An Assessment of the Relationship Between Abdominal Obesity and the Severity of Upper Extremity Lymphedema

Obesity is one of the well-known initiating and aggravating factors of lymphedema. Body mass index (BMI) is typically used to define obesity, but in Asian populations, health risks are elevated at lower BMI levels, and abdominal fat may be a better obesity metric. Thus, we assessed the potential association between abdominal obesity and lymphedema severity in postoperative breast cancer patients.

Thirty-three women with breast cancer-related lymphedema participated in this study. Arm circumference was measured at four locations per arm to identify the maximal circumference difference (MCD) between the affected and unaffected sides. All patients underwent lymphoscintigraphy, and we calculated the quantitative asymmetry index (QAI) of both arms. A computed tomography was also performed to assess abdominal obesity after lymphedema. Abdominal obesity was classified as a visceral fat cross-sectional area larger than 70 cm². Fourteen women (42%) were obese (BMI ≥25 kg/m²), and 18 women (54%) had increased abdominal fat. BMI obesity and abdominal obesity were significantly correlated, but five patients were classified with abdominal obesity, despite a BMI below 25 kg/m². The mean arm circumference difference was 2.8 ± 2.4 cm. Decreased axillary QAI was significantly correlated with obesity, and increased arm edema (MCD ≥2 cm) was significantly correlated with abdominal obesity.

Abdominal obesity was significantly correlated with increased MCD and should be considered along with obesity as an aggravating factor for lymphedema severity.