Research shows no obesity survival paradox when we measure body fat better
Published: 2023-03-22
Author: European Society of Cardiology | Contact: escardio.org
Peer-reviewed publications: Correct
Reference magazine: DOI Link to research paper
Library: Health and Disability Publications
Summary: Research shows that there is an obesity paradox, whereby overweight or obese heart failure patients are reported to be less likely to be hospitalized or die than those of average weight. BMI does not consider the body’s fat, muscle and bone composition or where fat is distributed. The study also found no paradox in obesity survival when we better measure body fat.
advertisement
Definition
- The obesity paradox
-
The obesity paradox refers to existing evidence that obesity in older adults or in patients with certain chronic diseases may be protective and associated with reduced mortality. Paradoxes have been observed in people with cardiovascular disease and cancer.
Main announcement
“Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: Revisiting the obesity paradox” – European Journal of Cardiology.
New research has disproved the idea that there is an “obesity paradox,” whereby overweight or obese heart failure patients are thought to be less likely to be hospitalized or die than those who are overweight or obese. normal weight.
The study was published in the journal European Journal of Cardiology (1), shows that if physicians measure patients’ waist-to-height ratio, instead of looking at their body mass index (BMI), the presumed survival advantage of those with a BMI of 25kg/m2 or more will disappear.
The “obesity paradox” involves counterintuitive findings that suggest that, although people are at higher risk of heart problems if they are overweight or obese, once a person has developed the heart disease, people with a higher BMI seem to do better and are less likely to die than people of a normal weight. Various explanations have been suggested, including the fact that once someone has heart problems, some excess fat somehow protects against further health problems. and mortality, especially as people with severe and chronic illnesses often lose weight.
John McMurray, Professor of Medical Cardiology at the University of Glasgow (UK), who led the latest study, said:
“It’s been suggested that living with obesity is a good thing for patients with heart failure and reduced ejection fraction – which is when the heart’s main chambers can’t squeeze out normal amounts of blood. We know this can’t be true and that obesity must be bad, not good. We think part of the problem is that BMI is a weak indicator of how much fat a patient has.”
As Professor Stephan von Haehling, Consultant Cardiologist, and Dr Ryosuke Sato, a researcher, both at the University Medical Center Göttingen (Germany), write in an accompanying editorial (2 ), BMI does not take into account the body’s fat composition, muscle and bone, or where fat is distributed.
“Is it possible to assume that an American professional wrestler (more muscular) and a Japanese sumo wrestler (fatter) with the same BMI would have the same risk of cardiovascular disease? true for people like Arnold Schwarzenegger in his research, the younger years when he played ‘Terminator’ with a BMI of ~30 kg/m2.
This study is the first to look at different ways of measuring patient size and proportions, including BMI, as well as anthropometric measurements such as waist-to-height ratio, circumference waist and waist-to-hip ratio, and adjusted patient results to account for other factors that play a role or predict these results, such as levels of natriuretic peptide — a hormone secreted in the blood during pregnancy. pressure on the heart, such as heart failure.
Professor McMurray said: “The sodium peptide diuretic is the most important prognostic factor in patients with heart failure. Normally, the concentration of the diuretic sodium peptide is increased in people with heart failure, but in obese patients. have lower levels than those of normal weight.
Professor McMurray and colleagues analyzed data from 1832 women and 6567 men with heart failure and reduced ejection fraction enrolled in the PARADIGM-HF international randomized controlled trial that took place in 47 countries on six continents (3). When the patients were randomized, the doctors collected data on BMI, blood pressure, anthropometric measurements, blood test results, medical history, and treatments. The researchers were interested in patients who were hospitalized with heart failure or who died from the disease.
An “obesity survival paradox” suggested a lower mortality rate for people with a BMI of 25 kg/m2 or higher (4), but this was removed when the researchers examined the results. Adjust results to account for all factors that may affect results, including levels of natriuretic peptides.
First author of the study, Dr Jawad Butt, a researcher from the University Hospital Copenhagen-Rigshospitalet, Copenhagen (Denmark) who performed the analysis, said:
“The paradox was much less obvious when we looked at the waist-to-height ratio, and it disappeared after adjusting for prognostic variables. After adjustment, both BMI and waist-to-dimensional ratio The higher the number, the higher the body fat, the higher the risk. death or hospitalization for heart failure, but this was more evident for the waist-to-height ratio. When we looked at the waist-to-height ratio, we found that the fattest 20% had a 39% higher risk. hospitalized for heart failure compared with those in the bottom 20 percent with the least fat.”
Prof McMurray says:
“Our study shows that there is no ‘paradox of obesity survival’ when we use better ways to measure body fat. BMI does not account for the location of fat in the body or its amount relative to muscle or the weight of the skeleton, which can vary by gender, age, and race.Especially in heart failure, retained fluid also contributes to weight. It was indicators that did not include weight, such as waist-to-height ratio, that made clear the true relationship between body fat and patient outcomes in our study, for found that greater obesity is actually associated with worse rather than better outcomes, including higher hospitalization rates and poorer health-related quality of life.”
“Obesity is not good but bad in patients with heart failure and reduced ejection fraction. These observations raise the question of whether weight loss can improve outcomes and we need trials to test this. In the UK, the National Institutes of Health and Care Excellence, NICE, now recommends that waist-to-height ratio rather than BMI be used for the general population, and we should also support this for heart failure patients.”
“This is important because the diagnosis of heart failure in people with obesity is a major problem in primary care. A patient’s symptoms of shortness of breath are often attributed to obesity. Obesity. Obesity is a risk factor and a cause of heart failure.” In the past, weight loss could be a concern for patients with heart failure and reduced ejection fraction, today it’s obesity.”
Professor von Haehling and Dr Sato wrote in their editorial:
“The current findings raise alarm bells about the term ‘obesity paradox’, which is believed to be based on BMI. Can we tell patients with HF (heart failure) to be obese? In order to adequately address this question, not only should the obesity paradox be revisited even in patients with HF with preserved ejection fraction (HFpEF) and in those HF patients are lean according to WHtR (waist-to-height ratio), which better reflects the pathophysiological processes of obesity, but further tests are also needed to confirm the effect of weight loss in obese ‘really’ HF patients with high WHtR.”
One limitation of the study is that it can be difficult to accurately measure body shapes, such as waist circumference, especially when the measurements are taken by different people; there may be additional unknown factors that may affect the results; analysis was performed based on measurements and other data taken at the time of study participants and did not take into account any changes in weight or waist circumference during the follow-up period; no data were available on the cardiovascular and respiratory status of the participants, which could influence the association between anthropometric measurements and the results; and finally, only 153 patients were underweight, with BMI less than 18.5 kg/m2, and 171 patients had a waist-to-height ratio less than 0.4 (0.5 is considered a healthy ratio). strong) the study results cannot be extrapolated to patients with low BMI or low waist-to-hip ratio.
Presenter:
(1) “Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox”, by Jaward H. Butt et al. European Journal of Cardiology. doi:10.1093/eurheartj/ehad083
(2) “Revisiting the obesity paradox in heart failure: what is the best anthropometric index to assess obesity?” by Ryosuke Sato and Stephan von Haehling. European Journal of Cardiology. doi:10.1093/eurheartj/ehad079
(3) PARADIGM-HF (Prospective Comparison of ARNI with ACEI to determine impact on mortality and global morbidity in heart failure) was a randomized, double-blind, controlled trial with placebo in chronic heart failure patients with reduced ejection fraction (HFrEF), efficacy and safety assessment of the angiotensin-neprilysin receptor blocker saubitril/valsartan compared with enalaparil, in addition to standard care .
(4) Research using BMI categories of the World Health Organization: <18.5 kg/m2 is underweight, 18.5-24.9 kg/m2 is normal weight, 25-29.9 kg/m2 is overweight and 30 kg/m2 or more is obese.
Attribution – Source(s):
Waist-to-height ratio Better index than BMI of heart failure patients Results | European Society of Cardiology (escardio.org). Disability World makes no warranties or representations regarding that. Content may have been edited for style, clarity, or length.
advertisement
Disability World is an independent disability community established in 2004 to provide disability information and information to people with disabilities, seniors, their families and/or carers. Surname. See our home page for news info, reviews, sports, stories and guides. You can also connect with us on Twitter and Facebook or learn more on our about us page.
Disability World provides general information only. The materials presented are never intended to be a substitute for the professional medical care of a qualified physician, nor should they be construed as such. Financial assistance is obtained from advertising or referral programs, if specified. Any 3rd party offer or advertisement does not constitute an endorsement.
• Cite This Page (APA): European Heart Association. (2023, March 22). Waist-to-height ratio is a better indicator of the BMI of patients with heart failure outcomes. World of People with Disabilities. Accessed March 23, 2023 from www.disabled-world.com/health/whr.php
• Permalinks: Waist-to-height Ratio Better than BMI of patients with heart failure outcome
