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Obesity Paradox in Amputation Risk Among Nonelderly Diabetic Men
Author(s) -
Sohn MinWoong,
BudimanMak Elly,
Oh Elissa H.,
Park Michael S.,
Stuck Rodney M.,
Stone Neil J.,
Pearce William B.
Publication year - 2012
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1038/oby.2011.301
Subject(s) - amputation , medicine , overweight , hazard ratio , obesity , obesity paradox , body mass index , confidence interval , physical therapy , surgery
The association between BMI and amputation risk is not currently well known. We used data for a cohort of diabetic patients treated in the US Department of Veterans Affairs Healthcare System in 2003. Men aged <65 years at the end of follow‐up were examined for their amputation risk and amputation‐free survival during the next 5 years (2004–2008). Compared to overweight individuals (BMI 25–29.9 kg/m 2 ), the risks of amputation and treatment failure (amputation or death) were higher for patients with BMI <25 kg/m 2 and were lower for those with BMI ≥30 kg/m 2 . Individuals with BMI ≥40 kg/m 2 were only half as likely to experience any (hazard ratios (HR) = 0.49; 95% confidence interval (CI), 0.30–0.80) and major amputations (HR = 0.53; 95% CI, 0.39–0.73) during follow‐up as overweight individuals. While the amputation risk continued to decrease for higher BMI, amputation‐free survival showed a slight upturn at BMI >40 kg/m 2 . The association between obesity and amputation risk in our data shows a pattern consistent with “obesity paradox” observed in many health conditions. More research is needed to better understand pathophysiological mechanisms that may explain the paradoxical association between obesity and lower‐extremity amputation (LEA) risk.