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      Relationship between BMI and prognosis of chronic heart failure outpatients in Vietnam: a single-center study

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          Abstract

          Background

          Insufficient data exists regarding the relationship between body mass index (BMI) and the prognosis of chronic heart failure (CHF) specifically within low- and middle-income Asian countries. The objective of this study was to evaluate the impact of BMI on adverse outcomes of ambulatory patients with CHF in Vietnam.

          Methods

          Between 2018 and 2020, we prospectively enrolled consecutive outpatients with clinically stable CHF in an observational cohort, single-center study. The participants were stratified according to Asian-specific BMI thresholds. The relationships between BMI and adverse outcomes (all-cause death and all-cause hospitalization) were analyzed by Kaplan–Meier survival curves and Cox proportional-hazards model.

          Results

          Among 320 participants (age 63.5 ± 13.3 years, 57.9% male), the median BMI was 21.4 kg/m 2 (IQR 19.5–23.6), and 10.9% were underweight (BMI <18.50 kg/m 2). Over a median follow-up time of 32 months, the cumulative incidence of all-cause mortality and hospitalization were 5.6% and 19.1%, respectively. After multivariable adjustment, underweight patients had a significantly higher risk of all-cause mortality than patients with normal BMI (adjusted hazard ratios = 3.03 [95% CI: 1.07–8.55]). Lower BMI remained significantly associated with a worse prognosis when analyzed as a continuous variable (adjusted hazard ratios = 1.27 [95% CI: 1.03–1.55] per 1 kg/m 2 decrease for all-cause mortality). However, BMI was not found to be significantly associated with the risk of all-cause hospitalization ( p > 0.05).

          Conclusion

          In ambulatory patients with CHF in Vietnam, lower BMI, especially underweight status (BMI < 18.5 kg/m 2), was associated with a higher risk of all-cause mortality. These findings suggest that BMI should be considered for use in risk classification, and underweight patients should be managed by a team consisting of cardiologists, nutritionists, and geriatricians.

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          Most cited references63

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          2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

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            2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

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              Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

              (2004)
              A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> or =25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations; for high risk it varies from 26 kg/m2 to 31 kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23.0, 27.5, 32.5, and 37.5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
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                Author and article information

                Contributors
                Journal
                Front Nutr
                Front Nutr
                Front. Nutr.
                Frontiers in Nutrition
                Frontiers Media S.A.
                2296-861X
                30 November 2023
                2023
                : 10
                : 1251601
                Affiliations
                [1] 1Vietnam National Heart Institute, Bach Mai Hospital , Hanoi, Vietnam
                [2] 2Department of Internal Medicine, VNU-University of Medicine and Pharmacy , Hanoi, Vietnam
                [3] 3Department of Cardiology, Hanoi Medical University , Hanoi, Vietnam
                [4] 4Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN, United States
                [5] 5School of Population Health, Curtin University , Perth, WA, Australia
                [6] 6School of Public Health and Preventive Medicine, Monash University , Melbourne, VIC, Australia
                [7] 7Cardiovascular Division, Department of Medicine, University of Washington Medical Center , Seattle, WA, United States
                [8] 8Department of Bioethics and Humanities, University of Washington Medical Center , Seattle, WA, United States
                Author notes

                Edited by: Owen Kelly, Sam Houston State University, United States

                Reviewed by: Michał Czapla, Wroclaw Medical University, Poland; Gen-Min Lin, Hualien Armed Forces General Hospital, Taiwan; Paula Acevedo-Cantero, Autonomous University of Madrid, Spain

                *Correspondence: Hoai Thi Thu Nguyen, hoainguyen1973@ 123456gmail.com
                Article
                10.3389/fnut.2023.1251601
                10720040
                38099185
                a4a74be7-d22a-44ac-8a5f-99774a1cbadc
                Copyright © 2023 Nguyen, Ha, Tran, Nguyen, Pham, Tran, Pham, Allison, Reid and Kirkpatrick.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 02 July 2023
                : 08 November 2023
                Page count
                Figures: 3, Tables: 3, Equations: 0, References: 65, Pages: 11, Words: 8859
                Categories
                Nutrition
                Original Research
                Custom metadata
                Clinical Nutrition

                chronic heart failure,body mass index,obesity paradox,underweight,mortality,hospitalization

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