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Complementary Role of Arm Circumference to Body Mass Index in Risk Stratification in Heart Failure
Kentaro Kamiya1, Takashi Masuda2, Yuya Matsue3
1Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
Insights
Mid-upper arm circumference (MUAC) improves body mass index (BMI) predictions for heart failure (HF) patient survival. MUAC, unlike waist circumference (WC), offers complementary data for better risk stratification in HF patients.
Area of Science:
- Cardiology
- Clinical Nutrition
- Public Health
Background:
- High body mass index (BMI) is paradoxically linked to better survival in heart failure (HF) patients.
- BMI does not differentiate between fat mass and lean muscle mass, limiting its prognostic accuracy.
- Accurate risk stratification is crucial for managing heart failure (HF) patients.
Purpose of the Study:
- To investigate if mid-upper arm circumference (MUAC) and waist circumference (WC) complement body mass index (BMI) in predicting prognosis for heart failure (HF) patients.
- To evaluate the added value of anthropometric measures beyond BMI in HF risk stratification.
- To determine the optimal anthropometric markers for predicting all-cause mortality in HF.
Main Methods:
- A cohort of 570 Japanese heart failure (HF) patients was analyzed.
- Body mass index (BMI), waist circumference (WC), and mid-upper arm circumference (MUAC) were measured.
- Patients were stratified by BMI, WC, and MUAC, and combined groups were formed to assess all-cause mortality.
Main Results:
- Mid-upper arm circumference (MUAC) was the strongest predictor of prognosis, showing an inverse association with mortality (HR: 0.52, p < 0.001).
- Adding MUAC to BMI significantly improved the predictive model's accuracy (AUC increased from 0.63 to 0.70, p = 0.012).
- Waist circumference (WC) did not significantly enhance BMI's predictive capability for heart failure (HF) prognosis.
Conclusions:
- Mid-upper arm circumference (MUAC) serves as a valuable complementary marker to BMI for predicting prognosis in heart failure (HF) patients.
- Waist circumference (WC) does not offer significant complementary prognostic information when combined with BMI in this population.
- Incorporating MUAC into risk assessment models can improve the stratification of heart failure (HF) patients.
Objectives:
This study was performed to investigate the complementary role of arm circumference to body mass index (BMI) in risk stratification of patients with heart failure (HF).
Background:
High BMI is associated with improved survival in patients with HF. However, it does not discriminate between fat and lean muscle as a predominant factor.
Methods:
BMI, waist circumference (WC), and mid-upper arm circumference (MUAC) were evaluated in 570 consecutive Japanese patients with HF (mean age 67.4 ± 14.0 years). Patients were stratified into low and high groups according to BMI, WC, and MUAC and combined into low- or high-BMI and low- or high-WC groups or low- or high-BMI and low- or high-MUAC groups. The endpoint was all-cause mortality.
Results:
Seventy deaths occurred over a median follow-up period of 1.5 years (interquartile range: 0.7 to 2.8 years). After adjusting for several pre-existing prognostic factors, including Seattle Heart Failure Score and exercise capacity, BMI (hazard ratio [HR]: 0.68; p = 0.016), WC (HR: 0.76; p = 0.044), and MUAC (HR: 0.52; p < 0.001) were all inversely associated with prognosis. Compared with the high-BMI/high-WC group, both the low-BMI/high-WC and low-BMI/low-WC groups showed comparably poorer prognosis. However, the low-BMI/low-MUAC group but not the low-BMI/high-MUAC group showed poorer prognosis than the high-BMI/high-MUAC group. Adding MUAC to BMI (0.70 vs. 0.63, p = 0.012) but not WC to BMI (0.64 vs. 0.63, p = 0.763) significantly increased the area under the curve on receiver-operating characteristic curve analysis.
Conclusions:
MUAC, but not WC, plays a complementary role to BMI in predicting prognosis in patients with HF.
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