The presence of obesity paradox in Greek patients with chronic heart failure

Abstract

PurposeTo investigate the effect of body mass index (BMI) values on 1- and 2-year mortality rates in patients with chronic heart failure (HF).Patients and methodsWe conducted a retrospective cohort study of 112 patients with confirmed HF who visited the HF outpatient unit of a tertiary hospital of Athens, Greece, during a 5-month period (December 2012 – April 2013). These patients were assigned to four groups based on their BMI category. Data collection was carried out through a review of the medical patient records and the filling in of a structured questionnaire, including information on the demographic and clinical patient variables. Additionally, 1- and 2-year patient mortality was recorded. The statistical significance was two-tailed, and p-values of less than 0.05 were considered significant. The statistical analysis was performed with Mann–Whitney U test, χ2 test, and Student’s t-test using the SPSS software (IBM SPSS 21.0 for Windows).ResultsObese patients had significantly lower 1-year (13% vs 34.6%, p=0.039) and 2-year (4% vs 21.4%, p=0.022) mortality rates compared with those with normal BMI values. Additionally, we found clinically and not statistically significant lower mortality in overweight and obese patients, when compared with normal BMI and overweight patients, respectively.ConclusionObesity paradox seems to be present in our study, translating to significantly lower long-term mortality rates of obese patients compared to those with normal BMI. The significantly higher left ventricular ejection fraction and hematocrit levels among obese HF patients could justify our study findings. Further research is needed due to the inherent weaknesses of BMI and the other study limitations.

The Obesity Paradox in Heart Failure: Is It Still Valid in Light of New Therapies?

“…The obesity paradox has been established in chronic [4, 5, 28, 32-34, 37-44, 66, 68-74, 80, 81, 83] and acutely decompensated HF [30, 35, 36, 45-52, 54, 55, 58-61, 63, 64, 82, 85]. It has been observed in both patients with HFrEF [33-42, 44, 80, 85] and HFpEF [30-34, 77], although a recent analysis of 39,647 patients from the Get With The Guidelines-Heart Failure Registry reported absence of the obesity paradox in patients with HFpEF [85]. In the majority of studies, a higher BMI was associated with better survival irrespective from sex [38, 50, 57, 84] or race [85].…”

Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients

“… 33 , 34 One possible explanation for the absence of the obesity paradox is the inherent weakness of the BMI to adequately evaluate the severity of obesity based on its inability to identify body weight components such as fat mass, fat-free mass, and lean mass. 35 …”

“…33,34 One possible explanation for the absence of the obesity paradox is the inherent weakness of the BMI to adequately evaluate the severity of obesity based on its inability to identify body weight components such as fat mass, fat-free mass, and lean mass. 35 Critics of the obesity paradox have argued that this phenomenon is a product of methodological artifacts and inadequate control of confounding factors. Some have suggested that obese patients are provided a level of medical care better than that provided to others, thus mitigating the potential adverse influence of obesity.…”

Associations of trajectories in body roundness index with incident cardiovascular disease: a prospective cohort study in rural China

“…Abdominal obesity defined by waist circumference (WC), is a strong predictor for the risk of CVD ( 5 ). Another problem with BMI is that some studies have found a phenomenon called the “obesity paradox,” which states that obesity defined by BMI plays a protective role in heart failure and mortality reduction ( 6 ). As a common anthropometric measure of central obesity, WC is limited by not accounting for the height and body mass of the subjects ( 7 , 8 ).…”