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. 2023 Dec 11:10:1239722.
doi: 10.3389/fcvm.2023.1239722. eCollection 2023.

Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

Nathália Felix Araujo Salvino  1   2 , Lyz Tavares de Sousa  3 , Fabio Maia Abrahao  1 , Pedro Pimenta de Mello Spineti  1 , Ana Luiza Ferreira Sales  1 , Felipe Neves de Albuquerque  1 , Marcelo Imbroinise Bittencourt  1 , Pedro Castello Branco de Moraes  1   2 , Roberto Esporcatte  1 , Ricardo Mourilhe-Rocha  1   2
Affiliations

Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

Nathália Felix Araujo Salvino et al. Front Cardiovasc Med. .

Abstract

Background: The obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population.

Methods: We analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56-70), BMI 18.5-24.9 = 35.1%, 25-29.9 = 37.2%, 30-34.9 = 17.8%, 35-39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing.

Results: BMI 30-34.9 and BMI 18.5-24.9 had the best prognosis, BMI 25-29.9 had an average performance, and BMI -39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30-34.9 group had a better prognosis compared to the BMI 35-39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI.

Conclusion: In not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.

Keywords: MAGGIC score; heart failure; heart failure reduced ejection fraction; obesity; obesity paradox.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patient selection/exclusion flow according to nutritional class and mortality.
Figure 2
Figure 2
(A) Survival according to nutritional classification and (B) survival grade I obesity versus grade II obesity.
Figure 3
Figure 3
MAGGIC score according to nutritional classification.
See this image and copyright information in PMC

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