What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (n=631). Intervention: Malnutrition combined with obesity (CONUT score ≥ 2 and BMI ≥ 25 kg/m2) vs. Non-malnourished, obese patients (CONUT score 0-1 and BMI ≥ 25 kg/m2). Primary outcome: Composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, heart-failure hospitalization, major bleeding, stroke, and venous thromboembolism (HR 2.25, 95% CI 1.01-5.00, p=0.047).

What question did this study set out to answer?

This research aims to clarify the prognostic role of nutritional status in obese cardiovascular patients, particularly concerning the obesity paradox.

April 1, 2026Open Access

Unmasking Risk Behind the Obesity-Paradox Signal: Prognostic Value of CONUT Score Combined with BMI

Key Result

Malnutrition combined with obesity significantly increased the risk of composite adverse events by 2.25-fold compared to non-malnourished obese patients undergoing percutaneous coronary intervention.

Key Points

This research aims to clarify the prognostic role of nutritional status in obese cardiovascular patients, particularly concerning the obesity paradox.
Evaluated the relationship between CONUT score and BMI in patients undergoing percutaneous coronary intervention (PCI).
Assessed outcomes related to nutritional status and obesity in a cardiovascular context.
Combining CONUT score with BMI improves interpretation of the obesity paradox in cardiovascular patients.
Indicates that poor nutritional status may affect outcomes even in obese individuals.

Study Design

Type

Observational (n=631)

Multicenter

Yes

Structured PICO

Does combining the CONUT score with BMI refine the prognostic interpretation of the obesity paradox in patients undergoing PCI?

Population

631 patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI)

Intervention

Stratification by nutritional status (CONUT score ≥ 2) and obesity (BMI ≥ 25 kg/m2)

Comparator

Non-malnourished, obese patients (CONUT score 0-1 and BMI ≥ 25 kg/m2)

Outcome

Composite of adverse clinical events (all-cause death, non-fatal myocardial infarction, stent thrombosis, hospitalization for heart failure, BARC type 3 or 5 bleeding events, stroke, and venous thromboembolism)composite

Main Result

Effect estimate: HR 2.25 (95% CI 1.01-5.00)

Absolute Event Rate: 25.5% vs 6.5%

p-value: p=0.047

Limitations

Observational design conducted in a single country limits generalizability to other settings and populations.
BMI and CONUT were measured only at admission, failing to capture temporal changes during hospitalization or follow-up.
Lack of direct body composition assessments precluded a definitive diagnosis of sarcopenic obesity.
Limited assessment of inflammation (only total leukocyte count available) and potential unmeasured confounding.
Exclusion of patients with missing nutritional or BMI data may have introduced selection bias.

Abstract

The "obesity paradox" suggests better outcomes in overweight cardiovascular patients, yet the prognostic role of poor nutritional status-even in obese individuals-remains unclear. We evaluated whether combining body mass index (BMI) with the Controlling Nutritional Status (CONUT) score refines interpretation of the obesity-paradox signal in patients undergoing percutaneous coronary intervention (PCI).

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Cite This Study

Sumida et al. (Mon,) conducted a observational in Coronary artery disease (n=631). Malnutrition combined with obesity (CONUT score ≥ 2 and BMI ≥ 25 kg/m2) vs. Non-malnourished, obese patients (CONUT score 0-1 and BMI ≥ 25 kg/m2) was evaluated on Composite of all-cause death, non-fatal myocardial infarction, stent thrombosis, heart-failure hospitalization, major bleeding, stroke, and venous thromboembolism (HR 2.25, 95% CI 1.01-5.00, p=0.047). Malnutrition combined with obesity significantly increased the risk of composite adverse events by 2.25-fold compared to non-malnourished obese patients undergoing percutaneous coronary intervention.

synapsesocial.com/papers/69cd79bb5652765b073a694b https://doi.org/https://doi.org/10.1536/ihj.25-603