title: [Assessment of body composition and prognosis in chronic heart failure. Beyond the "obesity paradox"].
abstract: OBJECTIVE
  It is unknown the influence of body composition in the inverse relationship of mortality with overweight and obesity in heart failure patients.
  
  
  METHODS
  234 patients with chronic heart failure were evaluated. Body mass index, tricipital skinfold thickness, brachial muscle circumference and body fat percentage determined by bioelectrical impedance analysis were measured. The influence of previous anthropometric variables on total mortality was analyzed.
  
  
  RESULTS
  Mean follow-up was 21±10.7 months. We observed an inverse relationship of total mortality with body mass index (hazard ratio=0.91, 95% confidence interval, 0.87-0.96; P<.001), with body fat estimated by the tricipital skinfold thickness (hazard ratio=0.95, 95% confidence interval, 0.92-0.99; P=.013) and the fat percentage obtained by bioelectrical impedance analysis (hazard ratio=0.96; 95% confidence interval, 0.93-0.99; P=.007) and with muscle mass estimated by the brachial muscle circumference (hazard ratio=0.87; 95% confidence interval,0.81-0.94; P=.001). Only brachial muscle circumference maintained its prognostic significance in multivariate analysis that included different anthropometric measurements (hazard ratio=0.88, 95% confidence interval 0.77-0.99; P=.035). Finally we found a positive linear correlation between the values of body mass index with tricipital skinfold thickness, fat percentage and brachial muscle circumference.
  
  
  CONCLUSIONS
  The muscle mass of patients with heart failure, estimated by the brachial muscle circumference, is associated inversely with overall mortality. The correlation between values of brachial muscle circumference with the body mass index would explain the "obesity paradox" observed.
authors.affiliation: Área de Cardiología, Servicio de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, España. Electronic address: antoniol.gamez.sspa@juntadeandalucia.es.
authors.forename: Antonio Luis
authors.initials: AL
authors.lastname: Gámez-López
authors.affiliation: Área de Cardiología, Servicio de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, España.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Bonilla-Palomas
authors.affiliation: Servicio de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, España.
authors.forename: María Cristina
authors.initials: MC
authors.lastname: López-Ibáñez
authors.affiliation: Servicio de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, España.
authors.forename: Mirian
authors.initials: M
authors.lastname: Moreno-Conde
authors.affiliation: Unidad de Gestión Clínica de Cardiología, Hospital Universitario Reina Sofía, Córdoba, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Anguita-Sánchez
authors.affiliation: Servicio de Medicina Interna, Hospital San Juan de la Cruz, Úbeda, Jaén, España.
authors.forename: Antonia
authors.initials: A
authors.lastname: Villar-Ráez
mesh_terms: D000368:Aged; D001823:Body Composition; D001837:Body Weights and Measures; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000378:metabolism* / Q000401:mortality*; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D011379:Prognosis; D011446:Prospective Studies
keywords: Body composition; Body mass index; Composición corporal; Heart failure; Insuficiencia cardiaca; Índice de masa corporal