Obesity Impact on Heart Failure Outcomes
Summary
Obesity represents a major modifiable risk factor for the development and progression of heart failure. Excess adiposity contributes to structural and functional alterations in the myocardium, promotes systemic inflammation, exacerbates neurohormonal activation and fosters comorbidities such as hypertension and type 2 diabetes. Paradoxically, epidemiological studies have reported that individuals with established heart failure and higher body mass index often exhibit better short-term survival than those of normal weight, a phenomenon termed the obesity paradox. This apparent protective effect varies by heart failure phenotype: it is most evident in patients with reduced ejection fraction but less pronounced or absent in those with preserved ejection fraction when diabetes is present. Recent work has emphasised the limitations of body mass index alone and highlighted new anthropometric indices that more accurately capture fat distribution and lean mass. A more nuanced understanding of the interplay between adiposity, muscle wasting and metabolic derangements is now shaping tailored strategies for risk stratification and management across the spectrum of heart failure severity.
Research from Nature Portfolio
Innovative anthropometric indices have been compared with traditional measures to predict incident heart failure in community cohorts. The relative fat mass index, which accounts for height and waist circumference, exhibited a stronger association with heart failure risk than body mass index, waist-hip ratio or body-shape index, and improved predictive models across preserved and reduced ejection fraction subtypes. In acute decompensated heart failure, a granular analysis of body mass index categories revealed that severely underweight patients faced substantially higher one-year mortality, whereas the apparent survival advantage of overweight and obese groups diminished after adjustment for clinical confounders. These findings underscore the importance of identifying very low body mass alongside novel adiposity markers to refine prognostic assessment and guide nutritional and pharmacological interventions in patients with heart failure.
Obesity Impact on Heart Failure Outcomes publication trend
The graph below shows the total number of articles in obesity impact on heart failure outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Body mass index (BMI): A ratio of weight to height squared used to classify underweight, normal weight, overweight and obesity.
Ejection fraction (EF): The percentage of blood ejected from the left ventricle with each heartbeat; used to distinguish reduced (HFrEF) from preserved (HFpEF) function.
Relative fat mass (RFM): An anthropometric index derived from height and waist circumference that estimates whole-body adiposity more accurately than BMI.
Waist-to-height ratio (WHtR): A measure of central adiposity calculated by dividing waist circumference by height; reflects visceral fat burden.
References
- Anthropometric measures and adverse outcomes in heart failure with reduced ejection fraction: revisiting the obesity paradox. European Heart Journal (2023).
- Obesity in heart failure with preserved ejection fraction with and without diabetes: risk factor or innocent bystander?. European Journal of Preventive Cardiology (2023).
- The Impact of Obesity on the Cardiovascular System. Journal of Diabetes Research (2018).
- Relative fat mass, a new index of adiposity, is strongly associated with incident heart failure: data from PREVEND. Scientific Reports (2022).
- Association between body mass index and prognosis of patients hospitalized with heart failure. Scientific Reports (2020).
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