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Clinical Research

Validation of the obesity paradox by body mass index and waist circumference in patients undergoing percutaneous coronary intervention

International Journal of Obesity volume 46, pages 1840–1848 (2022)Cite this article

Subjects

Abstract

Background

The paradoxical association of obesity with mortality, named the “obesity paradox”, has been inconsistent, possibly due to a difference between body mass index (BMI) and central obesity, estimated by waist circumference (WC) as patterns of adiposity.

Subjects/methods

We enrolled 8513 participants from the Kumamoto Intervention Conference Study, a multicenter registry that included consecutive patients undergoing percutaneous coronary intervention (PCI) at 18 centers between 2008 and 2017 in Japan. Patients were divided into quartiles in ascending order of the BMI or WC. The primary endpoints were all-cause mortality and cardiovascular death within a year.

Results

There were 186 deaths (case fatality rate, 22.1/1000 person-years) during the follow-up period. The lowest group (1st quartile) of BMI or WC had the worst prognosis among the quartiles (1st quartile, 4.2%; 2nd quartile, 1.9%; 3rd quartile, 1.5%; 4th quartile, 1.1%; P < 0.001 (χ2) and 1st quartile, 4.1%; 2nd quartile, 2.3%; 3rd quartile, 1.2%; 4th quartile, 1.5%; P < 0.001 (χ2), respectively). Similar results were obtained for cardiovascular death. In a multivariable analysis adjusted by nine conventional factors, the lowest group (1st quartile) of BMI (hazards ratio, 2.748; 95% confidence interval [CI], 1.712–4.411) and WC (hazards ratio, 2.340; 95% CI, 1.525–3.589) were independent prognostic factors for all-cause mortality. By dividing the participants into two groups according to either the BMI or WC based on the National Cholesterol Education Program Adult Treatment Panel III and World Health Organization classification, the highest mortality was observed in the lower group. However, the C-statistic after adding BMI (quartile) to conventional factors was found to be slightly higher than BMI (two categories) and WC (two categories) (0.735 vs. 0.734).

Conclusions

The obesity paradox was observed in patients after PCI, and single-use of BMI (or WC) was sufficient to predict the prognosis of patients after PCI.

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Fig. 1: Study flow chart.
Fig. 2: Histogram of BMI (A) and WC (B) in all patients.
Fig. 3: Event rates among the four groups according to the BMI (A) and WC (B) in the quartile.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The present Registry is funded by Daiichi Sankyo Co., Ltd. Japan.

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

    Yuichiro Shirahama, Noriaki Tabata, Kenji Sakamoto, Ryota Sato, Kenshi Yamanaga, Koichiro Fujisue, Daisuke Sueta, Satoshi Araki, Seiji Takashio, Yuichiro Arima, Seiji Hokimoto, Satoru Suzuki, Eiichiro Yamamoto, Koichi Kaikita, Kenichi Matsushita, Kenichi Tsujita, Shinsuke Hanatani, Hiroki Usuku, Koichiro Fujisue & Kenshi Yamanaga

  2. Department of Cardiovascular Medicine, Kumamoto City Hospital, Kumamoto, Japan

    Koji Sato & Koji Sato

  3. Cardiovascular Center, Kumamoto Saiseikai Hospital, Kumamoto, Japan

    Tomohiro Sakamoto, Koichi Nakao, Masahide Nagano, Takashi Fukunaga, Eiji Taguchi & Eiji Horio

  4. Division of Cardiology, Fukuoka Tokushukai Hospital, Kasuga, Japan

    Hideki Shimomura, Yuji Ogura, Mitsutoshi Miura, Takashi Kudo & Yoshihiro Yamada

  5. Kumamoto Rosai Hospital, Yatsushiro, Japan

    Toshiyuki Matsumura, Koji Abe & Hideki Doi

  6. National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan

    Shinji Tayama, Kazuteru Fujimoto, Hiroaki Kusaka, Shinji Tayama & Yuji Miyao

  7. Kumamoto Central Hospital, Kumamoto, Japan

    Shuichi Oshima, Kenji Morihisa, Shunichiro Fuchigami, Taku Rokutanda, Tsunenori Nishijima & Katsuo Noda

  8. Kumamoto General Hospital, Kumamoto, Japan

    Shinichi Nakamura, Ryuichiro Fukushima, Takashi Uemura, Tetsuji Katayama & Shinichi Nakamura

  9. Kumamoto Red Cross Hospital, Kumamoto, Japan

    Ryusuke Tsunoda, Hiromi Yoshimura, Tomokazu Ikemoto, Teruhiko Ito & Ryusuke Tsunoda

  10. Minamata City Hospital and Medical Center, Minamata, Japan

    Toyoki Hirose, Tomoaki Uemura & Hideki Maruyama

  11. Shinbeppu Hospital, Beppu, Japan

    Koichi Kikuta, Takashi Miyazaki, Eisaku Okuyama & Koichi Kikuta

  12. Amakusa Regional Medical Center, Kumamoto, Japan

    Naritsugu Sakaino & Shota Nakamura

  13. Miyazaki Prefectural NOBEOKA Hospital, Nobeoka, Japan

    Nobuyasu Yamamoto & Kazumasa Kurogi

  14. Arao City Hospital, Arao, Japan

    Ichiro Kajiwara, Tadasuke Chitose & Takamichi Ono

  15. Center of Metabolic Health Aging, Kumamoto University, Kumamoto, Japan

    Kenichi Tsujita

  16. Hitoyoshi Medical Center, Hitoyoshi, Japan

    Yosuke Hanaoka & Hirofumi Kurokawa

  17. Division of Cardiology, Aso Medical Center, Aso, Japan

    Shinzo Miyamoto

  18. Division of Cardiology, Kumamoto Kenhoku Hospital, Tamana, Japan

    Masakazu Matsukawa

  19. Division of Cardiology, Omuta Tenryo Hospital, Omuta, Japan

    Junichi Matsubara

Authors
  1. Yuichiro Shirahama
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  2. Noriaki Tabata
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  3. Kenji Sakamoto
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  4. Ryota Sato
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  5. Kenshi Yamanaga
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  6. Koichiro Fujisue
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  7. Daisuke Sueta
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  8. Satoshi Araki
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  9. Seiji Takashio
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  10. Yuichiro Arima
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  11. Seiji Hokimoto
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  12. Koji Sato
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  13. Tomohiro Sakamoto
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  14. Koichi Nakao
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  15. Hideki Shimomura
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  16. Toshiyuki Matsumura
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  17. Shinji Tayama
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  18. Kazuteru Fujimoto
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  19. Shuichi Oshima
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  20. Shinichi Nakamura
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  21. Ryusuke Tsunoda
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  22. Toyoki Hirose
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  23. Koichi Kikuta
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  24. Naritsugu Sakaino
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  25. Nobuyasu Yamamoto
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  26. Ichiro Kajiwara
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  27. Satoru Suzuki
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  28. Eiichiro Yamamoto
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  29. Koichi Kaikita
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  30. Kenichi Matsushita
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  31. Kenichi Tsujita
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Consortia

On behalf of the Kumamoto Intervention Conference Study (KICS) Investigators

  • Shinsuke Hanatani
  • , Hiroki Usuku
  • , Koichiro Fujisue
  • , Kenshi Yamanaga
  • , Koji Sato
  • , Masahide Nagano
  • , Takashi Fukunaga
  • , Eiji Taguchi
  • , Eiji Horio
  • , Yuji Ogura
  • , Mitsutoshi Miura
  • , Takashi Kudo
  • , Yoshihiro Yamada
  • , Koji Abe
  • , Hideki Doi
  • , Hiroaki Kusaka
  • , Shinji Tayama
  • , Yuji Miyao
  • , Kenji Morihisa
  • , Shunichiro Fuchigami
  • , Taku Rokutanda
  • , Tsunenori Nishijima
  • , Katsuo Noda
  • , Ryuichiro Fukushima
  • , Takashi Uemura
  • , Tetsuji Katayama
  • , Shinichi Nakamura
  • , Hiromi Yoshimura
  • , Tomokazu Ikemoto
  • , Teruhiko Ito
  • , Ryusuke Tsunoda
  • , Tomoaki Uemura
  • , Hideki Maruyama
  • , Takashi Miyazaki
  • , Eisaku Okuyama
  • , Koichi Kikuta
  • , Shota Nakamura
  • , Kazumasa Kurogi
  • , Tadasuke Chitose
  • , Takamichi Ono
  • , Yosuke Hanaoka
  • , Hirofumi Kurokawa
  • , Shinzo Miyamoto
  • , Masakazu Matsukawa
  •  & Junichi Matsubara

Contributions

The authors confirm contribution to the paper as follows: study conception and design: YS, NT, KSakamoto, RS, KY, KT; data collection: SH, KSato, TS, KN, HS, TM, STayama, SO, KFujimoto, RT, TH, KKikuta, NS, SN, NY, IK; analysis and interpretation of results: YS, NT, KFujisue, DS, SA, STakashio, YA, SS, EY, KKaikita, KM, KT; draft manuscript preparation: YS, NT, KT. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Noriaki Tabata.

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Conflict of interest

Koichi Kaikita received research grants and Kenichi Tsujita received honoraria and research grants from Daiichi Sankyo Co., Ltd. The other authors declare no competing interests.

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Shirahama, Y., Tabata, N., Sakamoto, K. et al. Validation of the obesity paradox by body mass index and waist circumference in patients undergoing percutaneous coronary intervention. Int J Obes 46, 1840–1848 (2022). https://doi.org/10.1038/s41366-022-01163-7

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  • DOI: https://doi.org/10.1038/s41366-022-01163-7

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