Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Kumamoto City Hospital, Kumamoto, Japan.
Int J Obes (Lond). 2022 Oct;46(10):1840-1848. doi: 10.1038/s41366-022-01163-7. Epub 2022 Jul 28.
The paradoxical association of obesity with mortality, named the "obesity paradox", has been inconsistent, possibly due to a difference between body mass index (BMI) and central obesity, estimated by waist circumference (WC) as patterns of adiposity.
SUBJECTS/METHODS: We enrolled 8513 participants from the Kumamoto Intervention Conference Study, a multicenter registry that included consecutive patients undergoing percutaneous coronary intervention (PCI) at 18 centers between 2008 and 2017 in Japan. Patients were divided into quartiles in ascending order of the BMI or WC. The primary endpoints were all-cause mortality and cardiovascular death within a year.
There were 186 deaths (case fatality rate, 22.1/1000 person-years) during the follow-up period. The lowest group (1st quartile) of BMI or WC had the worst prognosis among the quartiles (1st quartile, 4.2%; 2nd quartile, 1.9%; 3rd quartile, 1.5%; 4th quartile, 1.1%; P < 0.001 (χ) and 1st quartile, 4.1%; 2nd quartile, 2.3%; 3rd quartile, 1.2%; 4th quartile, 1.5%; P < 0.001 (χ), respectively). Similar results were obtained for cardiovascular death. In a multivariable analysis adjusted by nine conventional factors, the lowest group (1st quartile) of BMI (hazards ratio, 2.748; 95% confidence interval [CI], 1.712-4.411) and WC (hazards ratio, 2.340; 95% CI, 1.525-3.589) were independent prognostic factors for all-cause mortality. By dividing the participants into two groups according to either the BMI or WC based on the National Cholesterol Education Program Adult Treatment Panel III and World Health Organization classification, the highest mortality was observed in the lower group. However, the C-statistic after adding BMI (quartile) to conventional factors was found to be slightly higher than BMI (two categories) and WC (two categories) (0.735 vs. 0.734).
The obesity paradox was observed in patients after PCI, and single-use of BMI (or WC) was sufficient to predict the prognosis of patients after PCI.
肥胖与死亡率之间的矛盾关联，即“肥胖悖论”，一直存在争议，这可能是由于体重指数（BMI）与腰围（WC）所估计的中心性肥胖之间的差异，后者是体脂分布的模式。
对象/方法：我们从日本 2008 年至 2017 年间在 18 个中心接受经皮冠状动脉介入治疗（PCI）的连续患者中招募了 8513 名来自熊本干预会议研究的参与者，该研究是一个多中心登记处。患者按 BMI 或 WC 的升序分为四分位数。主要终点是一年内全因死亡率和心血管死亡。
在随访期间发生了 186 例死亡（病死率，22.1/1000 人年）。在四分位数中，BMI 或 WC 最低组（第 1 四分位数）的预后最差（第 1 四分位数，4.2%；第 2 四分位数，1.9%；第 3 四分位数，1.5%；第 4 四分位数，1.1%；P<0.001（χ）和第 1 四分位数，4.1%；第 2 四分位数，2.3%；第 3 四分位数，1.2%；第 4 四分位数，1.5%；P<0.001（χ），分别）。心血管死亡也得到了类似的结果。在调整了 9 个常规因素的多变量分析中，BMI 最低组（第 1 四分位数）（风险比，2.748；95%置信区间[CI]，1.712-4.411）和 WC（风险比，2.340；95%CI，1.525-3.589）是全因死亡的独立预后因素。根据国家胆固醇教育计划成人治疗专家组 III 和世界卫生组织分类，将参与者分为 BMI 或 WC 两组，发现死亡率最高的是较低组。然而，在将 BMI（四分位数）添加到常规因素后，C 统计量发现略高于 BMI（两类）和 WC（两类）（0.735 与 0.734）。
肥胖悖论在 PCI 后患者中观察到，单独使用 BMI（或 WC）足以预测 PCI 后患者的预后。
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