title: A 3-year follow-up study of inpatients with lower limb ulcers: evidence of an obesity paradox?
abstract: OBJECTIVE
  To determine whether body composition is related to long-term outcomes amongst vascular inpatients with lower limb ulcers.
  
  
  METHODS
  Prospective study with 3 years follow-up.
  
  
  METHODS
  Body mass index (BMI), fat, and fat-free mass were measured and associations with readmission to hospital (number, cause, length of stay) and all-cause mortality were explored.
  
  
  RESULTS
  Thirty patients (22 men, 8 women) participated in the study. Ten patients (33%) had a BMI ≥ 30 kg/m(2). 18/20 (90%) patients with a BMI < 30 kg/m(2) and 9/10 (90%) patients with a BMI ≥ 30 kg/m(2) were admitted to hospital in the 3 years of follow-up. Patients with a BMI < 30 kg/m(2) were admitted more frequently, earlier and for longer compared to those with BMI ≥ 30 kg/m(2) but these did not reach statistical significance. The 3 year mortality rate for patients with BMI ≥ 30 kg/m(2) was 20% (n = 2/10) compared to 70% (n = 14/20) with a BMI < 30 kg/m(2), P = 0.019.
  
  
  CONCLUSIONS
  This preliminary study suggests that higher BMI may have a protective effect against mortality in vascular patients with lower limb ulcers. These findings contradict the universal acceptance that obesity leads to poor health outcomes. Further work is required to confirm these findings and explore some of the potential mechanisms for this effect.
authors.affiliation: Department of Nutrition and Dietetics, Flinders University, Adelaide, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Miller
authors.forename: Christopher
authors.initials: C
authors.lastname: Delaney
authors.forename: Deanna
authors.initials: D
authors.lastname: Penna
authors.forename: Lilian
authors.initials: L
authors.lastname: Liang
authors.forename: Jolene
authors.initials: J
authors.lastname: Thomas
authors.forename: Phillip
authors.initials: P
authors.lastname: Puckridge
authors.forename: James I
authors.initials: JI
authors.lastname: Spark