selection, and classification criteria.…”

Section: Introductionmentioning

confidence: 99%

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No benefit from the obesity paradox for diabetic patients with heart failure

Zamora

Lupón

Enjuanes

et al. 2016

European J of Heart Fail

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Both BMI and survival after a mean follow-up of 4.3 ± 3.0 years (up to 10 years) were assessed for 2527 ambulatory patients (66.3% men; mean age 69 ± 12.3 years). A total of 1102 (43.6%) patients had T2D and ischaemic aetiology of HF was present in 47.8%; mean left ventricular ejection fraction was 38 ± 16%. Based on BMI scores, patients were categorized as either underweight, normal, overweight, or obese. A significant survival interaction was observed between BMI and T2D. Smooth spline curves for the estimation of risk of all-cause and cardiovascular death showed the classic obesity paradox, with reduced mortality as BMI increased in non-diabetics; for T2D patients this pattern was lost. After adjustment for age and sex, hazard ratios for low-weight and obesity were: 2.04 [95% confidence intervals (CI) 1.50-2.78, P < 0.001] and 0.76 (95% CI 0.58-0.99, P = 0.04), respectively, for non-T2D patients; and 1.30 (95% CI 0.77-2.19, P = 0.32) and 0.99 (95% CI 0.78-1.26, P = 0.95), respectively, for T2D patients. Multivariate analyses for mortality (including BMI as a continuous variable) were significant for non-diabetic patients only.

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Section: Discussioncontrasting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

“…The Pinho et al . study included only patients with depressed LVEF and in the DIG retrospective subanalysis the majority of patients had also depressed systolic function.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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No benefit from the obesity paradox for diabetic patients with heart failure

Zamora

Lupón

Enjuanes

et al. 2016

European J of Heart Fail

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“…In hemodialysis patients with increasing body mass index (BMI), the survival rate improves [ 1 , 2 ]. This phenomenon has also been observed in patients with heart failure, obstructive lung disease, cancer and in elderly people [ 3 , 4 ]. This survival paradox can be explained by the fact that an excess of fat mass is protective in the short term, though is likely to be harmful over a longer period of time.…”

Section: Introductionmentioning

confidence: 74%

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients

et al. 2018

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Purpose: Nutritional status has a significant impact on the outcomes in the dialysis population. The aim of this study was to evaluate the association between body composition and a one-year survival of hemodialysis patients.Methods: Forty-eight patients with chronic kidney disease stage V treated with hemodialysis for more than three months were included. Body composition was assessed by bioimpedance spectroscopy (Body Composition Monitor, Fresenius Medical Care). Blood samples for serum creatinine, serum albumin, serum prealbumin, high sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), insulin-like growth factor 1(IGF-1) concentrations were taken before the midweek dialysis session.Results: Over the course of a one-year observation, seven patients died. We observed a significantly lower lean tissue index (LTI) (p = .013) and higher IL-6 (p = .032) and hsCRP levels (p = .011) among the patients who died. The remaining biochemical markers did not differ between these two groups. Kapplan–Meier analysis revealed a worse survival rate in patients with sarcopenia (lower than the 10th percentile for their age and gender) in comparison with those with normal LTI. However, it was not of statistical significance (p = .055). LTI inversely correlated with age and IL-6 and positively with IGF-1.Conclusions: Sarcopenia defined as decreased LTI, is a relatively common condition among patients undergoing maintenance hemodialysis, it can also be associated with a lower one-year survival rate. Decreased lean tissue mass can be associated with old age, lower IGF-1 levels and higher IL-6 levels. Body composition assessment may provide prognostic data for hemodialysis patients.

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Obesity paradox in patients with reduced ejection fraction eligible for device implantation – an observational study

Merkel,

Behon,

Masszi

et al. 2024

ESC Heart Failure

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AimsPatients with obesity have an overall higher cardiovascular risk, at the same time obesity could be associated with a better outcome in a certain subgroup of patients, a phenomenon known as the obesity paradox. Data are scarce in candidates for cardiac resynchronization therapy (CRT). We aimed to investigate the association between body mass index (BMI) and all‐cause mortality in patients eligible for CRT.MethodsAltogether 1,585 patients underwent cardiac resynchronization therapy between 2000–2020 and were categorized based on their BMI, 459 (29%) patients with normal weight (BMI < 25 kg/m2), 641 (40%) patients with overweight (BMI 25‐ < 30 kg/m2) and 485 (31%) with obesity (BMI ≥ 30 kg/m2). The primary endpoint was all‐cause mortality, heart transplantation, and left ventricular assist device implantation. We assessed periprocedural complications and 6‐month echocardiographic response.ResultsNormal‐weight patients were older compared to patients with overweight or obesity (70 years vs. 69 years vs. 68 years; P ‹0.001), respectively. Sex distribution, ischaemic aetiology, and CRT‐D implantation rates were similar in the three patient groups. Diabetes mellitus (BMI < 25 kg/m2 26% vs. BMI 25‐ < 30 kg/m2 37% vs. BMI ≥ 30 kg/m2 48%; P ‹0.001) and hypertension (BMI < 25 kg/m2 71% vs. BMI 25‐ < 30 kg/m2 74% vs. BMI ≥ 30 kg/m2 82%; P ‹0.001) were more frequent in patients with overweight and obesity.During the mean follow‐up time of 5.1 years, 973 (61%) reached the primary endpoint, 66% in the BMI < 25 kg/m2 group, 61% in the BMI 25‐ < 30 kg/m2 group and 58% in the BMI ≥ 30 kg/m2 group (log‐rank P‹0.05). Patients with obesity showed mortality benefit over normal‐weight patients (HR 0.78; 95%CI 0.66–0.92; P = 0.003). The obesity paradox was present in patients free from diabetes, atrial fibrillation, and ischemic events. Periprocedural complication rates did not differ in the three groups (BMI < 25 kg/m2 25% vs. BMI 25‐ < 30 kg/m2 28% vs. BMI ≥ 30 kg/m2 26%; P = 0.48). Left ventricular ejection fraction improved significantly in all patient groups (BMI < 25 kg/m2 median ‐LVEF 7% vs. BMI 25‐ < 30 kg/m2 median ‐LVEF 7.5% vs. BMI ≥ 30 kg/m2 median ‐LVEF 6%; P < 0.0001) with a similar proportion of developing reverse remodeling (BMI < 25 kg/m2 58% vs. BMI 25‐ < 30 kg/m2 61% vs. BMI ≥ 30 kg/m2 57%; P = 0.48); P = 0.75).ConclusionsThe obesity paradox was present in our HF cohort at long‐term, patients underwent CRT implantation with obesity and free of comorbidities showed mortality benefit compared to normal weight patients. Patients with obesity showed similar echocardiographic response and safety outcomes compared to normal weight patients.

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Higher BMI in heart failure patients is associated with longer survival only in the absence of diabetes

Abstract: The reported obesity paradox in heart failure can only be observed in nondiabetic patients.

Cited by 19 publications

References 34 publications

No benefit from the obesity paradox for diabetic patients with heart failure

No benefit from the obesity paradox for diabetic patients with heart failure

Low lean tissue mass can be a predictor of one-year survival in hemodialysis patients

Obesity paradox in patients with reduced ejection fraction eligible for device implantation – an observational study

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