High BMI, Low Mortality: ! Or ?

[Guest guest]

This just came out. I havent seen the full study yet, but hope to this

week, so cant comment yet. There is always a rational answer to any

" paradox " .

If not, we are in trouble, and I am heading out to the buffet.

Regards

jeff

Vol. 165 No. 1, January 10, 2005

The Obesity Paradox

Body Mass Index and Outcomes in Patients With Heart Failure

Jeptha P. Curtis, MD; G. Selter, MD; Yongfei Wang, MS; Saif S.

Rathore, MPH; Ion S. Jovin, MD; Farid Jadbabaie, MD; Mikhail Kosiborod,

MD; L. Portnay, MD; Seth I. Sokol, MD; Feras Bader, MD; Harlan M.

Krumholz, MD

Arch Intern Med. 2005;165:55-61.

Background In the general population, obesity is associated with

increased risk of adverse outcomes. However, studies of patients with

chronic disease suggest that overweight and obese patients may

paradoxically have better outcomes than lean patients. We sought to

examine the association of body mass index (BMI) and outcomes in stable

outpatients with heart failure (HF).

Methods We analyzed data from 7767 patients with stable HF enrolled in

the Digitalis Investigation Group trial. Patients were categorized using

baseline BMI (calculated as weight in kilograms divided by the square of

height in meters) as underweight (BMI <18.5), healthy weight (BMI,

18.5-24.9, overweight (BMI, 25.0-29.9), and obese (BMI 30.0). Risks

associated with BMI groups were evaluated using multivariable

proportional hazards models over a mean follow-up of 37 months.

Results Crude all-cause mortality rates decreased in a near linear

fashion across successively higher BMI groups, from 45.0% in the

underweight group to 28.4% in the obese group (P for trend <.001). After

multivariable adjustment, overweight and obese patients were at lower

risk for death (hazard ratio

---

, 0.88; 95% confidence interval [CI],

0.80-0.96, and HR, 0.81; 95% CI, 0.72-0.92, respectively), compared with

patients at a healthy weight (referent). In contrast, underweight

patients with stable HF were at increased risk for death (HR 1.21; 95%

CI, 0.95-1.53).

Conclusions In a cohort of outpatients with established HF, higher BMIs

were associated with lower mortality risks; overweight and obese

patients had lower risk of death compared with those at a healthy

weight. Understanding the mechanisms and impact of the " obesity paradox "

in patients with HF is necessary before recommendations are made

concerning weight and weight control in this population.