Abstract 3789: Adiposity, Leanness and 4-year Mortality in Stable Latin American Outpatients with Established Cerebrovascular Disease: Challenging the Concept of Obesity Paradox

Abstract

Background. The lean weight index (LWI) is a new body composition measure recently described by our group that indicates better the fat-free mass content, as compared with other anthropometric measures such as body mass index (BMI). BMI reflects both fat and lean mass, and therefore, it is not the ideal body composition index for assessing obesity. This in part may be responsible for the apparently paradoxical protective effect of a high BMI (sometimes interpreted as “protective obesity”) in reducing the risk of long-term death in some chronic diseases. We aimed to assess both BMI and LWI as predictors of long-term death in stable outpatients with cerebrovascular disease (CVD).Methods. We analyzed 582 Latin American outpatients with CVD (56.7% men, mean age 68.9 years), pertaining to the Reduction of Atherothrombosis for Continued Health (REACH) registry. LWI [LWI = BMI / waist-to-height ratio (WHtR)] and BMI were included in adjusted multivariate analyses on 4-year all-cause mortality. A LWI 30 as a cut-off indicating obesity. Results. At baseline, 22.3% patients had BMI >30, and 12.2% had LWI 30, and 22.5% with LWI 30, and 14.1% with LWI <40), respectively. In multivariate analysis adjusted for multiple confounders, 4-year all-cause mortality was directly associated with a baseline LWI <40 [hazard ratio (HR): 2.00, 95% confidence interval (CI): 1.09-3.64], congestive heart failure (HR: 2.64, 95% CI: 1.35-5.18) and coronary artery disease (HR: 2.31, 95% CI: 1.35-3.95), and inversely associated with statin use (HR: 0.40, 95% CI: 0.23-0.69). Conclusion. As shown by our results, it is possible that a certain lean mass, as reflected by LWI, may be necessary to reduce the risk of long-term mortality. The obesity paradox, as examined by the BMI, is not confirmed here when LWI is included in the multivariate analyses.