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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 9/2020

01-09-2020 | Obesity | Original Article

Effect of obesity and underweight status on the hospital-acquired functional decline in patients with cardiovascular surgery: an analysis of data from a prospective observational multicenter cohort study

Published in: General Thoracic and Cardiovascular Surgery | Issue 9/2020

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Abstract

Objects

The aim of this study was to determine the association between underweight or obese status and hospital- acquired functional decline (HAFD) following cardiovascular surgery.

Methods

We performed a retrospective, observational, multicenter cohort study of cardiovascular surgery patients between April, 2010, and June, 2017. Body mass index (BMI) was categorized into four classes: underweight group (< 18.5 kg/m2), normal weight group (18.5 to < 25 kg/m2), overweight group (25 to < 30 kg/m2), and obese group (≥ 30 kg/m2). HAFD was defined as a decrease of at least one point on the short physical performance battery score at discharge, compared with the preoperative score.

Results

A total of 3,850 adult patients were included in the analysis data set (median age 72 years, 35% female). A total of 811 (21.0%) patients demonstrated HAFD: 27.2% in the underweight group, 21.3% in the normal weight group, 18.8% in the overweight group, and 19.3% in the obese group. The relative risk for HAFD was 1.381 (95% CI 1.052–1.814) for the underweight group versus the normal weight group, although that is comparable to the obese group after adjustment by confounding factors. Analyses of subgroup interactions showed that the relative risk of HAFD in the obese group compared with the normal group was higher in patients with muscle wasting (p < 0.05).

Conclusion

HAFD was significantly worse for underweight patients following cardiovascular surgery. In contrast, obese status was not associated with HAFD, exclusive of the obese patients with muscle wasting.
Literature
1.
Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash MD, Hollenbeck A, Leitzmann MF. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355:763–78.CrossRef
2.
Stamou SC, Nussbaum M, Stiegel RM, Reames MK, Skipper ER, Robicsek F, et al. Effect of body mass index on outcomes after cardiac surgery: is there an obesity paradox? Ann Thorac Surg. 2011;91:42–7.CrossRef
3.
Johnson AP, Parlow JL, Whitehead M, Xu J, Rohland S, Milne B. Body mass index, outcomes, and mortality following cardiac surgery in Ontario Canada. J Am Heart Assoc. 2015;4:e002140.CrossRef
4.
Greenberg JA. The obesity paradox in the US population. Am J Clin Nutr. 2013;97:1195–200.CrossRef
5.
Kalantar-Zadeh K, Block G, Horwich T, Fonarow GC. Reverse epidemiology of conventional cardiovascular risk factors in patients with chronic heart failure. J Am Coll Cardiol. 2004;43:1439–44.CrossRef
6.
Mariscalco G, Wozniak MJ, Dawson AG, Serraino GF, Porter R, Nath M, et al. Body mass index and mortality among adults undergoing cardiac surgery: a nationwide study with a systematic review and meta-analysis. Circulation. 2017;135:850–63.CrossRef
7.
Hueb W, Soares PR, Gersh BJ, César LA, Luz PL, Puig LB, et al. The medicine, angioplasty, or surgery study (MASS-II): a randomized, controlled clinical trial of three therapeutic strategies for multivessel coronary artery disease: one-year results. J Am Coll Cardiol. 2004;43:1743–51.CrossRef
8.
Forman DE, Arena R, Boxer R, Dolansky MA, Eng JJ, Fleg JL, et al. Prioritizing functional capacity as a principal end point for therapies oriented to older adults with cardiovascular disease: a scientific statement for healthcare professionals from the American heart association. Circulation. 2017;135:e894–e918.CrossRef
9.
Rudolph JL, Inouye SK, Jones RN, Yang FM, Fong TG, Levkoff SE, et al. Delirium: an independent predictor of functional decline after cardiac surgery. J Am Geriatr Soc. 2010;58:643–9.CrossRef
10.
Hoogerduijn JG, de Rooij SE, Grobbee DE, Schuurmans MJ. Predicting functional decline in older patients undergoing cardiac surgery. Age Ageing. 2014;43:218–21.CrossRef
11.
Govers AC, Buurman BM, Jue P, de Mol BA, Dongelmans DA, de Rooij SE. Functional decline of older patients 1 year after cardiothoracic surgery followed by intensive care admission: a prospective longitudinal cohort study. Age Ageing. 2014;43:575–80.CrossRef
12.
WHO. Physical Status: The Use and Interpretation of Anthropometry: Report of a WHO Expert Committee. Geneva, Switzerland: World Health Organization; 1995. WHO Technical Report Series 854.
13.
Saitoh M, Takahashi T, Sakurada K, Kumamaru M, Hanafusa Y, Iwatsu K, et al. Factors determining achievement of early postoperative cardiac rehabilitation goal in patients with or without preoperative kidney dysfunction undergoing isolated cardiac surgery. J Cardiol. 2013;61:299–303.CrossRef
14.
JCS Joint Working Group. Guidelines for Rehabilitation in Patients with Cardiovascular Disease (JCS 2012). Circ J. 2014;78:2022–93.CrossRef
15.
Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total body skeletal muscle mass: development and cross-validation of anthropometric prediction models. Am J Clin Nutr. 2000;72:796–803.CrossRef
16.
Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15:95–101.CrossRef
17.
Guralnik JM, Simonsick EM, Ferrucci L. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85–94.CrossRef
18.
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54:743–9.CrossRef
19.
Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156:13–22.CrossRef
20.
Gallagher D, Ruts E, Visser M, Heshka S, Baumgartner RN, Wang J, et al. Weight stability masks sarcopenia in elderly men and women. Am J Physiol Endocrinol Metab. 2000;279:E366–E375375.CrossRef
21.
Baumgartner RN. Body composition in healthy aging. Ann N Y Acad Sci. 2000;904:437–48.CrossRef
22.
Kim KM, Jang HC, Lim S. Differences among skeletal muscle mass indices derived from height-, weight-, and body mass index-adjusted models in assessing sarcopenia. Korean J Intern Med. 2016;31:643–50.CrossRef
23.
Lee CD, Blair SN, Jackson AS. Cardiorespiratory fitness, body composition, and all-cause and cardiovascular disease mortality in men. Am J Clin Nutr. 1999;69:373–80.CrossRef
24.
Bigaard J, Frederiksen K, Tjønneland A, Thomsen BL, Overvad K, Heitmann BL, et al. Body fat and fat-free mass and all-cause mortality. Obes Res. 2004;12:1042–9.CrossRef
25.
Heitmann BL, Erikson H, Ellsinger BM, Mikkelsen KL. Mortality associated with body fat, fat-free mass and body mass index among 60-year-old Swedish men—a 22-year followup. The study of men born in 1913. Int J Obes Relat Metab Disord. 2000;24:33–7.CrossRef
26.
Tanaka H, Kokubo Y. Epidemiology of Obesity in Japan. JMAJ. 2005;48:34–41.
Metadata
Title
Effect of obesity and underweight status on the hospital-acquired functional decline in patients with cardiovascular surgery: an analysis of data from a prospective observational multicenter cohort study
Publication date
01-09-2020
Published in
General Thoracic and Cardiovascular Surgery / Issue 9/2020
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-019-01279-0

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