Key result
Nutritional status impacts lower limb ischemia, with overweight and class I obesity associated with better endovascular and surgical treatment outcomes, suggesting an obesity paradox.
Why the study?
How does nutritional status affect the prevalence, course, and treatment outcomes of lower limb ischemia?
Systematic Review
How does nutritional status affect the prevalence, course, and treatment outcomes of lower limb ischemia?
This systematic review highlights an 'obesity paradox' in lower limb ischemia, where mild obesity and overweight status may be associated with better outcomes following invasive treatments compared to underweight or severely obese status.
Clinicians should not yet use nutritional status to guide LLI management; leaves open its prognostic role pending higher-quality data.
INTRODUCTION: The association of lower limb ischemia (LLI) with disturbances in nutritional status, in respect to over- or undernutrition, is still uncertain. The aim of this study was to present the current state of knowledge on this issue. EVIDENCE ACQUISITION: Systematic review of papers published between 2006 and 2018. EVIDENCE SYNTHESIS: The literature shows inconclusive evidence regarding the impact of nutritional status on the risk, course, prognosis and outcomes of conservative and invasive treatment of LLI. The majority of publications available demonstrate greater LLI prevalence in overweight and obese patients, a worse prognosis both in malnourished and severely obese patients, poorer outcomes of invasive treatment in underweight patients, and better results for endovascular and surgical treatment in patients with overweight and class I obesity, although without such a relationship for conservative therapy. Possible explanations linking nutritional status and LLI seem to be: the endocrine, paracrine, and autocrine activity of adipose tissue, a decrease in physical activity, and the effect of diet-dependent comorbidities, e.g. diabetes mellitus, hypertension and dyslipidemia. CONCLUSIONS: There is a growing body of evidence concerning an association between LLI and patients' nutritional status. A so-called "obesity paradox" or "BMI paradox" seems to exist among patients with LLI and mainly concerns outcomes of endovascular and surgical treatment. However, further studies are needed to evaluate the clinical importance of body composition, the distribution and endocrine activity of adipose tissue, and the effect of weight reduction and/or nutritional support in the LLI patient group.
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Spychalska-Zwolińska et al. (2018) conducted a systematic review in Lower limb ischemia (LLI). Nutritional status (over- or undernutrition) was evaluated on Prevalence, course, prognosis and outcomes of conservative and invasive treatment of LLI. Nutritional status impacts lower limb ischemia, with overweight and class I obesity associated with better endovascular and surgical treatment outcomes, suggesting an obesity paradox.
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