A U-shaped association of body mass index and all-cause mortality in heart failure patients: A dose-response meta-analysis of prospective cohort studies

SummaryBackground and Aims The role of body mass index (BMI) for the prognosis of heart failure (HF) patients remains to be a great interest for a long time. However, the precise effect of dose-response for BMI and mortality risk in patients with HF is still unclear. We conducted a dose-response meta-analysis to quantitatively assess the effect of BMI on all-cause mortality in subjects with HF. Methods Fourteen prospective cohort studies included 13 508 death cases identified among 46 794 patients with HF. Results The summary HR per 5 units increase in BMI was 0.95 (95% CI=0.92-0.97) with evidence of high heterogeneity (I2=90.10%, Pheterogeneity<.00001), and an U-shaped nonlinear relationship of BMI and risk of mortality from all-causes was revealed (Pnonlinearity=.0025). When stratified analyses were conducted, the heterogeneity in patients with HF aged more than 60 years decreased. Conclusion Heart failure patients with higher BMI (>28 kg/m2) have a better survival, whereas underweight and those with severe obesity (eg, BMI>37 kg/m2) have a higher mortality.