4.7 Article

Obesity paradox in peripheral artery disease

期刊

CLINICAL NUTRITION
卷 38, 期 5, 页码 2269-2276

出版社

CHURCHILL LIVINGSTONE
DOI: 10.1016/j.clnu.2018.09.031

关键词

Peripheral artery disease; Obesity; Mortality; Amputation

资金

  1. German Federal Ministry of Education and Research, Germany [BMBF 01EO1003, BMBF 01EO1503]

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Background & aims: Previous studies have suggested an obesity survival paradox in patients with peripheral artery disease (PAD). We investigated the influence of obesity and underweight on adverse in-hospital outcomes in PAD. Methods: Patients diagnosed with PAD based on ICD-code 170.2 of the German nationwide database were stratified for obesity, underweight and a reference group with normal-weight/over-weight and compared regarding adverse in-hospital outcomes. Results: Between 01/2005-12/2015, 5,611,484 inpatients (64.8% males) were diagnosed with PAD; of those, 8.9% were coded with obesity and 0.3% with underweight. Obese patients were younger (70 (IQR 63/76) vs. 73 (66/80) years, P < 0.001), more frequently female (36.7% vs. 35.1%, P < 0.001), had less cancer (4.9% vs. 7.9%, P < 0.001) and had less treatment with major amputation (2.6% vs. 3.2%, P < 0.001) compared to the reference group. Overall, 277 876 (5.0%) patients died in-hospital. Obese patients showed lower mortality rate (3.2% vs. 5.1%, P < 0.001) compared to the reference group and reduced risk of in-hospital mortality (OR, 0.617 [95%CI 0.607-0.627], P < 0.001). This obesity paradox was demonstrated in obesity classes I (OR, 0.475 [95%CI 0.461-0.490], P < 0.001), 11 (OR, 0.580 [95%CI 0.557 -0.605], P < 0.001), and III (OR, 0.895 [95%CI 0.857-0.934], P < 0.001) and was independent of age, sex and comorbidities. Underweight patients revealed higher in-hospital mortality (6.0% vs. 5.1%, P < 0.001) compared to the reference group (OR, 1.179 [95%CI 1.106-1.257], P < 0.001) and showed higher prevalence of cancer (22.0% vs. 7.9%, P < 0.001). Conclusions: Coding for obesity is associated with lower in-hospital mortality in PAD patients relative to those with normal-weight/over-weight. This obesity survival paradox was independent of age, gender and comorbidities and observed for all obesity classes. (C) 2018 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

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