Association of body mass index and mortality in chronic heart failure: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Jieyun , WANG Xiaoling , ZHONG Zhimei ,  ZHANG Jianfeng

Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, P.R.China;

Corresponding author：

ZHANG Jianfeng, Email: zhangjianfeng930@163.com

Keywords：

Body mass index; Chronic heart failure; Mortality; Meta-analysis; Systematical review; Cohort study

DOI：

10.7507/1672-2531.201909049

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the association of body mass index (BMI) and mortality in chronic heart failure (CHF) pationts.Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies about the association of BMI and mortality in CHF patients from inception to June, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies, then, meta-analysis was performed by using Stata 12.0 software.Results A total of 20 cohort studies involving 91 572 CHF patients were included. The results of meta-analysis showed that, compared to patients with normal weight, underweight individuals were associated with higher mortality (HR=1.48, 95%CI 1.36 to 1.62, P<0.001), whereas overweight (HR=0.86, 95%CI 0.78 to 0.94, P=0.002) and obese (HR=0.78, 95%CI 0.68 to 0.90, P=0.001) patients were associated with lower mortality.Conclusion Current evidence shows that underweight is associated with a higher risk of all-cause mortality among patients with CHF, whereas overweight and obese are associated with lower risk of all-cause mortality. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.

Citation： ZHU Jieyun, WANG Xiaoling, ZHONG Zhimei, ZHANG Jianfeng. Association of body mass index and mortality in chronic heart failure: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(2): 144-151. doi: 10.7507/1672-2531.201909049 Copy

1.	王拥军, 吴兆苏. 《中国心血管病报告 2018》概要. 中国循环杂志, 2019, 34(3): 209-220.
2.	吴穷, 李慧, 任妍, 等. 体质量指数对慢性心力衰竭患者预后的影响. 内科理论与实践, 2016, (3): 176-179.
3.	Wannamethee SG, Shaper AG, Whincup PH, et al. The obesity paradox in men with coronary heart disease and heart failure: the role of muscle mass and leptin. Int J Cardiol, 2014, 171(1): 49-55.
4.	Clark AL, Fonarow GC, Horwich TB. Impact of cardiorespiratory fitness on the obesity paradox in patients with systolic heart failure. Am J Cardiol, 2015, 115(2): 209-213.
5.	Clark AL, Chyu J, Horwich TB. The obesity paradox in men versus women with systolic heart failure. Am J Cardiol, 2012, 110(1): 77-82.
6.	Takiguchi M, Yoshihisa A, Miura S, et al. Impact of body mass index on mortality in heart failure patients. Eur J Clin Invest, 2014, 44(12): 1197-1205.
7.	Qin W, Liu F, Wan C. A U-shaped association of body mass index and all-cause mortality in heart failure patients: A dose-response meta-analysis of prospective cohort studies. Cardiovasc Ther, 2017, 35(2): e12232.
8.	Zhang J, Begley A, Jackson R, et al. Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis. Clin Res Cardiol, 2019, 108(2): 119-132.
9.	Kouvari M, Chrysohoou C, Tsiamis E, et al. The "overweight paradox" in the prognosis of acute coronary syndrome for patients with heart failure-A truth for all? A 10-year follow-up study. Maturitas, 2017, 102: 6-12.
10.	McAuley PA, Keteyian SJ, Brawner CA, et al. Exercise capacity and the obesity paradox in heart failure: The FIT (Henry Ford Exercise Testing) project. Mayo Clin Proc, 2018, 93(6): 701-708.
11.	Scrutinio D, Passantino A, Guida P, et al. Relationship among body mass index, NT-proBNP, and mortality in decompensated chronic heart failure. Heart Lung, 2017, 46(3): 172-177.
12.	Bozkurt B, Deswal A. Obesity as a prognostic factor in chronic symptomatic heart failure. Am Heart J, 2005, 150(6): 1233-1239.
13.	Curtis JP, Selter JG, Wang Y, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med, 2005, 165(1): 55-61.
14.	Gustafsson F, Kragelund CB, Torp-Pedersen C, et al. Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function. Eur Heart J, 2005, 26(1): 58-64.
15.	McAuley P, Myers J, Abella J, et al. Body mass, fitness and survival in veteran patients: another obesity paradox? Am J Med, 2007, 120(6): 518-524.
16.	Kapoor JR, Heidenreich PA. Obesity and survival in patients with heart failure and preserved systolic function: a U-shaped relationship. Am Heart J, 2010, 159(1): 75-80.
17.	Wu AH, Eagle KA, Montgomery DG, et al. Relation of body mass index to mortality after development of heart failure due to acute coronary syndrome. Am J Cardiol, 2009, 103(12): 1736-1740.
18.	Nochioka K, Shiba N, Kohno H, et al. Both high and low body mass indexes are prognostic risks in Japanese patients with chronic heart failure: implications from the CHART study. J Card Fail, 2010, 16(11): 880-887.
19.	Schwartzenberg S, Benderly M, Malnick S, et al. The "obesity paradox": does it persist among Israeli patients with decompensated heart failure? A subanalysis of the Heart Failure Survey in Israel (HFSIS). J Card Fail, 2012, 18(1): 62-67.
20.	Wang J, Yang YM, Zhu J, et al. Obesity paradox in patients with atrial fibrillation and heart failure. Int J Cardiol, 2014, 176(3): 1356-1358.
21.	Vest AR, Wu Y, Hachamovitch R, et al. The heart failure overweight/obesity survival paradox: the missing sex link. JACC Heart Fail, 2015, 3(11): 917-926.
22.	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): 1072-1079.
23.	Lin GM, Li YH, Yin WH, et al. The obesity-mortality paradox in patients with heart failure in taiwan and a collaborative meta-analysis for east asian patients. Am J Cardiol, 2016, 118(7): 1011-1018.
24.	Cai C, Hua W, Ding LG, et al. Association of body mass index with cardiac reverse remodeling and long-term outcome in advanced heart failure patients with cardiac resynchronization therapy. Circ J, 2014, 78(12): 2899-2907.
25.	Lee KS, Moser DK, Lennie TA, et al. Obesity paradox: comparison of heart failure patients with and without comorbid diabetes. Am J Crit Care, 2017, 26(2): 140-148.
26.	国家卫生计生委疾病预防控制局. 中国居民营养与慢性病状况报告(2015 年). 北京: 人民卫生出版社, 2015.
27.	陈贻珊, 张一民, 孔振兴, 等. 我国儿童青少年超重, 肥胖流行现状调查. 中华疾病控制杂志, 2017, 21(9): 866-869, 878.
28.	Nishikido T, Oyama JI, Nagatomo D, et al. A reduction of BMI predicts the risk of rehospitalization and cardiac death in non-obese patients with heart failure. Int J Cardiol, 2019, 276: 166-170.
29.	Vest AR, Chan M, Deswal A, et al. Nutrition, obesity, and cachexia in patients with heart failure: a consensus statement from the heart failure society of America scientific statements committee. J Card Fail, 2019, 25(5): 380-400.
30.	Tadic M, Cuspidi C. Obesity and heart failure with preserved ejection fraction: a paradox or something else? Heart Fail Rev, 2019, 24(3): 379-385.
31.	Satish K, Evans JC, Daniel L, et al. Obesity and the risk of heart failure. N Eng J Med, 2002, 57(2): 110.
32.	Zhai AB, Haddad H. The impact of obesity on heart failure. Curr Opin Cardiol, 2017, 32(2): 196-202.
33.	Chittal P, Babu AS, Lavie CJ. Obesity paradox: does fat alter outcomes in chronic obstructive pulmonary disease? COPD, 2015, 12(1): 14-18.
34.	Lavie CJ, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases and prognosis-the obesity paradox updated. Prog Cardiovasc Dis, 2016, 58(5): 537-547.
35.	朱洁云, 罗毅沣, 王霄玲, 等. BMI与慢性阻塞性肺病患者死亡率相关性的Meta分析. 中国循证医学杂志, 2019, 19(7): 811-817.
36.	Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol, 2002, 39(4): 578-584.
37.	郝素芳, 侯翠红, 裴娟慧, 等. 体重指数对慢性心力衰竭患者全因死亡风险的预测作用. 中国循环杂志, 2013, 28(1): 51-54.
38.	官文俊, 谢进, 许臣洪. BMI和BNP水平与慢性心力衰竭预后的相关性. 医学研究杂志, 2014, 43(8): 158-161.
39.	Guglin M, Baxi K, Schabath M. Anatomy of the obesity paradox in heart failure. Heart Fail Rev, 2014, 19(5): 621-635.

1. 王拥军, 吴兆苏. 《中国心血管病报告 2018》概要. 中国循环杂志, 2019, 34(3): 209-220.
2. 吴穷, 李慧, 任妍, 等. 体质量指数对慢性心力衰竭患者预后的影响. 内科理论与实践, 2016, (3): 176-179.
3. Wannamethee SG, Shaper AG, Whincup PH, et al. The obesity paradox in men with coronary heart disease and heart failure: the role of muscle mass and leptin. Int J Cardiol, 2014, 171(1): 49-55.
4. Clark AL, Fonarow GC, Horwich TB. Impact of cardiorespiratory fitness on the obesity paradox in patients with systolic heart failure. Am J Cardiol, 2015, 115(2): 209-213.
5. Clark AL, Chyu J, Horwich TB. The obesity paradox in men versus women with systolic heart failure. Am J Cardiol, 2012, 110(1): 77-82.
6. Takiguchi M, Yoshihisa A, Miura S, et al. Impact of body mass index on mortality in heart failure patients. Eur J Clin Invest, 2014, 44(12): 1197-1205.
7. Qin W, Liu F, Wan C. A U-shaped association of body mass index and all-cause mortality in heart failure patients: A dose-response meta-analysis of prospective cohort studies. Cardiovasc Ther, 2017, 35(2): e12232.
8. Zhang J, Begley A, Jackson R, et al. Body mass index and all-cause mortality in heart failure patients with normal and reduced ventricular ejection fraction: a dose-response meta-analysis. Clin Res Cardiol, 2019, 108(2): 119-132.
9. Kouvari M, Chrysohoou C, Tsiamis E, et al. The "overweight paradox" in the prognosis of acute coronary syndrome for patients with heart failure-A truth for all? A 10-year follow-up study. Maturitas, 2017, 102: 6-12.
10. McAuley PA, Keteyian SJ, Brawner CA, et al. Exercise capacity and the obesity paradox in heart failure: The FIT (Henry Ford Exercise Testing) project. Mayo Clin Proc, 2018, 93(6): 701-708.
11. Scrutinio D, Passantino A, Guida P, et al. Relationship among body mass index, NT-proBNP, and mortality in decompensated chronic heart failure. Heart Lung, 2017, 46(3): 172-177.
12. Bozkurt B, Deswal A. Obesity as a prognostic factor in chronic symptomatic heart failure. Am Heart J, 2005, 150(6): 1233-1239.
13. Curtis JP, Selter JG, Wang Y, et al. The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med, 2005, 165(1): 55-61.
14. Gustafsson F, Kragelund CB, Torp-Pedersen C, et al. Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function. Eur Heart J, 2005, 26(1): 58-64.
15. McAuley P, Myers J, Abella J, et al. Body mass, fitness and survival in veteran patients: another obesity paradox? Am J Med, 2007, 120(6): 518-524.
16. Kapoor JR, Heidenreich PA. Obesity and survival in patients with heart failure and preserved systolic function: a U-shaped relationship. Am Heart J, 2010, 159(1): 75-80.
17. Wu AH, Eagle KA, Montgomery DG, et al. Relation of body mass index to mortality after development of heart failure due to acute coronary syndrome. Am J Cardiol, 2009, 103(12): 1736-1740.
18. Nochioka K, Shiba N, Kohno H, et al. Both high and low body mass indexes are prognostic risks in Japanese patients with chronic heart failure: implications from the CHART study. J Card Fail, 2010, 16(11): 880-887.
19. Schwartzenberg S, Benderly M, Malnick S, et al. The "obesity paradox": does it persist among Israeli patients with decompensated heart failure? A subanalysis of the Heart Failure Survey in Israel (HFSIS). J Card Fail, 2012, 18(1): 62-67.
20. Wang J, Yang YM, Zhu J, et al. Obesity paradox in patients with atrial fibrillation and heart failure. Int J Cardiol, 2014, 176(3): 1356-1358.
21. Vest AR, Wu Y, Hachamovitch R, et al. The heart failure overweight/obesity survival paradox: the missing sex link. JACC Heart Fail, 2015, 3(11): 917-926.
22. 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): 1072-1079.
23. Lin GM, Li YH, Yin WH, et al. The obesity-mortality paradox in patients with heart failure in taiwan and a collaborative meta-analysis for east asian patients. Am J Cardiol, 2016, 118(7): 1011-1018.
24. Cai C, Hua W, Ding LG, et al. Association of body mass index with cardiac reverse remodeling and long-term outcome in advanced heart failure patients with cardiac resynchronization therapy. Circ J, 2014, 78(12): 2899-2907.
25. Lee KS, Moser DK, Lennie TA, et al. Obesity paradox: comparison of heart failure patients with and without comorbid diabetes. Am J Crit Care, 2017, 26(2): 140-148.
26. 国家卫生计生委疾病预防控制局. 中国居民营养与慢性病状况报告(2015 年). 北京: 人民卫生出版社, 2015.
27. 陈贻珊, 张一民, 孔振兴, 等. 我国儿童青少年超重, 肥胖流行现状调查. 中华疾病控制杂志, 2017, 21(9): 866-869, 878.
28. Nishikido T, Oyama JI, Nagatomo D, et al. A reduction of BMI predicts the risk of rehospitalization and cardiac death in non-obese patients with heart failure. Int J Cardiol, 2019, 276: 166-170.
29. Vest AR, Chan M, Deswal A, et al. Nutrition, obesity, and cachexia in patients with heart failure: a consensus statement from the heart failure society of America scientific statements committee. J Card Fail, 2019, 25(5): 380-400.
30. Tadic M, Cuspidi C. Obesity and heart failure with preserved ejection fraction: a paradox or something else? Heart Fail Rev, 2019, 24(3): 379-385.
31. Satish K, Evans JC, Daniel L, et al. Obesity and the risk of heart failure. N Eng J Med, 2002, 57(2): 110.
32. Zhai AB, Haddad H. The impact of obesity on heart failure. Curr Opin Cardiol, 2017, 32(2): 196-202.
33. Chittal P, Babu AS, Lavie CJ. Obesity paradox: does fat alter outcomes in chronic obstructive pulmonary disease? COPD, 2015, 12(1): 14-18.
34. Lavie CJ, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases and prognosis-the obesity paradox updated. Prog Cardiovasc Dis, 2016, 58(5): 537-547.
35. 朱洁云, 罗毅沣, 王霄玲, 等. BMI与慢性阻塞性肺病患者死亡率相关性的Meta分析. 中国循证医学杂志, 2019, 19(7): 811-817.
36. Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol, 2002, 39(4): 578-584.
37. 郝素芳, 侯翠红, 裴娟慧, 等. 体重指数对慢性心力衰竭患者全因死亡风险的预测作用. 中国循环杂志, 2013, 28(1): 51-54.
38. 官文俊, 谢进, 许臣洪. BMI和BNP水平与慢性心力衰竭预后的相关性. 医学研究杂志, 2014, 43(8): 158-161.
39. Guglin M, Baxi K, Schabath M. Anatomy of the obesity paradox in heart failure. Heart Fail Rev, 2014, 19(5): 621-635.

Chinese Journal of Evidence-Based Medicine

Association of body mass index and mortality in chronic heart failure: a meta-analysis

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