Obesity paradox and heart failure

Donataccio, Maria Pia; Vanzo, Angiola; Bosello, O

doi:10.1007/s40519-020-00982-9

Cited by 27 publications

(27 citation statements)

References 71 publications

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“…However, due to its ease of use and accessibility, it is an integral part of the physical examination of HF patients [ 27 , 28 ]. However, obesity can lead to an abnormal clinical course [ 29 ]. Many studies confirm that obese patients have a better prognosis for short- and long-term survival [ 30 , 31 , 32 ].…”

Section: Discussionmentioning

confidence: 99%

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure—A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2)

et al. 2021

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Background: A nutritional status is related to the prognosis and length of hospitalisation of patients with heart failure (HF). This study aims to assess the effect of nutritional status on in-hospital mortality in patients with heart failure. Methods: We conducted a retrospective study and analysis of medical records of 1056 patients admitted to the cardiology department of the University Clinical Hospital in Wroclaw (Poland). Results: A total of 1056 individuals were included in the analysis. A total of 5.5% of patients died during an in-hospital stay. It was found that in the sample group, 25% of patients who died had a BMI (body mass index) within the normal range, 6% were underweight, 47% were overweight, and 22% were obese. Our results show that non-survivors have a significantly higher nutrition risk screening (NRS) ≥3 (21% vs. 3%; p < 0.001); NYHA (New York Heart Association) grade 4 (70% vs. 24%; p < 0.001). The risk of death was lower in obese patients (HR = 0.51; p = 0.028) and those with LDL (low-density lipoprotein) levels from 116 to <190 mg/dL (HR = 0.10; p = 0.009, compared to those with LDL <55 mg/dL). The risk of death was higher in those with NRS (nutritional risk score) score ≥3 (HR = 2.31; p = 0.014), HFmrEF fraction (HR = 4.69; p < 0.001), and LDL levels > 190 mg/dL (HR = 3.20; p = 0.038). Conclusion: The malnutrition status correlates with an increased risk of death during hospitalisation. Higher TC (total cholesterol) level were related to a lower risk of death, which may indicate the “lipid paradox”. Higher BMI results were related to a lower risk of death, which may indicate the “obesity paradox”.

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Section: Discussionmentioning

confidence: 99%

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure—A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2)

et al. 2021

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“…In addition, obese patients may have better nutrition status, high-physical fitness levels, and increased various anti-inflammatory adipokines. Nevertheless, several studies did not support the contradictory phenomenon of “obesity paradox” in HF ( 7 ). Those obese patients with the lower death risks may have high levels of physical fitness.…”

Section: Discussionmentioning

confidence: 99%

“…Although the “obesity paradox” in HF has been described in the literature for many years, the applications to the clinical practice are still debated. More currently, Donataccio et al ( 7 ) have systematically performed a narrative review of the relationship between “obesity paradox” and HF, and presented several studies that did not support the “obesity paradox” in HF.…”

Section: Introductionmentioning

confidence: 99%

The “Obesity Paradox” in Patients With HFpEF With or Without Comorbid Atrial Fibrillation

Guo

Zhu

2022

Front. Cardiovasc. Med.

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Background: Overweight and mildly obese individuals have a lower risk of death than their normal-weight counterparts; this phenomenon is termed “obesity paradox.” Whether this “obesity paradox” exists in patients with heart failure (HF) or can be modified by comorbidities is still controversial. Our current study aimed to determine the association of body mass index (BMI) with outcomes with patients with HF with preserved ejection fraction (HFpEF) with or without coexisting atrial fibrillation (AF).Methods: Patients with HFpEF from the Americas in the TOPCAT trial were categorized into the 3 groups: normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obesity (≥30 kg/m2). The Cox proportional-hazards models were used to calculate the adjusted hazard ratios (HRs) and CIs.Results: We identified 1,749 patients with HFpEF, 42.1% of which had baseline AF. In the total population of HFpEF, both overweight (HR = 0.59, 95% CI: 0.42–0.83) and obesity (HR = 0.49, 95% CI: 0.35–0.69) were associated with a reduced risk of all-cause death. Among patients with HFpEF without AF, overweight (HR = 0.51, 95% CI: 0.27–0.95) and obesity (HR = 0.64, 95% CI: 0.43–0.98) were associated with a lower risk of all-cause death. In those with AF, obesity (HR = 0.62, 95% CI: 0.40–0.95) but not overweight (HR = 0.81, 95% CI: 0.54–1.21) was associated with a decreased risk of all-cause death.Conclusions: The “obesity paradox” assessed by BMI exists in patients with HFpEF regardless of comorbid AF.Clinical Trial Registration:https://clinicaltrials.gov, identifier: NCT00094302.

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“…Although obesity has been considered as a risk factor for the development of HF, numerous clinical evidences suggested that obesity is associated with the better outcomes in those with established HF, which is called as the obesity paradox ( Donataccio, Vanzo & Bosello, 2021 ; Horwich, Fonarow & Clark, 2018 ). Our study also observed such a phenomenon linking higher BMI and better prognosis (BMI per 1 kg/m2 increase, HR = 0.93 in the univariate analysis, P = 0.003).…”

Section: Discussionmentioning

confidence: 99%

A novel nutritional index as a predictor of mortality in dilated cardiomyopathy: a retrospective study

Wang

Qing

Chen

et al. 2022

PeerJ

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Background Research has associated nutritional status with the prognosis of cardiovascular diseases. This study aimed to investigate the prognostic value of a novel nutritional index, triglycerides × total cholesterol × body weight index (TCBI), in patients with dilated cardiomyopathy (DCM). Methods This retrospective cohort study enrolled 445 patients with DCM. The median follow-up period was 2.8 years, and the primary endpoint was all-cause death. Results During follow-up, the all-cause mortality was observed in 135 out of 445 patients (30.3%). In Kaplan–Meier survival analysis, the third TCBI tertile had a lower mortality risk (T3 vs. T2 vs. T1: 16.9% vs. 35.1% vs. 38.9%; log-rank P < 0.001). In the multivariable Cox regression analysis, patients in the third tertile were associated with a decreased mortality, whereas there was no significant difference between the T2 and T1 groups. Moreover, TCBI could significantly improve risk stratification (continuous net reclassification improvement and integrated discrimination improvement) over the Geriatric Nutritional Risk Index (GNRI) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Conclusions TCBI is independently associated with long-term survival in patients with DCM. Combination of TCBI and other biomarkers, such as GNRI and NT-proBNP, can significantly improve prognostic prediction. Further studies with larger sample size are required to validate our results.

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Obesity paradox and heart failure

Cited by 27 publications

References 71 publications

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure—A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2)

The Association between Nutritional Status and In-Hospital Mortality among Patients with Heart Failure—A Result of the Retrospective Nutritional Status Heart Study 2 (NSHS2)

The “Obesity Paradox” in Patients With HFpEF With or Without Comorbid Atrial Fibrillation

A novel nutritional index as a predictor of mortality in dilated cardiomyopathy: a retrospective study

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