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Body Composition and Coronary Heart Disease Mortality—An Obesity or a Lean Paradox Full Text
Mayo Clinic Proceedings, 08/31/2011
Exclusive author commentary
Clinical Article
Lavie CJ et al. - Although both low BF and low body mass index (BMI) are independent predictors of mortality in patients with coronary heart disease (CHD), only patients with combined low body fat (BF)/low BMI appear to be at particularly high risk of mortality during follow-up. Studies are needed to determine optimal body composition in the secondary prevention of CHD.
Methods- The authors studied 581 patients with CHD between January 1, 2000, and July 31, 2005, who were divided into low (<25) and high BMI (≥25), as well as low (≤25% men and ≤35% women) and high BF (>25% in men and >35% in women).
- Four groups were analyzed by total mortality during the 3-year follow-up by National Death Index: low BF/low BMI (n=119), high BF/low BMI (n=26), low BF/high BMI (n=125), and high BF/high BMI (n=311).
- During the 3-year follow-up, mortality was highest in the low BF/low BMI group (11%), which was significantly (P<.001) higher than that in the other 3 groups (3.9%, 3.2%, and 2.6%, respectively); using the high BF/high BMI group as a reference, the low BF/low BMI group had a 4.24-fold increase in mortality (confidence interval [CI], 1.76-10.23; P=.001).
- In multivariate logistic regression for mortality, when entered individually, both high BMI (odds ratio [OR], 0.79; CI, 0.69-0.90) and high BF (OR, 0.89; CI, 0.82-0.95) as continuous variables were independent predictors of better survival, whereas low BMI (OR, 3.60; CI, 1.37-9.47) and low BF (OR, 3.52; CI, 1.34-9.23) as categorical variables were independent predictors of higher mortality.
Carl J. Lavie (09/02/2011) comments:
Many studies have assessed the Obesity Paradox just with BMI. Our study is unique in that we also studied body composition with both BMI as well as % Body Fat(BF). In a large cohort with stable CHD, only those with both low BMI and low BF had a high 3-year mortality of 11%, whereas all of the other patients had a mortality of only 3 %. Both Low BMI and Low BF were independent predictors of higher mortality, increasing mortality by approximately 3.5-fold. I have an author interview , which can be viewed by going to the Mayo Clinic Proceedings web-site and looking at the Current Issue(or September, 2011 issue.)