IJCS | Volume 31, Nº3, May/ June 2018

232 1. Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV, Ventura HO. Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Fail. 2013;1(2):93-102. doi: 10.1016/j. jchf.2013.01.006. 2. The IDF consensus worldwide definition of metabolic syndrome. International Diabetes Federation, 2006 [Acesso em 2015 maio 10]. Disponível em: http://www.idf.org. 3. Tankó LB, Bagger YZ, Alexandersen P, Larsen PJ, Claus Christiansen C. Central and peripheral fat mass have contrasting effect on the progression of aortic calcification in postmenopausal women. Eur Heart J. 2003;24(16):1531-7. PMID: 12919778. 4. Gupta PP, Fonarow GC, Horwich TB. Obesity and the obesity paradox in heartfailure.CanJCardiol.2015;31(2):195-202.doi:10.1016/j.cjca.2014.08.004. 5. Lavie CJ, Milani RV, Ventura HO, Romero-Corral A. Body composition and heart failure prevalence and prognosis: getting to the fat of the matter in the “obesity paradox”. Mayo Clin Proc. 2010;85(7):605-8. doi: 10.4065/mcp.2010.0333. 6. Rezende F, Rosado L, Franceschinni S, Rosado G, Ribeiro R, Marins JC. Revisão crítica dos métodos disponíveis para avaliar a composição corporal em grandes estudos populacionais e clínicos. Arch Latino Am Nutr. 2007;57(4):327-34. References Faria et al. Bod composition and heart failure International Journal of Cardiovascular Sciences. 2018;31(3)226-234 Original Article In the study by Tajeda et al., 36 a lower PA (4.32 o ) was associated with changes in glomerular filtration rate and cardiac troponin T levels. Martínez et al. 37 showed that a lower PA was associated with worsening of functional class (from III to IV), even after adjusting for age and sex, and that PA values were significantly lower in patients with preserved systolic function. Colín-Ramírez et al. 38 evaluated patients with systolic and diastolic HF and observed that those with volume overload and anemia had reduced PA values, and such reduction was associated with thyroid disorders in the study by Silva‑Tinoco et al. 39 In the present study, PA had a significant correlation with BMI and a marginal significant correlation with WHtR and LFEV. Therefore, the higher the BMI and WHtR, the higher the PA, indicating that excess weight and body fat could be a protective factor for HF patients, corroborating the results of previous studies on the obesity paradox. 1,4 Besides, the correlation between LVEF and PA supports the use of the latter as a prognostic indicator of HF. The main limitation of this study was the sample size, as a larger sample size could result in stronger correlations between the variables and yield more definite results. Conclusion In our study, most patients had excessive total and central body fat, and correlations of BMI and C-index withWC andWHtR, and of WHtRwithWCwere found. Besides, there was a trend of correlation of WHtR and LVEF with PA, and a correlation between PA and BMI. We thereby demonstrate a possible example of obesity paradox. Also, we highlight the need for further studies on the use of PA in HFREF, to establish PA cutoff points and enable their application as a prognostic parameter in this population. Author contributions Conception and design of the research: Faria TC, Giannini DT, Gasparini PVF, Rocha RM. Acquisition of data: Faria TC. Analysis and interpretation of the data: FariaTC, GianniniDT, Gasparini PVF, RochaRM. Statistical analysis: Giannini DT.Writing of themanuscript: Faria TC, Giannini DT, Gasparini PVF, Rocha RM. Critical revision of the manuscript for intellectual content: Giannini DT, Gasparini PVF, Rocha RM. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding The present study had no external sources of funding. Study Association This manuscript is part of the final course work of the residency programpresented to the Division of Nutrition, Pedro Ernesto University Hospital, in partial fulfillment of the requirements for the certificate in Residency in Clinical Nutrition by Tathiana Carestiato Faria. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Pesquisa da Universidade do Estado do Rio de Janeiro under the protocol number 47828915.3.0000.5259. All the procedures in this studywere in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study.