Association between body mass index and prognosis of patients hospitalized with heart failure
ABSTRACT: The prognostic implications of very low body mass index (BMI) values remain unclear in patients with acute decompensated heart failure (ADHF). This study aimed to investigate the prognostic impact of BMI classification based on the World Health Organization criteria in patients with ADHF. Among 3509 patients with ADHF and available BMI data at discharge in 19 participating hospitals in Japan between October 2014 and March 2016, the study population was divided into five groups; (1) Severely underweight: BMI?
Project description:OBJECTIVE:To examine the relationship between body mass index (BMI) and outcomes after percutaneous coronary intervention (PCI) in a multiethnic South East Asian population. SETTING:Fifteen participating cardiology centres contributed to the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. PARTICIPANTS:28?742 patients from the NCVD-PCI registry who had their first PCI between January 2007 and December 2014 were included. Those without their BMI recorded or BMI <11?kg/m2 or >70?kg/m2 were excluded. MAIN OUTCOME MEASURES:In-hospital death, major adverse cardiovascular events (MACEs), vascular complications between different BMI groups were examined. Multivariable-adjusted HRs for 1-year mortality after PCI among the BMI groups were also calculated. RESULTS:The patients were divided into four groups; underweight (BMI <18.5?kg/m2), normal BMI (BMI 18.5 to <23?kg/m2), overweight (BMI 23 to <27.5?kg/m2) and obese (BMI ?27.5?kg/m2). Comparison of their baseline characteristics showed that the obese group was younger, had lower prevalence of smoking but higher prevalence of diabetes, hypertension and dyslipidemia. There was no difference found in terms of in-hospital death, MACE and vascular complications after PCI. Multivariable Cox proportional hazard regression analysis showed that compared with normal BMI group the underweight group had a non-significant difference (HR 1.02, p=0.952), while the overweight group had significantly lower risk of 1-year mortality (HR 0.71, p=0.005). The obese group also showed lower HR but this was non-significant (HR 0.78, p=0.056). CONCLUSIONS:Using Asian-specific BMI cut-off points, the overweight group in our study population was independently associated with lower risk of 1-year mortality after PCI compared with the normal BMI group.
Project description:OBJECTIVE:This study aimed to examine the association between body mass index (BMI) and self-rated health (SRH) in Korean adults. METHODS:The study included 214,997 adults who participated in the 2016 Korean Community Health Survey. Participants were categorized into four groups according to WHO Asian classification based on their BMI: underweight (<18.5 kg/m2), normal-weight (18.5-22.9 kg/m2), overweight (23.0?24.9 kg/m2), obese (25.0?29.9 kg/m2), and severely obese (?30.0 kg/m2). Multivariate Poisson regression analysis with sampling weights and robust variance estimators was performed to evaluate the relationship between BMI categories and poor SRH. RESULTS:A J-shaped association was observed between BMI and poor SRH in both sexes. Compared to normal-weight subjects, the age, lifestyle, and comorbidities adjusted prevalence rate ratios (PRRs) in men for poor SRH were 1.73 (95% confidence interval [CI], 1.60-1.88) for underweight, 0.87 (95% CI, 0.83-0.92) for overweight, 0.98 (95% CI, 0.93-1.03) for obese, and 1.79 (95% CI, 1.63-1.97) for severely obese. In women, compared to normal-weight subjects, the age, lifestyle, and comorbidities adjusted PRRs for poor SRH were 1.33 (95% CI, 1.26-1.41) for underweight, 1.02 (95% CI, 0.98-1.06) for overweight, 1.15 (95% CI, 1.10-1.19) for obese, and 1.42 (95% CI, 1.31-1.53) for severely obese. Associations between underweight and SRH were stronger at older ages than at younger ages, whereas those between high BMI and SRH were stronger at younger ages than at older ages. CONCLUSIONS:This cross-sectional study using a nationally representative survey observed a J-shaped relationship between BMI and poor SRH. This association differed depending on age and presence or absence of comorbidities.
Project description:The relation between obesity and stroke outcome has been disputed. This study was aimed to determine the association of body mass index (BMI) with mortality and functional outcome in patients with acute ischemic stroke. Data were from a national, multi-centre, prospective, hospital-based register: the ChinaQUEST (Quality Evaluation of Stroke Care and Treatment) study. Of 4782 acute ischemic stroke patients, 282 were underweight (BMI?<?18.5?kg/m2), 2306 were normal-weight (BMI 18.5 to?<?24?kg/m2), 1677 were overweight (BMI 24 to <28?kg/m2) and 517 were obese (BMI???28?kg/m2). The risks of death at 12 months and death or high dependency at 3 and 12 months in overweight (HR: 0.97, 95% CI: 0.78-1.20; OR: 0.93, 95% CI: 0.80-1.09; OR: 0.95, 95% CI: 0.81-1.12) and obese patients (HR: 1.07, 95% CI: 0.78-1.48; OR: 0.96, 95% CI: 0.75-1.22; OR: 1.06, 95% CI: 0.83-1.35) did not differ from normal-weight patients significantly after adjusting for baseline characteristics. Underweight patients had significantly increased risks of these three outcomes. In ischemic stroke patients, being overweight or obese was not associated with decreased mortality or better functional recovery but being underweight predicted unfavourable outcomes.
Project description:BACKGROUND:Obesity is a risk factor for breast cancer (BC) development, recurrence, and death. In view of this, we aimed to investigate the clinical value of obesity in BC patients treated with anti-HER2 therapies in the NeoALTTO trial, which randomized 455 patients to neo-adjuvant lapatinib, trastuzumab, or their combination plus paclitaxel. METHODS:Patients were classified according to their basal body mass index (BMI) into underweight (<?18.5?kg/m2), normal (??18.5; <?25?kg/m2), overweight (??25; <?30?kg/m2), and obese (??30?kg/m2) WHO categories. Univariate and multivariate logistic regression analyses were performed using BMI as a categorical variable. Pathological complete response (pCR) and event-free survival (EFS) were the NeoALTTO primary and secondary outcomes, respectively. RESULTS:Among 454 patients analyzed, 14 (3%), 220 (48%), 137 (30%), and 83 (18%) were classified as underweight, normal weight, overweight, and obese, respectively; 231 (51%) and 223 (49%) had hormone receptor (HR)-positive and HR-negative primary tumors; 160 (35%) achieved pCR. In the overall patient population, no association was found between BMI groups and pCR, as we reported pCR rates of 57.1%, 35%, 30.7%, and 39.8% in underweight, normal weight, overweight, and obese cases, respectively. In contrast, in HR-positive tumors, overweight or obesity was generally associated with decreased likelihood of achieving a pCR independently of other clinical variables, including planned surgery, nodal status, and tumor size (odds ratio [OR]?=?0.55, 95%CI 0.30-1.01, as compared to normal or underweight; p =?0.053); notably, no differential effect of BMI with respect to pCR was observed in HR-negative cases (odds ratio [OR]?=?1.30, 95%CI 0.76-2.23, as compared to normal or underweight; p =?0.331), resulting in a statistically significant interaction between BMI and HR status (p =?0.036). There was no association between BMI and EFS neither in the overall nor in the HR-positive population, but this analysis was under-powered. CONCLUSIONS:NeoALTTO patients overweight or obese at baseline and with HR-positive primary BC appeared less likely to achieve pCR after neo-adjuvant anti-HER2 therapies. This finding paves the way to future research in targeting the interplay between HER2/HR signaling and metabolism.
Project description:Although a raised body mass index (BMI) is associated with increased risk of colorectal cancer (CRC) and recurrence after adjuvant treatment, data in the metastatic setting is limited. We compared overall survival (OS) across BMI groups for metastatic CRC, and specifically examined the effect of BMI within the group of patients treated with targeted therapies (TT). Retrospective data were obtained from the South Australian Registry for mCRC from February 2006 to October 2012. The BMI at first treatment was grouped as underweight <18.5 kg/m(2) , Normal = 18.5 to <25 kg/m(2) , Overweight = 25 to <30 kg/m(2) , Obese I = 30 to <35 kg/m(2) , Obese II ?35 kg/m(2) . Of 1174 patients, 42 were underweight, 462 overweight, 175 Obese I, and 77 Obese II. The OS was shorter for patients who were underweight and overweight compared to normal (OS 13.7 and 22.3 vs. 24.1 months, respectively, hazard ratio [HR] 2.21 and 1.23). The adjusted median OS was longer for normal versus overweight or obese I patients receiving chemotherapy + targeted therapy (35.7 vs 25.1 or 22.8 months, HR 1.59 and 1.63, respectively) with no difference in OS for chemotherapy alone. On breakdown by type of targeted therapy, overweight and obese I patients had a poorer outcome with Bevacizumab. The BMI is predictive of a poorer outcome for underweight and overweight patients in the whole population. Of those receiving chemotherapy and targeted therapy, BMI is an independent predictor for OS for overweight and obese I patients, specifically for those treated with Bevacizumab. Patients who are overweight or obese (group I) may be a target group for lifestyle and nutrition advice to improve OS with TT.
Project description:The aim of study was to investigate correlation bewteen peripheral blood mononuclear cell (PBMC) transcriptome profiles and plasma lipid profiles of Korean adult with varying BMI. In Korean, BMI cut-off points are 18.5~22.9 kg/m2 (normal range), ≥ 23 kg/m2 (overweight), ≥ 25 kg/m2 (obese), ≥ 30 kg/m2 (severely obese). Thus, the obese group was subdivided into mildly obese (BMI 25~27 kg/m2, OA) and highly obese (BMI 27~30 kg/m2, OB). This study indicates that lipid, glucose and inflammation metabolism-related gene expressions were altered according to cahnge of varing phenotype biomarkers such as BMI, plasma total-C, TG, FFA and HDL-C. Thus, blood biomarkers and PBMC gene expression profiles identified in this study may be useful as indicative biomarkers for obese susceptibility in Korean adult as well as response to various intervention for treating obesity. Total RNA of PBMCs was obtained from normal weight, obese person and mRNA expression was measured.
Project description:<h4>Background</h4>Obesity paradox refers to lower mortality in subjects with higher body mass index (BMI), and has been documented under a variety of condition. However, whether obesity paradox exists in adults requiring mechanical ventilation in intensive critical units (ICU) remains controversial.<h4>Methods</h4>MEDLINE, EMBASE, China Biology Medicine disc (CBM) and CINAHL electronic databases were searched from the earliest available date to July 2017, using the following search terms: "body weight", "body mass index", "overweight" or "obesity" and "ventilator", "mechanically ventilated", "mechanical ventilation", without language restriction. Subjects were divided into the following categories based on BMI (kg/m2): underweight, < 18.5 kg/m2; normal, 18.5-24.9 kg/m2; overweight, BMI 25-29.9 kg/m2; obese, 30-39.9 kg/m2; and severely obese > 40 kg/m2. The primary outcome was mortality, and included ICU mortality, hospital mortality, short-term mortality (<6 months), and long-term mortality (6 months or beyond). Secondary outcomes included duration of mechanical ventilation, length of stay (LOS) in ICU and hospital. A random-effects model was used for data analyses. Risk of bias was assessed using the Newcastle-Ottawa quality assessment scale.<h4>Results</h4>A total of 15,729 articles were screened. The final analysis included 23 articles (199,421 subjects). In comparison to non-obese patients, obese patients had lower ICU mortality (odds ratio (OR) 0.88, 95% CI 0.0.84-0.92, I2 = 0%), hospital mortality (OR 0.83, 95% CI 0.74-0.93, I2 = 52%), short-term mortality (OR 0.81, 95% CI 0.74-0.88, I2 = 0%) as well as long-term mortality (OR 0.69, 95% CI 0.60-0.79, I2 = 0%). In comparison to subjects with normal BMI, obese patients had lower ICU mortality (OR 0.88, 95% CI 0.82-0.93, I2 = 5%). Hospital mortality was lower in severely obese and obese subjects (OR 0.71, 95% CI 0.53-0.94, I2 = 74%, and OR 0.80, 95% CI 0.73-0.89, I2 = 30%). Short-term mortality was lower in overweight and obese subjects (OR 0.82, 95% CI 0.75-0.90, I2 = 0%, and, OR 0.75, 95% CI 0.66-0.84, I2 = 8%, respectively). Long-term mortality was lower in severely obese, obese and overweight subjects (OR 0.39, 95% CI 0.18-0.83, and OR 0.63, 95% CI 0.46-0.86, I2 = 56%, and OR 0.66, 95% CI 0.57-0.77, I2 = 0%). All 4 mortality measures were higher in underweight subjects than in subjects with normal BMI. Obese subjects had significantly longer duration on mechanical ventilation than non-obese group (mean difference (MD) 0.48, 95% CI 0.16-0.80, I2 = 37%), In comparison to subjects with normal BMI, severely obese BMI had significantly longer time in mechanical ventilation (MD 1.10, 95% CI 0.38-1.83, I2 = 47%). Hospital LOS did not differ between obese and non-obese patients (MD 0.05, 95% CI -0.52 to 0.50, I2 = 80%). Obese patients had longer ICU LOS than non-obese patients (MD 0.38, 95% CI 0.17-0.59, I2 = 70%). Hospital LOS and ICU LOS did not differ significantly in subjects with different BMI status.<h4>Conclusions</h4>In ICU patients receiving mechanical ventilation, higher BMI is associated with lower mortality and longer duration on mechanical ventilation.
Project description:<label>BACKGROUND</label>Obesity or overweight is related to worse outcomes in patients with atrial fibrillation (AF) following catheter ablation (CA). The role of being underweight in relation to recurrent arrhythmias post AF ablation is less certain. We conducted a retrospective study to investigate the association of body mass index (BMI) with arrhythmia outcomes in AF patients undergoing CA.<label>METHODS</label>In a cohort of 1410 AF patients (mean age 57.2?±?11.6?years; 68% male) undergoing single CA, the association between BMI and AF ablation outcome was analyzed using BMI as a continuous variable and by four BMI categories (<18.5?kg/m2, 18.5-24?kg/m2, 25-29?kg/m2, and???30?kg/m2).<label>RESULT</label>We observed a positive association between a cut off value of BMI and risk of AF recurrence post AF ablation. BMI ?26.36?kg/m2 was related to more AF recurrence (c-statistic 0.55, 95%CI 0.51-0.58; P?<?0.01) with 50% increased risk of AF recurrence (HR 1.50, 95% CI 1.22-1.86; P?<?0.01). Recurrence rates in the four BMI categories were 33.3%, 23.2%, 27.2 and 41.8%, respectively (P?<?0.01). Kaplan-Meier analysis showed that BMI categories of <18.5?kg/m2 and???30?kg/m2 were all associated with more AF recurrence (P?=?0.01). Both underweight (HR 1.85, 95%CI 1.12-3.08; P?=?0.02) and obesity (HR 1.78, 95%CI 1.17-2.72; P?=?0.01) significantly increased the risk of AF recurrence in a Cox proportional hazard model.<label>CONCLUSION</label>BMI had good predictive value for AF ablation outcomes with a cut off value of ?26.36?kg/m2. Apart from being obese/overweight, being underweight might also be a risk factor for AF recurrence post ablation.
Project description:Background:Unlike patterns observed in the general population, obesity is associated with better survival among hemodialysis patients, which could be explained by reverse causation or illness-related weight loss. However, the time-varying effect of body mass index (BMI) on hemodialysis survival has not been investigated. Therefore, this study investigated the time-varying effect of BMI on mortality after starting hemodialysis. Methods:In the present study, we examined Korean Society of Nephrology data from 16,069 adult patients who started hemodialysis during or after the year 2000. Complete survival data were obtained from Statistics Korea. Survival analysis was performed using Cox regression and a non-proportional hazard fractional polynomial model. Results:During the median follow-up of 8.6 years, 9,272 patients (57.7%) died. Compared to individuals with normal BMI (18.5-24.9 kg/m2), the underweight group (< 18.5 kg/m2) had a higer mortality hazard ratio (HR, 1.292; 95% confidence interval [CI], 1.203-1.387; P < 0.001) and the overweight group (25.0-29.9 kg/m2) had a lower mortality HR (0.904; 95% CI, 0.829-0.985; P = 0.022). The underweight group had increasing HRs during the first 3 to 7 years after starting hemodialysis, which varied according to age group. The young obese group (< 40 years old) had a U-shaped temporal trend in their mortality HRs, which reflected increased mortality after 7 years. Conclusion:The obese hemodialysis group had better survival during the early post-dialysis period, although the beneficial effect of obesity disappeared 7 years after starting hemodialysis. The young obese group also had an increased mortality HR after 7 years.
Project description:<h4>Background and purpose</h4>The impact of excess body weight on prognosis after stroke is controversial. Many studies report higher survival rates in obese patients ("obesity paradox"). Recently, obesity has been linked to worse outcomes after intravenous (IV) thrombolysis, but the number and sample size of these studies were small. Here, we aimed to assess the relationship between body weight and stroke outcome after IV thrombolysis in a large cohort study.<h4>Methods</h4>In a prospective observational multicenter study, we analyzed baseline and outcome data of 896 ischemic stroke patients who underwent IV thrombolysis. Patients were categorized according to body mass index (BMI) as underweight (<18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (30-34.9 kg/m2) or severely obese (>35 kg/m2). Using uni- and multivariate modeling, we assessed the relationship of BMI with favorable outcome (defined as modified Rankin Scale 0 or 1) and mortality 3 months after stroke as well as the occurrence of symptomatic intracerebral hemorrhages (sICH). We also measured the incidence of patients that had an early neurological improvement of >40% on the National Institutes of Health Stroke Scale (NIHSS) after 24 hours.<h4>Results</h4>Among 896 patients, 321 were normal weight (35.8%), 22 underweight (2.5%), 378 overweight (42.2%), 123 obese (13.7%) and 52 severely obese (5.8%). Three-month mortality was comparable in obese vs. non-obese patients (8.1% vs. 8.3%) and did not differ significantly among different BMI groups. This was also true for favorable clinical outcome, risk of sICH and early neurological improvement on NIHSS at 24 hours. These results remained unchanged after adjusting for potential confounding factors in the multivariate analyses.<h4>Conclusion</h4>BMI was not related to clinical outcomes in stroke patients treated with IVT. Our data suggest that the current weight-adapted dosage scheme of IV alteplase is appropriate for different body weight groups, and challenge the existence of the obesity paradox after stroke.