Obesity Paradox in Patients with Acute Coronary Syndrome: Is Malnutrition the Answer?

Autor:	Chen QF; Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China., Ni C; Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China., Katsouras CS; Second Department of Cardiology, University Hospital of Ioannina Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece., Liu C; Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Yao H; Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Lian L; Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Shen TW; Wenzhou Medical University Renji College, Wenzhou, China., Shi J; Wenzhou Medical University Renji College, Wenzhou, China., Zheng J; Department of Cardiac Care Unit, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Shi R; Department of Cardiology, Yueqing People's Hospital, Wenzhou, China., Yujing W; Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; The First Clinical Medical Institute, Wenzhou Medical University, Wenzhou, China., Lin WH; Medical Care Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Zhou XD; Department of Cardiovascular Medicine, the Heart Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: zhouxiaodong@wmu.edu.cn.
Jazyk:	angličtina
Zdroj:	The Journal of nutrition [J Nutr] 2024 Jun; Vol. 154 (6), pp. 1853-1860. Date of Electronic Publication: 2024 Apr 16.
DOI:	10.1016/j.tjnut.2024.04.016
Abstrakt:	Background: Obesity paradox has been reported in patients with cardiovascular disease, showing an inverse association between obesity as defined by BMI (in kg/m 2 ) and prognosis. Nutritional status is associated with systemic inflammatory response and affects cardiovascular disease outcomes. Objectives: This study sought to examine the influence of obesity and malnutrition on the prognosis of patients with acute coronary syndrome (ACS). Methods: This study included consecutive patients diagnosed with ACS and underwent coronary angiogram between January 2009 and February 2023. At baseline, patients were categorized according to their BMI as follows: underweight (<18), normal weight (18-24.9), overweight (25.0-29.9), and obese (>30.0). We assessed the nutritional status by Prognostic Nutritional Index (PNI). Malnutrition was defined as a PNI value of <38. Results: Of the 21,651 patients with ACS, 582 (2.7%) deaths from any cause were observed over 28.7 months. Compared with the patient's state of normal weight, overweight, and obesity were associated with decreased risk of all-cause mortality. Malnutrition was independently associated with poor survival (hazards ratio: 2.64; 95% CI: 2.24, 3.12; P < 0.001). In malnourished patients, overweight and obesity showed a 39% and 72% reduction in the incidence of all-cause mortality, respectively. However, in nourished patients, no significant reduction in the incidence of all-cause mortality was observed (all P > 0.05). Conclusions: Obesity paradox appears to occur in patients with ACS. Malnutrition may be a significant independent risk factor for prognosis in patients with ACS. The obesity paradox is influenced by the status of malnutrition. (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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