Motie Marjan, Evangelista Lorraine S, Lombardo Dawn, Horwich Tamara B, Hamilton Michele, Fonarow Gregg C
Program in Nursing Science, University of California Irvine, Irvine, California, USA.
Department of Medicine, University of California Irvine Medical Center, Irvine, California, USA.
J Diabetes Obes. 2017;4(2). doi: 10.15436/2376-0494.17.1108. Epub 2017 Feb 20.
This study was conducted to examine the relationship between adiposity and functional status (i.e. peak oxygen consumption [VOmax]), and left ventricular (LV) structural characteristics (i.e., LV ejection fraction [LVEF], LV end diastolic dimension [LVEDD], LV posterior wall thickness [LVPWT]) in heart failure (HF) patients with diabetes mellitus (DM), and/or metabolic syndrome (MS). We hypothesize that excess weight and body fat are significantly related to cardiac functional status.
Ninety four patients' clinical characteristics were analyzed at baseline to examine the relationships of interest. Results show that weight was correlated with fat and lean mass and LVEF (all p's < 0.050). Novel findings from our data showed that weight, fat mass, and percent fat were inversely related to VOmax; weight, fat mass and lean mass were positively related with LVPWT. In a multivariate analysis, body mass index and fat mass accounted for 28.8% of the variance in VOmax, showing significantly higher predictive value than other covariates (P = 0.002).
Our findings show a possible relationship between body fat on functional status in this patient cohort and challenges existing research that supports that higher weight and increased fat are good in the setting of chronic HF (i.e. obesity paradox). Strategies to optimize weight and reduce adiposity warrants further investigation in this subgroup of patients.
本研究旨在探讨肥胖与糖尿病（DM）和/或代谢综合征（MS）的心力衰竭（HF）患者的功能状态（即峰值耗氧量[VOmax]）以及左心室（LV）结构特征（即左心室射血分数[LVEF]、左心室舒张末期内径[LVEDD]、左心室后壁厚度[LVPWT]）之间的关系。我们假设超重和体脂与心脏功能状态显著相关。
分析了94例患者的基线临床特征，以研究感兴趣的关系。结果显示体重与脂肪、去脂体重和LVEF相关（所有p值<0.050）。我们数据的新发现表明，体重、脂肪量和脂肪百分比与VOmax呈负相关；体重、脂肪量和去脂体重与LVPWT呈正相关。在多变量分析中，体重指数和脂肪量占VOmax变异的28.8%，显示出比其他协变量显著更高的预测价值（P = 0.002）。
我们的研究结果表明，该患者队列中体脂与功能状态之间可能存在关系，并对现有支持在慢性HF情况下较高体重和增加脂肪有益（即肥胖悖论）的研究提出了挑战。在这一亚组患者中，优化体重和减少肥胖的策略值得进一步研究。
