- •An obesity paradox may exist in patients with chronic limb-threatening ischaemia.
- •Obesity is associated with favourable rates of amputation-free survival at 1-year.
- •Generic weight loss advice may be inappropriate.
The obesity paradox is a well-documented phenomenon in cardiovascular disease, however it remains poorly understood. We aimed to investigate the relationship between body mass (as measured by body mass index [BMI]) and 1-year amputation-free survival (AFS) for patients undergoing lower limb revascularisation for chronic limb-threatening ischaemia (CLTI).
A retrospective analysis was undertaken of all consecutive patients undergoing lower limb revascularisation for CLTI at the Leicester Vascular Institute between February 2018–19. Baseline demographics and outcomes were collected using electronic records. BMI was stratified using the World Health Organization criteria. One-year AFS (composite of major amputation/death) was the primary outcome. Kaplan-Meier survival analysis and adjusted Cox's proportional hazard models were used to compare groups to patients of normal mass.
One-hundred and ninety patients were included. Overall, no difference was identified in 1-year AFS across all groups (pooled P = 0.335). Compared to patients with normal BMI (n = 66), obese patients (n = 43) had a significantly lower adjusted combined risk of amputation/death (aHR 0.39, 95% CI 0.16–0.92, P = 0.032), however no significant differences were observed for overweight (aHR 0.89, 95% CI 0.47–1.70, P = 0.741), morbidly obese (aHR 1.15, 95% CI 0.41–3.20, P = 0.797) and underweight individuals (aHR 1.86, 95% CI 0.56–6.20, P = 0.314).
In the context of CLTI, obesity is potentially associated with favourable amputation-free survival at 1 year, compared to normal body mass. The results of this study support the notion of an obesity paradox existing within CLTI and question whether current guidance on weight management requires a more patient-specific approach.
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- World Health Organization. Tackling NCDs.2017 (Available at)[accessed December 1, 2020])
World Health Organization. Obesity and Overweight. 2020. Available from: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight [accessed December 1, 2020]
- Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss.J Am Coll Cardiol. 2009; 53: 1925-1932
- The disease burden associated with overweight and obesity.JAMA. 1999; 282: 1523-1529
- Body mass index is inversely associated with mortality in patients with peripheral vascular disease.Atherosclerosis. 2013; 229: 549-555
- The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox?.J Am Coll Cardiol. 2002; 39: 578-584
- Global vascular guidelines on the management of chronic limb-threatening ischemia.Eur J Vasc Endovasc Surg. 2019; 58: S1-S109.e33
- Does The introduction of a vascular limb salvage service improve one-year amputation outcomes for patients with chronic limb-threatening ischaemia?.Eur J Vasc Endovasc Surg. 2021; 61: 612-619
- World Health Organization. The World Health Report 2004 - Changing History.2004 (Available from)[accessed December 2, 2020])
- Inter-society consensus for the management of peripheral arterial disease (TASC II).J Vasc Surg. 2007; 45: S5-S67
- The global epidemic of obesity: an overview.Epidemiol Rev. 2007; 29: 1-5
- The impact of obesity on US mortality levels: the importance of age and cohort factors in population estimates.Am J Public Health. 2013; 103: 1895-1901
- Obesity paradox does exist.Diabetes Care. 2013; 36 (Supplement): S276
- Obesity paradox in elderly patients with cardiovascular diseases.Int J Cardiol. 2012; 155: 56-65
- Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo.Am J Physiol. 1999; 277: E971-E975
- The effect of smoking on obesity: evidence from a randomized trial.J Health Econ. 2018; 57: 31-44
- Obesity paradox in peripheral arterial disease: results of a propensity match analysis from the national inpatient sample.Cureus. 2019; 11: e4704-e
- Complex relationship of body mass index with mortality in patients with critical limb ischemia undergoing endovascular treatment.Eur J Vasc Endovasc Surg. 2015; 49: 297-305
- Comparisons of percentage body fat, body mass index, waist circumference, and waist-stature ratio in adults.Am J Clin Nutr. 2008; 89: 500-508
- Comparison of body mass index, waist circumference, and waist/hip ratio in predicting incident diabetes: a meta-analysis.Epidemiol Rev. 2007; 29: 115-128
Published online: August 30, 2021
Accepted: June 12, 2021
Received in revised form: May 31, 2021
Received: February 10, 2021
Previous communication: Poster presentation at the Vascular Society of Great Britain and Ireland's 2020 Annual Scientific Meeting (Virtual Meeting, November 24–27, 2020).
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