Body Mass Index and Lymphedema Morbidity: Comparison of Obese versus Normal-Weight Patients
- 28 April 2020
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Plastic and Reconstructive Surgery
- Vol. 146 (2), 402-407
- https://doi.org/10.1097/prs.0000000000007021
Abstract
Background: Obesity is a risk factor for the development of secondary lymphedema after axillary lymphadenectomy and radiation therapy. The purpose of this study was to determine whether obesity influences the morbidity of lymphedema in patients who have the condition. Methods: Two cohorts of patients were compared: group 1, normal weight (body mass index ≤25 kg/m2); and group 2, obese (body mass index ≥30 kg/m2). Inclusion criteria were patients aged 21 years or older with lymphedema confirmed by lymphoscintigraphy. Covariates included age, sex, lymphedema type (primary or secondary), location, comorbidities, lymph node dissection, radiation therapy, lymphoscintigram result, and disease duration. Outcome variables were infection, hospitalization, and degree of limb overgrowth. The cohorts were compared using the Mann-Whitney U test, Fisher’s exact test, and multivariable logistic regression. Results: Sixty-seven patients were included: group 1, n = 33; and group 2, n = 34. Disease duration did not differ between groups (p = 0.72). Group 2 was more likely to have an infection (59 percent), hospitalization (47 percent), and moderate or severe overgrowth (79 percent), compared to group 1 (18, 6, and 40 percent, respectively; p < 0.001). Multivariable logistic regression showed that obesity was an independent risk factor for infection (OR, 7.9; 95 percent CI, 2.5 to 26.3; p < 0.001), hospitalization (OR, 30.0; 95 percent CI, 3.6 to 150.8; p < 0.001), and moderate to severe limb overgrowth (OR, 6.7; 95 percent CI, 2.1 to 23.0; p = 0.003). Conclusions: Obesity negatively affects patients with established lymphedema. Obese individuals are more likely to have infections, hospitalizations, and larger extremities compared to subjects with a normal body mass index. Patients with lymphedema should be counseled about the negative effects of obesity on their condition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.Keywords
This publication has 30 references indexed in Scilit:
- Diagnostic Accuracy of Lymphoscintigraphy for Lymphedema and Analysis of False-Negative TestsPlastic and Reconstructive Surgery - Global Open, 2017
- Massive Localized Lymphedema: A Case-Control StudyJournal of the American College of Surgeons, 2016
- Obesity-Induced LymphedemaPlastic and Reconstructive Surgery, 2015
- Lower-Extremity Lymphedema and Elevated Body-Mass IndexThe New England Journal of Medicine, 2012
- Body mass index and breast cancer treatment-related lymphedemaSupportive Care in Cancer, 2011
- Obesity is a Risk Factor for Developing Postoperative Lymphedema in Breast Cancer PatientsThe Breast Journal, 2010
- Hypercholesterolemic Mice Exhibit Lymphatic Vessel Dysfunction and DegenerationThe American Journal of Pathology, 2009
- Estimating the Population Burden of LymphedemaAnnals of the New York Academy of Sciences, 2008
- Lymphoedema: an underestimated health problemQJM: An International Journal of Medicine, 2003
- Arm edema in conservatively managed breast cancer: obesity is a major predictive factor.Radiology, 1991