Potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement
Key Summary Points Aim The present study aimed to investigate potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis. Findings The obesity paradox was observed in older patients following TAVR. Cachexia may re...
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| Veröffentlicht in: | European geriatric medicine 2024-02, Vol.15 (1), p.179-187 |
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| creator | Higuchi, Satoshi Matsumoto, Hidenari Masaki, Ryota Hirano, Takaho Fuse, Shiori Tanisawa, Hiroki Masuda, Tomoaki Mochizuki, Yasuhide Maruta, Kazuto Kondo, Seita Omoto, Tadashi Aoki, Atsushi Shinke, Toshiro |
| description | Key Summary Points
Aim
The present study aimed to investigate potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Findings
The obesity paradox was observed in older patients following TAVR. Cachexia may reflect higher mortality in patients with lower BMI and higher subcutaneous fat accumulation (SFA) may represent lower mortality in those with higher BMI.
Message
Considering higher mortality in lower BMI with cachexia, prevention or treatment of the comorbidity would be important in older patients following TAVR.
Purpose
A higher body mass index (BMI) is associated with lower mortality in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. The current study aimed to investigate potential confounders of association between BMI and prognosis.
Methods
The retrospective single-center study included consecutive patients following TAVR and excluded those in whom subcutaneous fat accumulation (SFA), visceral fat accumulation (VFA), and major psoas muscle (MPM) volume were not assessed by computed tomography. Cachexia was defined as a combination of BMI |
| doi_str_mv | 10.1007/s41999-023-00855-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2860617110</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2860617110</sourcerecordid><originalsourceid>FETCH-LOGICAL-c298t-c024c34b379c34ac9c0c2371df4ab76f5f90d701e1e2d68027ae52c3b038b75e3</originalsourceid><addsrcrecordid>eNp9kMtOxSAURYnRqLn6Aw4MQyfVA7SlDI3xlZjoQMeE0lOt4cIVqI-_F73qUCaHwFo7OZuQAwbHDECepJoppSrgogLomqZiG2SXdbKrZNvIzb97rXbIfkrPUI7gSsl6m-wI2bYg6nqXhLuQ0efJOGqDH8PsB4yJhpHmJ6ShxzTlD7oy0QzhnU6eBleA8pCnoiU6BufC2-QfaY7GJ2uKlgtgQsyTpa_GvSKNuHLG4rIYe2RrNC7h_s9ckIeL8_uzq-rm9vL67PSmslx1ubLAayvqXkhVhrHKguVCsmGsTS_bsRkVDBIYMuRD2wGXBhtuRQ-i62WDYkGO1rmrGF5mTFkvp2TROeMxzEnzroWWScagoHyN2hhSijjqVZyWJn5oBvqra73uWpeu9XfXmhXp8Cd_7pc4_Cm_zRZArIFUvvwjRv0c5ujLzv_FfgJGP4wz</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2860617110</pqid></control><display><type>article</type><title>Potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Higuchi, Satoshi ; Matsumoto, Hidenari ; Masaki, Ryota ; Hirano, Takaho ; Fuse, Shiori ; Tanisawa, Hiroki ; Masuda, Tomoaki ; Mochizuki, Yasuhide ; Maruta, Kazuto ; Kondo, Seita ; Omoto, Tadashi ; Aoki, Atsushi ; Shinke, Toshiro</creator><creatorcontrib>Higuchi, Satoshi ; Matsumoto, Hidenari ; Masaki, Ryota ; Hirano, Takaho ; Fuse, Shiori ; Tanisawa, Hiroki ; Masuda, Tomoaki ; Mochizuki, Yasuhide ; Maruta, Kazuto ; Kondo, Seita ; Omoto, Tadashi ; Aoki, Atsushi ; Shinke, Toshiro</creatorcontrib><description>Key Summary Points
Aim
The present study aimed to investigate potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Findings
The obesity paradox was observed in older patients following TAVR. Cachexia may reflect higher mortality in patients with lower BMI and higher subcutaneous fat accumulation (SFA) may represent lower mortality in those with higher BMI.
Message
Considering higher mortality in lower BMI with cachexia, prevention or treatment of the comorbidity would be important in older patients following TAVR.
Purpose
A higher body mass index (BMI) is associated with lower mortality in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. The current study aimed to investigate potential confounders of association between BMI and prognosis.
Methods
The retrospective single-center study included consecutive patients following TAVR and excluded those in whom subcutaneous fat accumulation (SFA), visceral fat accumulation (VFA), and major psoas muscle (MPM) volume were not assessed by computed tomography. Cachexia was defined as a combination of BMI < 20 kg/m
2
and any biochemical abnormalities.
Results
After 2 patients were excluded, 234 (age, 86 ± 5 years; male, 77 [33%]; BMI, 22.4 ± 3.8 kg/m
2
; SFA, 109 (54–156) cm
2
; VFA, 71 (35–115) cm
2
; MPM, 202 (161–267) cm
3
; cachexia, 49 [21%]) were evaluated. SFA and VFA were strongly correlated with BMI (ρ = 0.734 and ρ = 0.712, respectively), whereas MPM was weakly correlated (ρ = 0.346). Two-year all-cause mortality was observed in 31 patients (13%). Higher BMI was associated with lower mortality (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.77–0.95). A similar result was observed in the multivariate model including SFA (aHR in an increase of 20 cm
2
, 0.87; 95% CI, 0.77–0.98) instead of BMI, whereas VFA was not significant. Cachexia was a worse predictor (aHR, 2.51; 95% CI 1.11–5.65).
Conclusions
Association of higher BMI with lower mortality may be confounded by SFA in older patients following TAVR. Cachexia might reflect higher mortality in patients with lower BMI.</description><identifier>ISSN: 1878-7649</identifier><identifier>ISSN: 1878-7657</identifier><identifier>EISSN: 1878-7657</identifier><identifier>DOI: 10.1007/s41999-023-00855-1</identifier><identifier>PMID: 37660344</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Aged ; Aged, 80 and over ; Cachexia - etiology ; Geriatrics/Gerontology ; Humans ; Internal Medicine ; Male ; Medicine ; Medicine & Public Health ; Obesity Paradox ; Research Paper ; Retrospective Studies ; Risk Factors ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - methods ; Treatment Outcome</subject><ispartof>European geriatric medicine, 2024-02, Vol.15 (1), p.179-187</ispartof><rights>The Author(s), under exclusive licence to European Geriatric Medicine Society 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to European Geriatric Medicine Society.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c298t-c024c34b379c34ac9c0c2371df4ab76f5f90d701e1e2d68027ae52c3b038b75e3</cites><orcidid>0000-0002-7914-8256</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s41999-023-00855-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s41999-023-00855-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37660344$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Higuchi, Satoshi</creatorcontrib><creatorcontrib>Matsumoto, Hidenari</creatorcontrib><creatorcontrib>Masaki, Ryota</creatorcontrib><creatorcontrib>Hirano, Takaho</creatorcontrib><creatorcontrib>Fuse, Shiori</creatorcontrib><creatorcontrib>Tanisawa, Hiroki</creatorcontrib><creatorcontrib>Masuda, Tomoaki</creatorcontrib><creatorcontrib>Mochizuki, Yasuhide</creatorcontrib><creatorcontrib>Maruta, Kazuto</creatorcontrib><creatorcontrib>Kondo, Seita</creatorcontrib><creatorcontrib>Omoto, Tadashi</creatorcontrib><creatorcontrib>Aoki, Atsushi</creatorcontrib><creatorcontrib>Shinke, Toshiro</creatorcontrib><title>Potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement</title><title>European geriatric medicine</title><addtitle>Eur Geriatr Med</addtitle><addtitle>Eur Geriatr Med</addtitle><description>Key Summary Points
Aim
The present study aimed to investigate potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Findings
The obesity paradox was observed in older patients following TAVR. Cachexia may reflect higher mortality in patients with lower BMI and higher subcutaneous fat accumulation (SFA) may represent lower mortality in those with higher BMI.
Message
Considering higher mortality in lower BMI with cachexia, prevention or treatment of the comorbidity would be important in older patients following TAVR.
Purpose
A higher body mass index (BMI) is associated with lower mortality in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. The current study aimed to investigate potential confounders of association between BMI and prognosis.
Methods
The retrospective single-center study included consecutive patients following TAVR and excluded those in whom subcutaneous fat accumulation (SFA), visceral fat accumulation (VFA), and major psoas muscle (MPM) volume were not assessed by computed tomography. Cachexia was defined as a combination of BMI < 20 kg/m
2
and any biochemical abnormalities.
Results
After 2 patients were excluded, 234 (age, 86 ± 5 years; male, 77 [33%]; BMI, 22.4 ± 3.8 kg/m
2
; SFA, 109 (54–156) cm
2
; VFA, 71 (35–115) cm
2
; MPM, 202 (161–267) cm
3
; cachexia, 49 [21%]) were evaluated. SFA and VFA were strongly correlated with BMI (ρ = 0.734 and ρ = 0.712, respectively), whereas MPM was weakly correlated (ρ = 0.346). Two-year all-cause mortality was observed in 31 patients (13%). Higher BMI was associated with lower mortality (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.77–0.95). A similar result was observed in the multivariate model including SFA (aHR in an increase of 20 cm
2
, 0.87; 95% CI, 0.77–0.98) instead of BMI, whereas VFA was not significant. Cachexia was a worse predictor (aHR, 2.51; 95% CI 1.11–5.65).
Conclusions
Association of higher BMI with lower mortality may be confounded by SFA in older patients following TAVR. Cachexia might reflect higher mortality in patients with lower BMI.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cachexia - etiology</subject><subject>Geriatrics/Gerontology</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obesity Paradox</subject><subject>Research Paper</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Transcatheter Aortic Valve Replacement - methods</subject><subject>Treatment Outcome</subject><issn>1878-7649</issn><issn>1878-7657</issn><issn>1878-7657</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kMtOxSAURYnRqLn6Aw4MQyfVA7SlDI3xlZjoQMeE0lOt4cIVqI-_F73qUCaHwFo7OZuQAwbHDECepJoppSrgogLomqZiG2SXdbKrZNvIzb97rXbIfkrPUI7gSsl6m-wI2bYg6nqXhLuQ0efJOGqDH8PsB4yJhpHmJ6ShxzTlD7oy0QzhnU6eBleA8pCnoiU6BufC2-QfaY7GJ2uKlgtgQsyTpa_GvSKNuHLG4rIYe2RrNC7h_s9ckIeL8_uzq-rm9vL67PSmslx1ubLAayvqXkhVhrHKguVCsmGsTS_bsRkVDBIYMuRD2wGXBhtuRQ-i62WDYkGO1rmrGF5mTFkvp2TROeMxzEnzroWWScagoHyN2hhSijjqVZyWJn5oBvqra73uWpeu9XfXmhXp8Cd_7pc4_Cm_zRZArIFUvvwjRv0c5ujLzv_FfgJGP4wz</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Higuchi, Satoshi</creator><creator>Matsumoto, Hidenari</creator><creator>Masaki, Ryota</creator><creator>Hirano, Takaho</creator><creator>Fuse, Shiori</creator><creator>Tanisawa, Hiroki</creator><creator>Masuda, Tomoaki</creator><creator>Mochizuki, Yasuhide</creator><creator>Maruta, Kazuto</creator><creator>Kondo, Seita</creator><creator>Omoto, Tadashi</creator><creator>Aoki, Atsushi</creator><creator>Shinke, Toshiro</creator><general>Springer International Publishing</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7914-8256</orcidid></search><sort><creationdate>20240201</creationdate><title>Potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement</title><author>Higuchi, Satoshi ; Matsumoto, Hidenari ; Masaki, Ryota ; Hirano, Takaho ; Fuse, Shiori ; Tanisawa, Hiroki ; Masuda, Tomoaki ; Mochizuki, Yasuhide ; Maruta, Kazuto ; Kondo, Seita ; Omoto, Tadashi ; Aoki, Atsushi ; Shinke, Toshiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c298t-c024c34b379c34ac9c0c2371df4ab76f5f90d701e1e2d68027ae52c3b038b75e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cachexia - etiology</topic><topic>Geriatrics/Gerontology</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obesity Paradox</topic><topic>Research Paper</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Transcatheter Aortic Valve Replacement - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Higuchi, Satoshi</creatorcontrib><creatorcontrib>Matsumoto, Hidenari</creatorcontrib><creatorcontrib>Masaki, Ryota</creatorcontrib><creatorcontrib>Hirano, Takaho</creatorcontrib><creatorcontrib>Fuse, Shiori</creatorcontrib><creatorcontrib>Tanisawa, Hiroki</creatorcontrib><creatorcontrib>Masuda, Tomoaki</creatorcontrib><creatorcontrib>Mochizuki, Yasuhide</creatorcontrib><creatorcontrib>Maruta, Kazuto</creatorcontrib><creatorcontrib>Kondo, Seita</creatorcontrib><creatorcontrib>Omoto, Tadashi</creatorcontrib><creatorcontrib>Aoki, Atsushi</creatorcontrib><creatorcontrib>Shinke, Toshiro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European geriatric medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Higuchi, Satoshi</au><au>Matsumoto, Hidenari</au><au>Masaki, Ryota</au><au>Hirano, Takaho</au><au>Fuse, Shiori</au><au>Tanisawa, Hiroki</au><au>Masuda, Tomoaki</au><au>Mochizuki, Yasuhide</au><au>Maruta, Kazuto</au><au>Kondo, Seita</au><au>Omoto, Tadashi</au><au>Aoki, Atsushi</au><au>Shinke, Toshiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement</atitle><jtitle>European geriatric medicine</jtitle><stitle>Eur Geriatr Med</stitle><addtitle>Eur Geriatr Med</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>15</volume><issue>1</issue><spage>179</spage><epage>187</epage><pages>179-187</pages><issn>1878-7649</issn><issn>1878-7657</issn><eissn>1878-7657</eissn><abstract>Key Summary Points
Aim
The present study aimed to investigate potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic stenosis.
Findings
The obesity paradox was observed in older patients following TAVR. Cachexia may reflect higher mortality in patients with lower BMI and higher subcutaneous fat accumulation (SFA) may represent lower mortality in those with higher BMI.
Message
Considering higher mortality in lower BMI with cachexia, prevention or treatment of the comorbidity would be important in older patients following TAVR.
Purpose
A higher body mass index (BMI) is associated with lower mortality in older patients following transcatheter aortic valve replacement (TAVR) for severe aortic valve stenosis. The current study aimed to investigate potential confounders of association between BMI and prognosis.
Methods
The retrospective single-center study included consecutive patients following TAVR and excluded those in whom subcutaneous fat accumulation (SFA), visceral fat accumulation (VFA), and major psoas muscle (MPM) volume were not assessed by computed tomography. Cachexia was defined as a combination of BMI < 20 kg/m
2
and any biochemical abnormalities.
Results
After 2 patients were excluded, 234 (age, 86 ± 5 years; male, 77 [33%]; BMI, 22.4 ± 3.8 kg/m
2
; SFA, 109 (54–156) cm
2
; VFA, 71 (35–115) cm
2
; MPM, 202 (161–267) cm
3
; cachexia, 49 [21%]) were evaluated. SFA and VFA were strongly correlated with BMI (ρ = 0.734 and ρ = 0.712, respectively), whereas MPM was weakly correlated (ρ = 0.346). Two-year all-cause mortality was observed in 31 patients (13%). Higher BMI was associated with lower mortality (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.77–0.95). A similar result was observed in the multivariate model including SFA (aHR in an increase of 20 cm
2
, 0.87; 95% CI, 0.77–0.98) instead of BMI, whereas VFA was not significant. Cachexia was a worse predictor (aHR, 2.51; 95% CI 1.11–5.65).
Conclusions
Association of higher BMI with lower mortality may be confounded by SFA in older patients following TAVR. Cachexia might reflect higher mortality in patients with lower BMI.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>37660344</pmid><doi>10.1007/s41999-023-00855-1</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-7914-8256</orcidid></addata></record> |
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| ispartof | European geriatric medicine, 2024-02, Vol.15 (1), p.179-187 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Aged Aged, 80 and over Cachexia - etiology Geriatrics/Gerontology Humans Internal Medicine Male Medicine Medicine & Public Health Obesity Paradox Research Paper Retrospective Studies Risk Factors Transcatheter Aortic Valve Replacement - adverse effects Transcatheter Aortic Valve Replacement - methods Treatment Outcome |
| title | Potential confounders of the obesity paradox in older patients following transcatheter aortic valve replacement |
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