背景：肥胖為導致缺血性心臟病'高血壓或動脈粥狀硬化等心衰竭前置因子’然研究顯示肥胖或體重過重之心衰 竭病人其疾病預後優於體重正常與體重過輕病人。此肥胖矛盾現象在東方人群體少有著墨，釐清此現象將 有助於心衰竭病人營養照護。
目的：比較不同身體質量指數(body mass index, BMI)心衰竭病人疾病預後（非預期就醫、住院與死亡）差異。
方法：此為前瞻性長期追蹤研究，測量125名心衰竭病人身高、體重與疾病相關資料後，持續追蹤12個月以瞭解疾 病預後。依BMI將心衰竭病人分為肥胖(30 - 45 kg/m2)、體重過重(25 - 29.9 kg/m2)與正常體重或體重過輕（17 -24.9 kg/m2)3組，並比較疾病預後差異。資料輸入SPSS後以Kaplan-Meier存活曲線檢視不同BMI心衰竭病 人疾病結果。
結果：Log-rank test結果顯示LVEF(left ventricular ejection fraction)小於40%(350.8 士 18.6 vs. 508.3 士 46.6 days, p = .001)，NYHA(New York Heart Association) III / IV class (326.6 士 23.2 vs. 496.6 士 42.4 days,p < .001)以及 正常/過輕體重心衰竭病人（371.3 士 18.8 days)，有較短存活時間及較高死亡風險，BMI整體達顯著差異 (p = .006, df = 2)，事後比較得知，正常/過輕體重組較體重過重組(p = .008)與肥胖組(p = .044)有較短存活時間。
結論/實務應用：本研究之個案，其正常與體重過輕的心衰竭病人疾病預後較差。此結果可作為此類個案在體重管 理衛教方面的另一思考觀點。

Background: Obesity is a risk factor for cardiovascular diseases and a confirmed cause of ischemic heart disease, hypertension, and atherosclerosis, all of which are predisposing factors of heart failure (HF). HF and various other chronic diseases can also induce systemic inflammation response syndrome. This inflammatory condition causes poor nutritional status, cachexia, and unfavorable disease prognoses. However, this obesity paradox has not been verified in Asian populations. Clarifying the effect of obesity on HF prognoses can help healthcare professionals improve HF patient nutritional care.
Purpose: The purpose of this study was to monitor and compare disparities in heart-related events (e.g., unscheduled medical visits, hospitalization, and death) over a 12-month period among an HF patient population with varying body masses.
Methods: This study adopted a prospective long-term follow-up research method. The 125 participants were symptomatic patients diagnosed with chronic heart failure (CHF) based on echocardiography results. Patient height, weight, and disease data were measured and monthly telephone interviews were conducted with each patient for 12 months in order to understand the nature of their inpatient and unscheduled outpatient visits. Patients were assigned into 3 body mass index (BMI) groups, including obese (30 to 45 kg/m2), overweight (25 to 29.9 kg/m2), and normal/underweight (17 to 24.9 kg/m2) groups. Prognosis results for the 3 groups were compared and data were entered into SPSS software. The Kaplan-Meier survival curve then examined participant disease outcomes.
Results: Possible predictors correlated to survival included age (65-year-old group), left ventricular ejection fraction (LVEF; 40% group), HF classifications announced by the New York Heart Association (NYHA Class III/IV vs. Class I/II), and BMI. Log-rank test results suggested that patients who had an LVEF lower than 40% (350.8 土
18.6 vs. 508.3 土 46.6 d, p = .001), were diagnosed with NYHA-based Class III/IV HF (326.6 土 23.2 vs. 496.6 土 42.4 days, p < .001), or had a BMI in the normal/underweight range (371.3 土 18.8 d) had a relatively shorter life expectancy and higher mortality risk. Results further indicated that, overall, BMI caused significant differences among group outcomes (p for log-rank test = .006 with 2 df). Post-hoc test results suggested that life expectancy for normal/underweight group participants was shorter than for overweight and obese group participants (p for normal/underweight vs. overweight = .008; p for normal/underweight vs. obese = .044).
Conclusion / Practical Implications: Disease prognoses for normal and underweight HF patients were unfavorable compared to those of overweight patients. In other words, hospitalizations and deaths of normal and underweight HF patients occurred earlier. This study recommends that clinical practitioners dismiss the stereotype that obesity only negatively impacts the cardiovascular system, as our results indicate that reducing or maintaining body mass may not benefit HF patient prognoses.