Pre- and post-diagnosis body mass index and heart failure mortality

a dose-response meta-analysis of observational studies reveals greater risk of being underweight than being overweight

A Milajerdi, K Djafarian, S Shab-Bidar (Corresponding Author), J R Speakman (Corresponding Author)

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

OBJECTIVE: To investigate the dose-response association between pre- and post-diagnosis body mass index (BMI) and heart failure (HF) mortality.

METHODS: Eligible observational studies were searched in databases, up to November 2017. We used random-effects generalized least squares spline models for trend estimation to derive pooled BMI unit-HF mortality relationship.

RESULTS: Sixteen cohort studies (six pre-diagnosis and 10 post-diagnosis BMI) were included, comprising a total of 258,379 subjects with 13,201 deaths due to HF. A nonlinear U-shaped association was found between pre-diagnosis BMI and the risk of HF mortality, with a greater risk from being at the lowest extreme, rather than being at the top category. The combined hazard ratio of HF mortality among the highest compared to the lowest category of pre-diagnosis BMI was 1.24 (0.65-2.37, I2 = 90.7%). No significant nonlinear association was found between post-diagnosis BMI and HF mortality as well as when comparing the highest to the lowest category of BMI.

CONCLUSIONS: This meta-analysis showed those with both high and low pre-diagnosis BMI had higher risk for HF mortality, with a greater risk from being too underweight, rather than being obese. No significant association was found between post-diagnosis BMI and the risk of HF mortality. Further detailed investigations are needed to accurately examine the potential mechanistic links between BMI and health outcomes.

Original languageEnglish
Pages (from-to)252-261
Number of pages11
JournalObesity Reviews
Volume20
Issue number2
Early online date22 Nov 2018
DOIs
Publication statusPublished - 28 Feb 2019

Fingerprint

Thinness
Observational Studies
Meta-Analysis
Body Mass Index
Heart Failure
Mortality
Least-Squares Analysis
Cohort Studies
Databases

Keywords

  • body mass index
  • heart failure
  • meta-analysis
  • obesity
  • Body mass index
  • Body Mass Index
  • Comorbidity
  • Humans
  • Overweight/epidemiology
  • Risk
  • Thinness/epidemiology
  • Heart Failure/mortality
  • MYOCARDIAL-INFARCTION
  • PROGNOSIS
  • NECROSIS-FACTOR-ALPHA
  • TREND ESTIMATION
  • OBESITY PARADOX
  • CARDIOVASCULAR-DISEASE
  • PHYSICAL-ACTIVITY
  • UPDATE
  • WEIGHT
  • ASSOCIATION

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Endocrinology, Diabetes and Metabolism

Cite this

Pre- and post-diagnosis body mass index and heart failure mortality : a dose-response meta-analysis of observational studies reveals greater risk of being underweight than being overweight. / Milajerdi, A; Djafarian, K; Shab-Bidar, S (Corresponding Author); Speakman, J R (Corresponding Author).

In: Obesity Reviews, Vol. 20, No. 2, 28.02.2019, p. 252-261.

Research output: Contribution to journalReview article

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abstract = "OBJECTIVE: To investigate the dose-response association between pre- and post-diagnosis body mass index (BMI) and heart failure (HF) mortality.METHODS: Eligible observational studies were searched in databases, up to November 2017. We used random-effects generalized least squares spline models for trend estimation to derive pooled BMI unit-HF mortality relationship.RESULTS: Sixteen cohort studies (six pre-diagnosis and 10 post-diagnosis BMI) were included, comprising a total of 258,379 subjects with 13,201 deaths due to HF. A nonlinear U-shaped association was found between pre-diagnosis BMI and the risk of HF mortality, with a greater risk from being at the lowest extreme, rather than being at the top category. The combined hazard ratio of HF mortality among the highest compared to the lowest category of pre-diagnosis BMI was 1.24 (0.65-2.37, I2 = 90.7{\%}). No significant nonlinear association was found between post-diagnosis BMI and HF mortality as well as when comparing the highest to the lowest category of BMI.CONCLUSIONS: This meta-analysis showed those with both high and low pre-diagnosis BMI had higher risk for HF mortality, with a greater risk from being too underweight, rather than being obese. No significant association was found between post-diagnosis BMI and the risk of HF mortality. Further detailed investigations are needed to accurately examine the potential mechanistic links between BMI and health outcomes.",
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T2 - a dose-response meta-analysis of observational studies reveals greater risk of being underweight than being overweight

AU - Milajerdi, A

AU - Djafarian, K

AU - Shab-Bidar, S

AU - Speakman, J R

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AB - OBJECTIVE: To investigate the dose-response association between pre- and post-diagnosis body mass index (BMI) and heart failure (HF) mortality.METHODS: Eligible observational studies were searched in databases, up to November 2017. We used random-effects generalized least squares spline models for trend estimation to derive pooled BMI unit-HF mortality relationship.RESULTS: Sixteen cohort studies (six pre-diagnosis and 10 post-diagnosis BMI) were included, comprising a total of 258,379 subjects with 13,201 deaths due to HF. A nonlinear U-shaped association was found between pre-diagnosis BMI and the risk of HF mortality, with a greater risk from being at the lowest extreme, rather than being at the top category. The combined hazard ratio of HF mortality among the highest compared to the lowest category of pre-diagnosis BMI was 1.24 (0.65-2.37, I2 = 90.7%). No significant nonlinear association was found between post-diagnosis BMI and HF mortality as well as when comparing the highest to the lowest category of BMI.CONCLUSIONS: This meta-analysis showed those with both high and low pre-diagnosis BMI had higher risk for HF mortality, with a greater risk from being too underweight, rather than being obese. No significant association was found between post-diagnosis BMI and the risk of HF mortality. Further detailed investigations are needed to accurately examine the potential mechanistic links between BMI and health outcomes.

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