Miura Yusuke, Higuchi Satoshi, Kohno Takashi, Shiraishi Yasuyuki, Kitamura Mitsunobu, Nagatomo Yuji, Kawakubo Ichihara Yumiko, Mizuno Atsushi, Nakano Shintaro, Soejima Kyoko, Goda Ayumi, Kohsaka Shun, Yoshikawa Tsutomu
Department of Cardiovascular Medicine, Kyorin University Hospital, Tokyo, Japan.
Division of Cardiology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
Int J Obes (Lond). 2025 May;49(5):888-895. doi: 10.1038/s41366-025-01716-6. Epub 2025 Jan 26.
Obesity is a risk factor for heart failure (HF) development but is associated with a lower incidence of mortality in HF patients. This obesity paradox may be confounded by unrecognized comorbidities, including cachexia.
A retrospective assessment was conducted using data from a prospectively recruiting multicenter registry, which included consecutive acute heart failure patients. A low, normal, and high body mass index (BMI) was defined as <20 kg/m, 20-25 kg/m, and ≥25 kg/m, respectively. Cachexia was defined as a combination of BMI < 20 kg/m and any biochemical abnormalities including albumin, hemoglobin, or C-reactive protein. Patients with either of the three biochemical abnormalities were categorized as those with cachectic biomarkers. Two-year all-cause, cardiac, and noncardiac mortality were evaluated.
This study evaluated 3314 patients (mean BMI, 22 ± 4 kg/m [low BMI with cachexia, 828 (25%); low BMI without cachexia, 273 (8%); normal BMI, 1584 (48%); high BMI, 629 (19%)]). Overall, an increase of 1 point in BMI was associated with a decreased incidence of all-cause mortality (adjusted hazard ratio [HR], 0.92; 95% confidence interval [CI], 0.90-0.94; p < 0.001). Regardless of the mode of death, the low BMI with cachexia indicated the worst prognosis, while the low BMI without cachexia showed a similar prognosis to the normal BMI. Cachectic biomarkers, which were observed more frequently in the low BMI, predicted a higher incidence of 2-year all-cause mortality across the BMI categories (adjusted HR for the low BMI, 1.90; 95% CI, 1.30-2.77; p = 0.001; adjusted HR for the normal BMI, 1.94; 95% CI, 1.34-2.79; p < 0.001; adjusted HR for the high BMI, 3.60; 95% CI, 1.61-8.08; p = 0.002).
BMI could be only a surrogate marker. The cachectic biomarkers may reflect the underlying conditions and contribute to elucidating the obesity paradox.
肥胖是心力衰竭(HF)发生的一个危险因素,但与HF患者较低的死亡率相关。这种肥胖悖论可能被包括恶病质在内的未被识别的合并症所混淆。
使用来自一个前瞻性招募的多中心登记处的数据进行回顾性评估,该登记处纳入了连续的急性心力衰竭患者。低、正常和高体重指数(BMI)分别定义为<20kg/m²、20 - 25kg/m²和≥25kg/m²。恶病质定义为BMI<20kg/m²且伴有包括白蛋白、血红蛋白或C反应蛋白在内的任何生化异常。有这三种生化异常之一的患者被归类为具有恶病质生物标志物的患者。评估了两年的全因死亡率、心脏死亡率和非心脏死亡率。
本研究评估了3314例患者(平均BMI,22±4kg/m²[伴有恶病质的低BMI,828例(25%);不伴有恶病质的低BMI,273例(8%);正常BMI,1584例(48%);高BMI,629例(19%)])。总体而言,BMI每增加1个单位与全因死亡率的发生率降低相关(调整后的风险比[HR],0.92;95%置信区间[CI],0.90 - 0.94;p<0.001)。无论死亡方式如何,伴有恶病质的低BMI表明预后最差,而不伴有恶病质的低BMI显示出与正常BMI相似的预后。恶病质生物标志物在低BMI中更频繁地被观察到,其预测了各BMI类别中2年全因死亡率的更高发生率(低BMI的调整后HR,1.90;95%CI,1.30 - 2.77;p = 0.001;正常BMI的调整后HR,1.94;95%CI,1.34 - 2.79;p<0.001;高BMI的调整后HR,3.60;95%CI,1.61 - 8.08;p = 0.002)。
BMI可能只是一个替代标志物。恶病质生物标志物可能反映潜在状况并有助于阐明肥胖悖论。