New analysis has debunked the concept that there’s an “weight problems paradox,” whereby sufferers with coronary heart failure who’re obese or overweight are considered much less prone to find yourself in hospital or die than folks of regular weight.
The examine, which is revealed within the European Coronary heart Journal, exhibits that if docs measure the waist-to-height ratios of their sufferers, relatively than taking a look at their physique mass index (BMI), the supposed survival benefit for folks with a BMI of 25kg/m2 or extra disappears.
The “weight problems paradox” pertains to counter-intuitive findings suggesting that though individuals are at higher danger of growing coronary heart issues if they’re obese or overweight, as soon as an individual has developed a coronary heart situation, these with larger BMIs appeared to do higher and have been much less prone to die than these of regular weight. Numerous explanations have been steered, together with the truth that as soon as somebody has developed coronary heart issues, some additional fats is someway protecting towards additional well being issues and loss of life, particularly as individuals who develop a extreme and power sickness typically shed weight.
John McMurray, Professor of Medical Cardiology on the College of Glasgow (UK), who led the most recent analysis, stated, “It has been steered that dwelling with weight problems is an effective factor for sufferers with coronary heart failure and diminished ejection fraction—which is when the primary chamber of the guts is unable to squeeze out the traditional quantities of blood. We knew this might not be right and that weight problems have to be dangerous relatively than good. We reckoned that a part of the issue was that BMI was a weak indicator of how a lot fatty tissue a affected person has.”
As Professor Stephan von Haehling, Guide Heart specialist, and Dr. Ryosuke Sato, a analysis fellow, each on the College of Göttingen Medical Middle (Germany), write in an accompanying editorial, BMI fails to take account of the physique’s composition of fats, muscle and bone, or the place the fats is distributed. “Wouldn’t it be possible to imagine that an American skilled wrestler (extra muscle) and a Japanese sumo wrestler (extra fats) with the identical BMI would have the same danger of heart problems? The identical is true for individuals corresponding to Arnold Schwarzenegger in his youthful years when he starred because the ‘Terminator’ with a BMI of ~30 kg/m2.”
The examine revealed at the moment is the primary to take a look at alternative ways of measuring the scale and proportions of sufferers, together with BMI, but in addition anthropometric measurements corresponding to waist-to-height ratio, waist circumference and waist-to-hip ratio, and adjusting the affected person outcomes to take account of different elements that play a task in or predict these outcomes, corresponding to ranges of natriuretic peptides—hormones which are secreted within the blood when the guts is below strain, as with coronary heart failure.
“Natriuretic peptides are the one most essential prognostic variable in sufferers with coronary heart failure. Usually, ranges of natriuretic peptides rise in folks with coronary heart failure, however sufferers dwelling with weight problems have decrease ranges than those that are regular weight,” stated Prof. McMurray.
Prof. McMurray and colleagues analyzed knowledge from 1,832 girls and 6,567 males with coronary heart failure and diminished ejection fraction who have been enrolled within the PARADIGM-HF worldwide randomized managed trial going down in 47 international locations on six continents. When the sufferers have been randomized, docs collected knowledge on BMI, blood strain, anthropometric measurements, outcomes from blood assessments, medical histories and coverings. The researchers have been during which sufferers have been hospitalized with coronary heart failure or who died from it.
An “obesity-survival paradox” confirmed decrease loss of life charges for folks with BMIs of 25 kg/m2 or extra, however this was eradicated when the researchers adjusted the outcomes to take account of all of the elements that may have an effect on outcomes, together with ranges of natriuretic peptides.
First writer of the examine, Dr. Jawad Butt, a analysis fellow from Copenhagen College Hospital-Rigshospitalet, Copenhagen (Denmark), who carried out the analyses, stated, “The paradox was far much less evident after we checked out waist-to-height ratios, and it disappeared after adjustment for prognostic variables. After adjustment, each BMI and waist-to-height ratio confirmed that extra physique fats was related to a higher danger of loss of life or hospitalization for coronary heart failure, however this was extra evident for waist-to-height ratio. When taking a look at waist-to-height ratio, we discovered the highest 20% of individuals with essentially the most fats had a 39% elevated danger of being hospitalized for coronary heart failure in comparison with folks within the backside 20% who had the least fats.”
Prof. McMurray stated, “Our examine exhibits there is no such thing as a ‘weight problems survival paradox’ after we use higher methods of measuring physique fats. BMI doesn’t have in mind the situation of fats within the physique or its quantity relative to muscle or the burden of the skeleton, which can differ in keeping with intercourse, age and race. In coronary heart failure particularly, retained fluid additionally contributes to physique weight. It’s indices that don’t embrace weight, corresponding to waist-to-height ratio, which have clarified the true relationship between physique fats and affected person outcomes in our examine, exhibiting that higher adiposity is definitely related to worse—not higher—outcomes, together with excessive charges of hospitalization and worse health-related high quality of life.
“Weight problems isn’t good and is dangerous in sufferers with coronary heart failure and diminished ejection fraction. These observations increase the query as as to whether weight reduction may enhance outcomes, and we want trials to check this. Within the UK, the Nationwide Institute for Well being and Care Excellence, NICE, now recommends that waist-to-height ratio as an alternative of BMI is used for the overall inhabitants, and we should always assist this for sufferers with coronary heart failure too.
“It is crucial as a result of the underdiagnosis of coronary heart failure in folks dwelling with weight problems is a serious difficulty in major care. Sufferers’ signs of breathlessness are sometimes dismissed as due solely to weight problems. Weight problems is a danger issue and driver of coronary heart failure. Whereas prior to now weight reduction might have been a priority for sufferers with coronary heart failure and diminished ejection fraction, at the moment it’s weight problems.”
Prof. von Haehling and Dr. Sato write of their editorial: “The current findings increase the alarm over the time period ‘weight problems paradox,’ which has been claimed to be based mostly on BMI. Can we inform overweight HF [heart failure] sufferers simply to remain as they’re? To adequately deal with this query, not solely ought to the weight problems paradox be revisited even in sufferers with HF with preserved ejection fraction (HFpEF) and in lean HF sufferers by WHtR [waist-to-height ratio], which higher displays pathophysiological processes of weight problems, but in addition additional assessments are warranted to validate the impact of weight reduction in ‘really’ overweight HF sufferers with a excessive WHtR.”
Limitations of the examine are that it may be tougher to precisely measure physique shapes, corresponding to waist circumference, particularly when the measurements are carried out by completely different folks; there could also be additional unknown elements that might have an effect on the outcomes; the evaluation was carried out on measurements and different knowledge taken on the time individuals joined the examine and didn’t take account of any modifications in weight or waist circumference in the course of the follow-up interval; there have been no knowledge on the cardiorespiratory health of the individuals, which may affect the hyperlink between anthropometric measurements and outcomes; and eventually, solely 153 sufferers have been underweight, with a BMI of lower than 18.5 kg/m2, and 171 sufferers with a waist-to-height ratio of lower than 0.4 (0.5 is taken into account a wholesome ratio), so the examine’s findings can’t be extrapolated to sufferers with low BMIs or waist-to-hip ratio.
Extra data:
John JJV Mcmurray et al, Anthropometric Measures and Antagonistic Outcomes in Coronary heart Failure With Decreased Ejection Fraction: Revisiting the Weight problems Paradox, European Coronary heart Journal (2023). DOI: 10.1093/eurheartj/ehad083
European Society of Cardiology
Quotation:
Waist-to-height ratio, not BMI, precisely signifies outcomes in sufferers with coronary heart failure, says examine (2023, March 21)
retrieved 21 March 2023
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