title: Complementary Role of Arm Circumference to Body Mass Index in Risk Stratification in Heart Failure.
abstract: OBJECTIVE
  This study was performed to investigate the complementary role of arm circumference to body mass index (BMI) in risk stratification of patients with heart failure (HF).
  
  
  BACKGROUND
  High BMI is associated with improved survival in patients with HF. However, it does not discriminate between fat and lean muscle as a predominant factor.
  
  
  METHODS
  BMI, waist circumference (WC), and mid-upper arm circumference (MUAC) were evaluated in 570 consecutive Japanese patients with HF (mean age 67.4 ± 14.0 years). Patients were stratified into low and high groups according to BMI, WC, and MUAC and combined into low- or high-BMI and low- or high-WC groups or low- or high-BMI and low- or high-MUAC groups. The endpoint was all-cause mortality.
  
  
  RESULTS
  Seventy deaths occurred over a median follow-up period of 1.5 years (interquartile range: 0.7 to 2.8 years). After adjusting for several pre-existing prognostic factors, including Seattle Heart Failure Score and exercise capacity, BMI (hazard ratio [HR]: 0.68; p = 0.016), WC (HR: 0.76; p = 0.044), and MUAC (HR: 0.52; p < 0.001) were all inversely associated with prognosis. Compared with the high-BMI/high-WC group, both the low-BMI/high-WC and low-BMI/low-WC groups showed comparably poorer prognosis. However, the low-BMI/low-MUAC group but not the low-BMI/high-MUAC group showed poorer prognosis than the high-BMI/high-MUAC group. Adding MUAC to BMI (0.70 vs. 0.63, p = 0.012) but not WC to BMI (0.64 vs. 0.63, p = 0.763) significantly increased the area under the curve on receiver-operating characteristic curve analysis.
  
  
  CONCLUSIONS
  MUAC, but not WC, plays a complementary role to BMI in predicting prognosis in patients with HF.
authors.affiliation: Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan. Electronic address: k-kamiya@kitasato-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kamiya
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Masuda
authors.affiliation: Department of Cardiology, Kameda Medical Center, Chiba, Japan.
authors.forename: Yuya
authors.initials: Y
authors.lastname: Matsue
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inomata
authors.affiliation: Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Hamazaki
authors.affiliation: Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Matsuzawa
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Nozaki
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Maekawa
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Chiharu
authors.initials: C
authors.lastname: Noda
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Yamaoka-Tojo
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
authors.forename: Atsuhiko
authors.initials: A
authors.lastname: Matsunaga
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
authors.affiliation: Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Ako
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001132:Arm / Q000033:anatomy & histology*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D055815:Young Adult
keywords: arm circumference; heart failure; obesity paradox; waist circumference