title: The Obesity-Mortality Paradox in Patients With Heart Failure in Taiwan and a Collaborative Meta-Analysis for East Asian Patients.
abstract: A global heart failure (HF) registry suggested that the inverse association between body mass index (BMI) and all-cause mortality differed by race, particularly stronger in Japanese patients at 1-year follow-up. Whether this finding was consistent across all East Asian populations was unknown. In a multicenter prospective study in Taiwan, we enrolled 1,301 patients hospitalized for systolic HF from 2013 to 2014 and followed up the mortality after their discharge for a median of 1-year period. Cox proportional hazard regression analyses were used to assess the association of BMI with all-cause mortality. The results showed that BMI was inversely associated with all-cause mortality (hazard ratio and 95% CI per 5-kg/m(2) increase: 0.75 [0.62 to 0.91]) after adjusting for demographics, traditional risk factors, HF severity, and medications at discharge. Subsequently, we sought previous studies regarding the BMI association with mortality for East Asian patients with HF from Medline, and a random-effect meta-analysis was performed by the inverse variance method. The meta-analysis including 7 previous eligible studies (3 for the Chinese and 4 for the Japanese cohorts) and the present one showed similar results that BMI was inversely associated with all-cause mortality (hazard ratio 0.65 [0.58 to 0.73], I(2) = 37%). In conclusion, our study in Taiwan and a collaborative meta-analysis confirmed a strong inverse BMI-mortality association consistently among East Asian patients with HF.
authors: Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Medicine, Hualien Armed Forces General Hospital, Hualien, Taiwan; Department of Public Health, Tzu Chi University, Hualien, Taiwan.
authors: Gen-Min
authors: GM
authors: Lin
authors: Department of Public Health, Tzu Chi University, Hualien, Taiwan.
authors: Yi-Hwei
authors: YH
authors: Li
authors: Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Wei-Hsian
authors: WH
authors: Yin
authors: Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors: Yen-Wen
authors: YW
authors: Wu
authors: Department of Cardiology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Pao-Hsien
authors: PH
authors: Chu
authors: Division of Cardiology, Department of Internal Medicine, National Taiwan Univeristy Hospital, Hsinchu Branch, Hsinchu, Taiwan.
authors: Chih-Cheng
authors: CC
authors: Wu
authors: Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors: Chih-Hsin
authors: CH
authors: Hsu
authors: Department of Cardiology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Ming-Shien
authors: MS
authors: Wen
authors: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Wen-Chol
authors: WC
authors: Voon
authors: Department of Cardiology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: Chun-Chieh
authors: CC
authors: Wang
authors: Department of Cardiology, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors: San-Jou
authors: SJ
authors: Yeh
authors: Division of Cardiology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: wslin545@ms27.hinet.net.
authors: Wei-Shiang
authors: WS
authors: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002423:Cause of Death; D015331:Cohort Studies; D015897:Comorbidity; D005202:Asia, Eastern / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000401:mortality; D054143:Heart Failure, Systolic / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009765:Obesity / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D065840:Protective Factors; D012720:Severity of Illness Index; D013624:Taiwan / Q000453:epidemiology