title: Triceps skinfold as a prognostic predictor in outpatient heart failure.
abstract: BACKGROUND
  Most reports regarding the obesity paradox have focused on body mass index (BMI) to classify obesity and the prognostic values of other indirect measurements of body composition remain poorly examined in heart failure (HF).
  
  
  OBJECTIVE
  To evaluate the association between BMI and other indirect, but easily accessible, body composition measurements associated with the risk of all-cause mortality in HF.
  
  
  METHODS
  Anthropometric parameters of body composition were assessed in 344 outpatients with a left ventricular ejection fraction (LVEF) of <50% from a prospective HF cohort that was followed-up for 30 ± 8.2 months. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis.
  
  
  RESULTS
  HF patients were predominantly male, of non-ischemic etiology, and had moderate to severe LV systolic dysfunction (mean LVEF = 32 ± 9%). Triceps skinfold (TSF) was the only anthropometric index that was associated with HF prognosis and had significantly lower values in patients who died (p = 0.047). A TSF > 20 mm was present in 9% of patients that died and 22% of those who survived (p = 0.027). Univariate analysis showed that serum creatinine level, LVEF, and NYHA class were associated with the risk of death, while Cox proportional hazard regression analysis showed that TSF > 20 was a strong independent predictor of all-cause mortality (hazard ratio = 0.36; 95% confidence interval = 0.13-0.97, p = 0.03).
  
  
  CONCLUSIONS
  Although BMI is the most widely used anthropometric parameter in clinical practice, our results suggested that TSF is a better predictive marker of mortality in HF outpatients.
authors.forename: Priccila
authors.initials: P
authors.lastname: Zuchinali
authors.forename: Gabriela Corrêa
authors.initials: GC
authors.lastname: Souza
authors.forename: Fernanda Donner
authors.initials: FD
authors.lastname: Alves
authors.forename: Karina Sanches Machado
authors.initials: KS
authors.lastname: d'Almeida
authors.forename: Lívia Adams
authors.initials: LA
authors.lastname: Goldraich
authors.forename: Nadine Oliveira
authors.initials: NO
authors.lastname: Clausell
authors.forename: Luis Eduardo Paim
authors.initials: LE
authors.lastname: Rohde
mesh_terms: D000368:Aged; D001132:Arm; D001823:Body Composition; D015992:Body Mass Index; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal; D009765:Obesity / Q000150:complications*; D010045:Outpatients; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012885:Skinfold Thickness; D018487:Ventricular Dysfunction, Left / Q000209:etiology
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