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Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox.
Mayo Clin Proc. 2014 Aug; 89(8):1072-9.MC

Abstract

OBJECTIVE

To evaluate the effects of body composition as a function of lean mass index (LMI) and body fat (BF) on the correlation between increasing body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and decreasing mortality, which is known as the obesity paradox.

PATIENTS AND METHODS

We retrospectively assessed 47,866 patients with preserved left ventricular ejection fraction (≥50%). We calculated BF by using the Jackson-Pollock equation and LMI using (1 - BF) × BMI. The population was divided according to the sex-adjusted BMI classification, sex-adjusted LMI classification, and sex-adjusted BF tertiles. The population was analyzed by using multivariate analysis for total mortality over a mean follow-up duration of 3.1 years by using the National Death Index, adjusting for left ventricular ejection fraction, left ventricular mass index, age, sex, and relative wall thickness.

RESULTS

In the entire population, higher BMI was narrowly associated (hazard ratio [HR], 0.99; P<.001) with lower mortality. The higher LMI group was clearly protective (HR, 0.71; P<.001), whereas BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.87; P<.001 without LMI; HR, 0.97; P=.23 with LMI). In the lean patients, low BMI was clearly associated with higher mortality (HR, 0.92; P<.001) and lower BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.80; P<.001 without LMI; HR, 1.01; P=.83 with LMI). The underweight patients stratified by BF seemed to have an increased mortality (HR, 1.91; 95% CI, 1.56-2.34) that was independent of LMI. However, in obese patients, both BMI (HR, 1.03; P<.001) and BF (HR, 1.18; P=.003) were associated with higher mortality, even after adjusting for LMI, which remained protective (HR, 0.57; P<.001) independently of BF.

CONCLUSION

Body composition could explain the inverse J shape of the mortality curve noted with increasing BMI. Body fat seems to be protective in this cohort only if no adjustment was made for LMI, although being underweight stratified by BF seems to be an independent risk factor. Lean mass index seems to remain protective in obese patients even when BMI is not.

Authors+Show Affiliations

John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Medicine, Cleveland Clinic Florida, Weston.John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA; Department of Preventive Medicine, Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge. Electronic address: clavie@ochsner.org.Department of Medicine, Cleveland Clinic Florida, Weston.John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA.John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25039037

Citation

De Schutter, Alban, et al. "Body Composition and Mortality in a Large Cohort With Preserved Ejection Fraction: Untangling the Obesity Paradox." Mayo Clinic Proceedings, vol. 89, no. 8, 2014, pp. 1072-9.
De Schutter A, Lavie CJ, Kachur S, et al. Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. Mayo Clin Proc. 2014;89(8):1072-9.
De Schutter, A., Lavie, C. J., Kachur, S., Patel, D. A., & Milani, R. V. (2014). Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. Mayo Clinic Proceedings, 89(8), 1072-9. https://doi.org/10.1016/j.mayocp.2014.04.025
De Schutter A, et al. Body Composition and Mortality in a Large Cohort With Preserved Ejection Fraction: Untangling the Obesity Paradox. Mayo Clin Proc. 2014;89(8):1072-9. PubMed PMID: 25039037.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Body composition and mortality in a large cohort with preserved ejection fraction: untangling the obesity paradox. AU - De Schutter,Alban, AU - Lavie,Carl J, AU - Kachur,Sergey, AU - Patel,Dharmendrakumar A, AU - Milani,Richard V, Y1 - 2014/07/16/ PY - 2013/09/10/received PY - 2014/03/11/revised PY - 2014/04/16/accepted PY - 2014/7/21/entrez PY - 2014/7/21/pubmed PY - 2014/10/31/medline SP - 1072 EP - 9 JF - Mayo Clinic proceedings JO - Mayo Clin Proc VL - 89 IS - 8 N2 - OBJECTIVE: To evaluate the effects of body composition as a function of lean mass index (LMI) and body fat (BF) on the correlation between increasing body mass index (BMI; calculated as the weight in kilograms divided by the height in meters squared) and decreasing mortality, which is known as the obesity paradox. PATIENTS AND METHODS: We retrospectively assessed 47,866 patients with preserved left ventricular ejection fraction (≥50%). We calculated BF by using the Jackson-Pollock equation and LMI using (1 - BF) × BMI. The population was divided according to the sex-adjusted BMI classification, sex-adjusted LMI classification, and sex-adjusted BF tertiles. The population was analyzed by using multivariate analysis for total mortality over a mean follow-up duration of 3.1 years by using the National Death Index, adjusting for left ventricular ejection fraction, left ventricular mass index, age, sex, and relative wall thickness. RESULTS: In the entire population, higher BMI was narrowly associated (hazard ratio [HR], 0.99; P<.001) with lower mortality. The higher LMI group was clearly protective (HR, 0.71; P<.001), whereas BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.87; P<.001 without LMI; HR, 0.97; P=.23 with LMI). In the lean patients, low BMI was clearly associated with higher mortality (HR, 0.92; P<.001) and lower BF tertile was associated with lower mortality only if no adjustment was made for LMI (HR, 0.80; P<.001 without LMI; HR, 1.01; P=.83 with LMI). The underweight patients stratified by BF seemed to have an increased mortality (HR, 1.91; 95% CI, 1.56-2.34) that was independent of LMI. However, in obese patients, both BMI (HR, 1.03; P<.001) and BF (HR, 1.18; P=.003) were associated with higher mortality, even after adjusting for LMI, which remained protective (HR, 0.57; P<.001) independently of BF. CONCLUSION: Body composition could explain the inverse J shape of the mortality curve noted with increasing BMI. Body fat seems to be protective in this cohort only if no adjustment was made for LMI, although being underweight stratified by BF seems to be an independent risk factor. Lean mass index seems to remain protective in obese patients even when BMI is not. SN - 1942-5546 UR - https://www.unboundmedicine.com/medline/citation/25039037/Body_composition_and_mortality_in_a_large_cohort_with_preserved_ejection_fraction:_untangling_the_obesity_paradox_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0025-6196(14)00389-9 DB - PRIME DP - Unbound Medicine ER -