Abstract
Although an increased body mass index is associated with lower mortality in patients undergoing hemodialysis (HD), known as the “obesity paradox,” the relationship of abdominal fat levels with all-cause mortality has rarely been studied. We investigated the impact of computed-tomography-measured abdominal fat levels (visceral fat area (VFA) and subcutaneous fat area (SFA)) on all-cause mortality in this population. A total of 201 patients undergoing HD were enrolled and cross-classified by VFA and SFA levels according to each cutoff point, VFA of 78.7 cm2 and SFA of 93.2 cm2, based on the receiver operator characteristic (ROC) curve as following; group 1 (G1): lower VFA and lower SFA, G2: higher VFA and lower SFA, G3: lower VFA and higher SFA, G4: higher VFA and higher SFA. During a median follow-up of 4.3 years, 67 patients died. Kaplan–Meier analysis revealed 10-year survival rates of 29.0%, 50.0%, 62.6%, and 72.4% in G1, G2, G3, and G4 (p < 0.0001), respectively. The adjusted hazard ratio was 0.30 (95% confidence interval [CI] 0.05–1.09, p = 0.070) for G2 vs. G1, 0.37 (95% CI 0.18–0.76, p = 0.0065) for G3 vs. G1, and 0.21 (95% CI 0.07–0.62, p = 0.0035) for G4 vs. G1, respectively. In conclusion, combined SFA and VFA levels were negatively associated with risks for all-cause mortality in patients undergoing HD. These results are a manifestation of the “obesity paradox.”
Highlights
Obesity is a risk factor for cardiovascular diseases, and it is associated with an increased risk of mortality in the general population [1,2]
Combined subcutaneous fat area (SFA) and visceral fat area (VFA) levels were negatively associated with risks for all-cause mortality in patients undergoing HD
Some studies have illustrated that body fat distribution may be more important than overall adiposity; in particular, visceral fat is an independent predictor of dyslipidemia and insulin resistance [7,8] and is associated with metabolic risk factors [9]
Summary
Obesity is a risk factor for cardiovascular diseases, and it is associated with an increased risk of mortality in the general population [1,2]. Many studies have reported that an increased body mass index (BMI) is associated with better survival in patients with end-stage renal disease undergoing hemodialysis (HD) [3,4]. This phenomenon has been described as the “obesity paradox.”. Some studies reported that the abdominal visceral fat area (VFA), but not the subcutaneous fat area (SFA), was associated with all-cause mortality in the general population, but the results were controversial [10,11,12,13,14,15,16]. In patients undergoing HD, a study suggested that increased VFA is a risk factor for cardiovascular death [17]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
