Cachectic biomarkers as confounders behind the obesity paradox in patients with acute decompensated heart failure

Miura, Y; Higuchi, S; Kohno, T; Shiraishi, Y; Kitamura, M; Nagatomo, Y; Kawakubo Ichihara, Y; Mizuno, A; Nakano, S; Soejima, K; Goda, A; Kohsaka, S; Yoshikawa, T; West Tokyo Heart Failure (WET-HF) Registry Investigators

doi:10.1038/s41366-025-01716-6

Obesity

Cachectic biomarkers as confounders behind the obesity paradox in patients with acute decompensated heart failure

Int J Obes (Lond)Published 26 Jan 2025Retrospective cohort study

Main finding · All-cause mortalityResultAdjusted hazard ratio 0.92 95% CI 0.90–0.94

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Authors' conclusion

BMI could be only a surrogate marker. The cachectic biomarkers may reflect the underlying conditions and contribute to elucidating the obesity paradox.

Study context

Population: Consecutive patients with acute heart failure (HF) from a prospective multicenter registry
Participants: 3,314 patients

Exposure: Body mass index (BMI) categories with and without cachexia/cachectic biomarkers
Low BMI with cachexian = 828
Low BMI without cachexian = 273
Normal BMIn = 1,584reference
High BMIn = 629
Outcome: All-cause, cardiac and noncardiac mortality
Follow-up: 2 years

Methodological detailsmulticenter registry, consecutive patients

Multicenter registry
Consecutive patients

Main finding

All-cause mortality

Adjusted hazard ratio

0.92

95% CI 0.90–0.94

P < 0.001

BMI per 1-point increase

adjusted HR 0.92 (95% CI 0.90–0.94); P < 0.001

Per 1-point increase, as printed

As reported in the abstract

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk ←→ Higher risk →	Adjusted HR (95% CI)	P value
All-cause mortality with vs without cachectic biomarkers, by BMI category · 2 yearsCachectic biomarkers (low BMI)vs No cachectic biomarkers (low BMI)	0.10.31310	1.90 (1.30–2.77)	P = 0.001
All-cause mortality with vs without cachectic biomarkers, by BMI category · 2 yearsCachectic biomarkers (normal BMI)vs No cachectic biomarkers (normal BMI)	0.10.31310	1.94 (1.34–2.79)	P < 0.001
All-cause mortality with vs without cachectic biomarkers, by BMI category · 2 yearsCachectic biomarkers (high BMI)vs No cachectic biomarkers (high BMI)	0.10.31310	3.60 (1.61–8.08)	P = 0.002
	0.10.31310Adjusted hazard ratio (log scale)

Reference

Authors: Miura Y, Higuchi S, Kohno T, Shiraishi Y, Kitamura M, Nagatomo Y, et al.
All 14 authors
Miura Y, Higuchi S, Kohno T, Shiraishi Y, Kitamura M, Nagatomo Y, Kawakubo Ichihara Y, Mizuno A, Nakano S, Soejima K, Goda A, Kohsaka S, Yoshikawa T, West Tokyo Heart Failure (WET-HF) Registry Investigators
Journal: International Journal of Obesity
Published: 26 Jan 2025
DOI: 10.1038/s41366-025-01716-6
PubMed: 39863776

Topic: Obesity

Exposure definitions

Low BMI with cachexia: BMI <20 kg/m² plus albumin, hemoglobin or C-reactive protein abnormality
Low BMI without cachexia: BMI <20 kg/m² without biochemical abnormalities
Normal BMI: BMI 20-25 kg/m²
High BMI: BMI ≥25 kg/m²

Key notes

Low BMI with cachexia had the worst prognosis regardless of mode of death; low BMI without cachexia had prognosis similar to normal BMI

Original publication

Cachectic biomarkers as confounders behind the obesity paradox in patients with acute decompensated heart failure. Int J Obes (Lond). Published 26 January 2025. doi:10.1038/s41366-025-01716-6

Read the original article ↗

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