Comparison of direct body composition assessment methods in patients with chronic heart failure

Effectiveness of a cardiac rehabilitation program on biomechanical, imaging, and physiological biomarkers in elderly patients with heart failure with preserved ejection fraction (HFpEF): FUNNEL + study protocol

BACKGROUND

Patients with heart failure with preserved ejection fraction (HFpEF) have a low functional status, which in turn is a risk factor for hospital admission and an important predictor of survival in HFpEF. HFpFE is a heterogeneous syndrome and recent studies have suggested an important role for careful, pathophysiological-based phenotyping to improve patient characterization. Cardiac rehabilitation has proven to be a useful tool in the framework of secondary prevention in patients with HFpEF. Facilitating decision-making and implementing cardiac rehabilitation programs is a challenge in public health systems for HFpEF management. The FUNNEL + study proposes to evaluate the efficacy of an exercise and education-based cardiac rehabilitation program on biomechanical, physiological, and imaging biomarkers in patients with HFpEF.

METHODS

A randomised crossover clinical trial is presented among people older than 70 years with a diagnosis of HFpEF. The experimental group will receive a cardiac rehabilitation intervention for 12 weeks. Participants in the control group will receive one educational session per week for 12 weeks on HFpEF complications, functional decline, and healthy lifestyle habits. VO2peak is the primary outcome. Biomechanical, imaging and physiological biomarkers will be assessed as secondary outcomes. Outcomes will be assessed at baseline, 12 weeks, and 24 weeks.

DISCUSSION

Identifying objective functional parameters indicative of HFpEF and the subsequent development of functional level stratification based on functional impairment ("biomechanical phenotypes") may help clinicians identify cardiac rehabilitation responders and non-responders and make future clinical decisions. In this way, future pharmacological and non-pharmacological interventions, such as exercise, could be improved and tailored to improve quality of life and prognosis and reducing patients' hospital readmissions, thereby reducing healthcare costs.

TRIAL REGISTRATION

NCT05393362 (Clinicaltrials.gov).

Impact of the Obesity Paradox Between Sexes on In-Hospital Mortality in Cardiogenic Shock: A Retrospective Cohort Study

Background

Several studies have shown that obesity is associated with better outcomes in patients with cardiogenic shock (CS). Although this phenomenon, the “obesity paradox,” reportedly manifests differently based on sex in other disease entities, it has not yet been investigated in patients with CS.

Methods and Results

A total of 1227 patients with CS from the RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) registry in Korea were analyzed. The study population was classified into obese and nonobese groups according to Asian Pacific criteria (BMI ≥25.0 kg/m² for obese). The clinical impact of obesity on in‐hospital mortality according to sex was analyzed using logistic regression analysis and restricted cubic spline curves. The in‐hospital mortality rate was significantly lower in obese men than nonobese men (34.2% versus 24.1%, respectively; P=0.004), while the difference was not significant in women (37.3% versus 35.8%, respectively; P=0.884). As a continuous variable, higher BMI showed a protective effect in men; conversely, BMI was not associated with clinical outcomes in women. Compared with patients with normal weight, obesity was associated with a decreased risk of in‐hospital death in men (multivariable‐adjusted odds ratio [OR], 0.63; CI, 0.43–0.92 [P=0.016]), but not in women (multivariable‐adjusted OR, 0.94; 95% CI, 0.55–1.61 [P=0.828]). The interaction P value for the association between BMI and sex was 0.023.

Conclusions

The obesity paradox exists and apparently occurs in men among patients with CS. The differential effect of BMI on in‐hospital mortality was observed according to sex.

Registration

URL: https://www.clinicaltrials.gov; Unique identifier: NCT02985008.

Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis

This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD −1.50 [−1.93, −1.08] kg/m²) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox—a sustained catabolic state presenting with lower BMI—is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.

A comparison of non-invasive methods of measuring body composition in patients with heart failure: a report from SICA-HF

Background

Cachexia is common in patients with chronic heart failure and is associated with poor prognosis. How best to measure body composition is not clear.

Methods and results

We characterized body composition in 120 patients with chronic heart failure: mean (SD) age 70 (10) years, left ventricular ejection fraction 44 (10) %, and median (Q1–Q3) N‐terminal pro B‐type natriuretic peptide 845 (355–1368) ng/L. We measured body composition using dual‐energy X‐ray absorptiometry (DEXA) and a multi‐frequency bioelectrical impedance analysis (BIA) device (Tanita BIA MC‐180MA). Mean (SD) fat mass (FM) was 27.2 (11.7) kg by BIA and 32.3 (12.2) kg by DEXA (mean difference −5.1 kg, 95% limits of agreement: −11.7, 1.5; 4% of values outside limit of agreement); mean (SD) lean mass (LM) was 56.6 (10.9) kg by BIA and 51.1 (9.9) kg by DEXA (mean difference 5.5 kg, 95% limits of agreement: −1.3, 12.3; 6% of values outside limit of agreement); and mean (SD) bone mass (BM) was 3.0 (0.5) kg by BIA and 2.8 (0.6) kg by DEXA (mean difference 0.2 kg, 95% limits of agreement: −0.5, 0.8; 5% of values outside limit of agreement). There was a close correlation between DEXA and BIA for both LM and FM (LM: r = 0.95, P < 0.001; FM: r = 0.96, P < 0.001) but less so for BM (r = 0.84, P < 0.001). Both DEXA and BIA body composition measurements correlated well with other measures of body size (body mass index, hip circumference, and waist circumference).

Conclusions

There are differences in the measurements of FM, LM, and BM between the two techniques, which should not be used interchangeably.

Re-appraisal of the obesity paradox in heart failure: a meta-analysis of individual data

Background

Higher body mass index (BMI) is associated with better outcome compared with normal weight in patients with HF and other chronic diseases. It remains uncertain whether the apparent protective role of obesity relates to the absence of comorbidities. Therefore, we investigated the effect of BMI on outcome in younger patients without co-morbidities as compared to older patients with co-morbidities in a large heart failure (HF) population.

Methods

In an individual patient data analysis from pooled cohorts, 5,819 patients with chronic HF and data available on BMI, co-morbidities and outcome were analysed. Patients were divided into four groups based on BMI (i.e. ≤ 18.5 kg/m², 18.5–25.0 kg/m²; 25.0–30.0 kg/m²; 30.0 kg/m²). Primary endpoints included all-cause mortality and HF hospitalization-free survival.

Results

Mean age was 65 ± 12 years, with a majority of males (78%), ischaemic HF and HF with reduced ejection fraction. Frequency of all-cause mortality or HF hospitalization was significantly worse in the lowest two BMI groups as compared to the other two groups; however, this effect was only seen in patients older than 75 years or having at least one relevant co-morbidity, and not in younger patients with HF only. After including medications and N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin concentrations into the model, the prognostic impact of BMI was largely absent even in the elderly group with co-morbidity.

Conclusions

The present study suggests that obesity is a marker of less advanced disease, but does not have an independent protective effect in patients with chronic HF.

Graphic abstract

Categories of BMI are only predictive of poor outcome in patients aged > 75 years or with at least one co-morbidity (bottom), but not in those aged < 75 years without co-morbidities (top). The prognostic effect largely disappears in multivariable analyses even for the former group. These findings question the protective effect of obesity in chronic heart failure (HF).

Supplementary Information

The online version contains supplementary material available at 10.1007/s00392-021-01822-1.

Impact of Cardiorespiratory Fitness on the Obesity Paradox in Heart Failure with Reduced Ejection Fraction

Fundamento:

Índice de massa corporal (IMC) elevado tem sido associado a desfechos melhores em pacientes com insuficiência cardíaca com fração de ejeção reduzida. Este achado tem levado ao conceito do paradoxo da obesidade.

Objetivo:

Investigar o impacto de tolerância ao exercício e capacidade cardiorrespiratória no paradoxo da obesidade.

Método:

Pacientes ambulatoriais com insuficiência cardíaca sintomática e fração de ejeção ventricular esquerda (FEVE) ≤ 40%, acompanhados no nosso centro, foram prospectivamente submetidos à avaliação abrangente de linha de base incluindo parâmetros clínicos, laboratoriais, eletrocardiográficos, ecocardiográficos e de exercício cardiopulmonar. A população do estudo foi dividida de acordo com o IMC (< 25, 25 – 29,9 e ≥ 30 kg/m²). Todos os pacientes foram acompanhados durante 60 meses. O desfecho composto foi definido como morte cardíaca, transplante cardíaco urgente ou necessidade de suporte circulatório mecânico. Valores de p < 0,05 foram considerados significativos.

Resultados:

Dos 282 pacientes incluídos (75% masculino, 54 ± 12 anos, IMC 27 ± 4 kg/m², FEVE 27% ± 7%), o desfecho composto ocorreu em 24,4% durante o acompanhamento. Os pacientes com IMC elevado eram mais velhos e apresentavam FEVE e níveis séricos de sódio mais elevados, bem como menor inclinação de eficiência ventilatória (VE/VCO₂). VE/VCO₂ e consumo de oxigênio de pico (VO₂p) eram fortes preditores prognósticos (p < 0,001). Na análise univariada de regressão de Cox, o IMC elevado foi associado a desfechos melhores (razão de risco 0,940, intervalo de confiança 0,886 – 0,998, p 0,042). Porém, após ajustar para ou inclinação VE/VCO₂ ou VO₂p, o papel protetor do IMC sumiu. O benefício de sobrevida do IMC não foi evidente quando os pacientes foram agrupados de acordo com a classe de aptidão cardiorrespiratória (VE/VCO₂, valor de corte de 35, e VO₂p, valor de corte de 14 mL/kg/min).

Conclusão:

Estes resultados sugerem que a aptidão cardiorrespiratória supera a relação entre o IMC e a sobrevida em pacientes com insuficiência cardíaca.

Does the Energy Restriction Intermittent Fasting Diet Alleviate Metabolic Syndrome Biomarkers? A Randomized Controlled Trial

The aim of this study was to determine the efficacy of an energy restriction intermittent fasting diet in metabolic biomarkers and weight management among adults with metabolic syndrome. This randomized controlled study was performed with metabolic syndrome patients, aged 18–65 years, at an academic institution in Istanbul, Turkey (n = 70). All participants were randomized to the Intermittent Energy Restriction (IER) intervention group and Continuous Energy Restriction (CER) control group. Biochemical tests including lipid profile, fasting plasma glucose, insulin, glycosylated hemoglobin Type A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), blood pressure, and body composition were evaluated at baseline and at the 12th week in diet interviews. Dietary intake was measured with the 24-h dietary recall method and dietary quality was evaluated with the Healthy Eating Index-2010. Changes in body weight (≈7% weight loss) and composition were similar in both groups. Blood pressure, total cholesterol, triglyceride, low-density lipoprotein (LDL), fasting glucose, and insulin at the 12th week decreased in both groups (p < 0.05). No significant differences were observed in metabolic syndrome biomarkers between the IER and CER groups. The energy-restricted intermittent fasting diet did not cause any deficiencies in macronutrient and fiber intake in the subjects. Healthy Eating Index (HEI) index scores were achieved similarly in both groups, and subjects’ dietary intakes were close to daily reference nutritional intake values. The technique used to achieve energy restriction, whether intermittent or continuous, appears to alleviate the metabolic syndrome biomarkers activated by weight loss.

Estimating fat mass in heart failure patients

Introduction

Body composition (BC) assessments in heart failure (HF) patients are mainly based on body weight, body mass index and waist-to-hip ratio. The present study compares BC assessments by basic anthropometry, dual energy X-ray absorptiometry (DXA), bioelectrical impedance spectroscopy (BIS), and air displacement plethysmography (ADP) for the estimation of fat (FM) and fat-free mass (FFM) in a HF population.

Material and methods

In this single-centre, observational pilot study we enrolled 52 patients with HF (33 HF with reduced ejection fraction (HFrEF), 19 HF with preserved ejection fraction (HFpEF); mean age was 67.7 ±9.9 years, 41 male) and 20 healthy controls. DXA was used as a reference standard for the measurement of FM and FFM.

Results

In the HF population, linear regression for DXA-FM and waist-to-hip ratio (r = –0.05, 95% CI: (–0.32)–0.23), body mass index (r = 0.47, 95% CI: 0.23–0.669), and body density (r = –0.87, 95% CI: (–0.93)–(–0.87)) was obtained. In HF, Lin’s concordance correlation coefficient of DXA-FM (%) with ADP-FM (%) was 0.76 (95% CI: 0.64–0.85) and DXA-FFM [kg] with DXA-ADP [kg] was 0.93 (95% CI: 0.88–0.96). DXA-FM (%) for BIS-FM (%) was 0.69 (95% CI: 0.54–0.80) and 0.73 (95% CI: 0.60–0.82) for DXA-FFM [kg] and BIS-FFM [kg].

Conclusions

Body density is a useful surrogate for FM. ADP was found suitable for estimating FM (%) and FFM [kg] in HF patients. BIS showed acceptable results for the estimation of FM (%) in HFrEF and for FFM [kg] in HFpEF patients. We encourage selecting a suitable method for BC assessment according to the compartment of interest in the HF population.

The Obesity Paradox in Kidney Disease: How to Reconcile it with Obesity Management

Obesity, a risk factor for de novo chronic kidney disease (CKD), confers survival advantages in advanced CKD. This so-called obesity paradox is the archetype of the reverse epidemiology of cardiovascular risks, in addition to the lipid, blood pressure, adiponectin, homocysteine, and uric acid paradoxes. These paradoxical phenomena are in sharp contradistinction to the known epidemiology of cardiovascular risks in the general population. In addition to advanced CKD, the obesity paradox has also been observed in heart failure, chronic obstructive lung disease, liver cirrhosis, and metastatic cancer, as well as in the elderly. These are populations in whom protein-energy wasting and inflammation are strong predictors of early death. Both larger muscle mass and higher body fat provide longevity in these patients, whereas thinner body habitus and weight loss are associated with higher mortality. Muscle mass appears to be superior to body fat in conferring an even greater survival. The obesity paradox may be the result of a time discrepancy between competing risk factors, i.e., overnutrition as the long-term killer versus undernutrition as the short-term killer. Hemodynamic stability of obesity, lipoprotein defense against circulating endotoxins, protective cytokine profiles, toxin sequestration of fat mass, and antioxidation of muscle may play important roles. Despite claims that obesity paradox is a statistical fallacy and a result of residual confounding, the consistency of data and other causality clues suggest a high biologic plausibility. Examining the causes and consequences of the obesity paradox may help discover important pathophysiologic mechanisms leading to improved outcomes in patients with CKD.

Obesity paradox in heart failure: a heavy matter

Obesity and heart failure are two of the leading causes of morbidity and mortality in the world. The relationship between obesity and cardiovascular diseases is complex and not fully understood. While the risk of developing heart failure has been shown to be higher in patients who are obese, there is a survival advantage for obese and overweight patients compared with normal weight or low weight patients. This phenomenon was first described by Horwich et al. and was subsequently confirmed in other large trials. The advantage exists irrespective of the type, aetiology, or stage of heart failure. Patients with morbid obesity (body mass index >40 kg/m²), however, do not have the same survival advantage of their obese counterparts. There are several alternative indices of obesity available that may be more accurate than body mass index. The role of weight loss in patients with heart failure is unclear; thus, providing sound clinical advice to patients remains difficult. Future prospective trials designed to evaluate the link between obesity and heart failure will help us understand more fully this complex relationship.

The paradox of obesity cardiomyopathy and the potential for weight loss as a therapy

Obesity is an independent risk factor for developing heart failure and the combination of the two disease states will prove to be a significant health burden over the coming years. Obesity is likely to contribute to the development of heart failure through a variety of mechanisms, including structural and functional changes, lipotoxicity and steatosis and altered substrate selection. However, once heart failure has developed, it seems that obesity confers a beneficial influence on prognosis in what has been termed the 'obesity paradox'. This may be a statistical phenomenon, but it should be considered that there is truly a protective state in the physiology of obesity. There is little evidence regarding the impact of weight loss in obese heart failure and whether or not this is beneficial. There have been small studies regarding the cardiovascular effects of both dietary weight loss and bariatric surgery, but few in heart failure. This is an important and increasingly relevant clinical question which must be addressed.

Assessment of obesity in chronic kidney disease: what is the best measure?

PURPOSE OF REVIEW

Obesity is a major driver of the current epidemic of chronic kidney disease (CKD), but metrics of obesity in the CKD population have been studied sparsely. This review updates knowledge on this issue.

RECENT FINDINGS

Measures of abdominal obesity, waist circumference and waist-to-hip ratio (WHR), are better predictors than BMI of the high risk of mortality in predialysis and dialysis patients and waist circumference reliably reflects visceral fat in CKD patients. Skinfold thickness and WHR are superior to BMI for the classification of obesity in CKD patients. Multifrequency body impedance analysis (BIA) provides valid estimates of fat mass in hemodialysis patients.

SUMMARY

Skinfold thickness,WHR and multifrequency BIA are superior to BMI for measuring body fat in CKD patients and measures of abdominal obesity are stronger predictors of adverse clinical outcomes than the BMI. These metrics should be preferentially applied for the assessment of obesity in CKD, but it remains unproven that these techniques offer real advantages over the BMI in clinical practice in CKD patients.

Research on cachexia, sarcopenia and skeletal muscle in cardiology

BACKGROUND

The awareness of cardiac cachexia, i.e. involuntary weight loss in patients with underlying cardiovascular disease, has increased over the last two decades.

METHODS AND RESULTS

This mini-review looks at recent research in the cardiovascular literature that is relevant to the areas of interest of the Journal of Cachexia, Sarcopenia and Muscle. It identifies significant research in the last 3 years on the obesity paradox, the causes and effects of skeletal muscle wasting, animal models of cachexia and emerging treatment ideas in cardiac cachexia.

CONCLUSIONS

Assuming a similar literature in the fields of cancer, chronic obstructive pulmonary disease, chronic renal failure and chronic liver failure, the emergence of cachexia as a vibrant area of clinical and experimental research seems assured.

Effect of bioimpedance body composition analysis on function of implanted cardiac devices

BACKGROUND

It is routinely recommended that patients with pacemakers, implantable cardioverter defibrillators (ICD), and cardiac resynchronization therapy-defibrillators (CRT-D) avoid bioelectrical impedance analysis (BIA)--a commonly used method to estimate body composition--because of the concern for the potential for BIA interference with pacemaker or ICD function. However, the prevalence of such interference is not known.

OBJECTIVE

Assess for incidence of interference between BIA and ICD or CRT-D devices.

METHODS AND RESULTS

Twenty patients with heart failure and cardiac implanted electronic devices (50% ICD, 50% CRT-D) underwent BIA during real-time device interrogation to detect interference. Study patients were 90% male, with mean age 54 ± 14 years, and mean LVEF 23 ± 11%. Devices from all four leading cardiac device manufacturers were included. Device therapies were temporarily disabled to prevent inappropriate shocks. During body composition testing using BIA, no evidence of interference with ICD function was seen in any patient, including no telemetry disruption, no oversensing on any lead, and no patient symptoms.

CONCLUSIONS

Despite the manufacturers' recommendation to avoid BIA in patients with ICDs, this study showed no evidence of any interference in 20 patients. Bioimpedance analysis might be safe in such patients, but further confirmatory studies are required.

Obesity, body composition, and prostate cancer

Background

Established risk factors for prostate cancer have not translated to effective prevention or adjuvant care strategies. Several epidemiologic studies suggest greater body adiposity may be a modifiable risk factor for high-grade (Gleason 7, Gleason 8-10) prostate cancer and prostate cancer mortality. However, BMI only approximates body adiposity, and may be confounded by centralized fat deposition or lean body mass in older men. Our objective was to use bioelectric impedance analysis (BIA) to measure body composition and determine the association between prostate cancer and total body fat mass (FM) fat-free mass (FFM), and percent body fat (%BF), and which body composition measure mediated the association between BMI or waist circumference (WC) with prostate cancer.

Methods

The study used a multi-centered recruitment protocol targeting men scheduled for prostate biopsy. Men without prostate cancer at biopsy served as controls (n = 1057). Prostate cancer cases were classified as having Gleason 6 (n = 402), Gleason 7 (n = 272), or Gleason 8-10 (n = 135) cancer. BIA and body size measures were ascertained by trained staff prior to diagnosis, and clinical and comorbidity status were determined by chart review. Analyses utilized multivariable linear and logistic regression.

Results

Body size and composition measures were not significantly associated with low-grade (Gleason 6) prostate cancer. In contrast, BMI, WC, FM, and FFM were associated with an increased risk of Gleason 7 and Gleason 8-10 prostate cancer. Furthermore, BMI and WC were no longer associated with Gleason 8-10 (OR_BMI = 1.039 (1.000, 1.081), OR_WC = 1.016 (0.999, 1.033), continuous scales) with control for total body FFM (OR_BMI = 0.998 (0.946, 1.052), OR_WC = 0.995 (0.974, 1.017)). Furthermore, increasing FFM remained significantly associated with Gleason 7 (OR_FFM = 1.030 (1.008, 1.052)) and Gleason 8-10 (OR_FFM = 1.044 (1.014, 1.074)) after controlling for FM.

Conclusions

Our results suggest that associations between BMI and WC with high-grade prostate cancer are mediated through the measurement of total body FFM. It is unlikely that FFM causes prostate cancer, but instead provides a marker of testosterone or IGF1 activities involved with retaining lean mass as men age.

Cachexia and sarcopenia: emerging syndromes of importance in dogs and cats

Cachexia is the loss of lean body mass (LBM) that affects a large proportion of dogs and cats with congestive heart failure (CHF), chronic kidney disease (CKD), cancer, and a variety of other chronic diseases. Sarcopenia, the loss of LBM that occurs with aging, is a related syndrome, although sarcopenia occurs in the absence of disease. As many of the diseases associated with muscle loss are more common in aging, cachexia and sarcopenia often are concurrent problems. Both cachexia and sarcopenia have important clinical implications because they are associated with increased morbidity and mortality. The pathophysiology of these 2 syndromes is complex and multifactorial, but recent studies have provided new information that has helped to clarify mechanisms and identify potential new targets for treatment. Newly identified mechanisms and pathways that mediate cachexia appear to act by increasing energy requirements, decreasing energy intake, impairing nutrient absorption, and causing metabolic alterations. Whereas cachexia and sarcopenia are important areas of research for drug development in people, they are only beginning to be recognized in veterinary medicine. Greater awareness and earlier diagnosis will help provide practical approaches to managing body weight and lean tissue in dogs and cats, as well as more directed targets for treatment.

Methods for nurses to measure body composition

Among the methods available for assessing body composition, traditional methods like hydrodensitometry and skin-fold measurements are well known. In this review, we focus on the impedance and interactance methods, which use systems that are usually inexpensive, easily transportable and simple to operate. We also discuss the usefulness of dual energy X-ray absorptiometry, particularly for the measurement of fat distribution. Nurses need to be skilled in the use of the equipment and familiar with the techniques.

Do anthropometric indices accurately reflect directly measured body composition in men and women with chronic heart failure?

How well anthropometric indices such as body mass index (BMI), waist circumference, waist-stature ratio, and waist index correlate with direct measures of body composition (lean body mass, body fat) in men and women with chronic heart failure (CHF) has not been reported. Body composition was assessed by dual-energy x-ray absorptiometry in 140 patients with CHF. Age-adjusted Pearson correlations between each index and measures of body composition for men and women were calculated. Diagnostic accuracy of detecting obesity or high central fat was also examined. In men, all of the anthropometric indices except waist index were just as strongly correlated with lean body mass (correlation coefficients varied between 0.56 for waist-stature ratio to 0.74 for BMI) as with percentage of body fat (correlation coefficients varied between 0.72 for BMI to 0.79 for waist circumference). In women, all 4 anthropometric measures were unable to significantly differentiate between body fat and lean body mass. The positive likelihood ratios for the detection of obesity varied between 2.26 for waist circumference and 3.42 for BMI, waist-stature ratio, and waist index. Anthropometric indices do not accurately reflect body composition in patients with CHF, especially in women. When accurate assessment of body composition is required, direct measurements should be obtained.