Phookan S, et al. – This analysis ascertained if body mass index (BMI) and access to fresh food exerted an impact on the heart failure outcomes. A correlation was disclosed between residing in a food desert with higher rates of obesity in the study cohort. Nevertheless, an obesity paradox existed for heart failure in food deserts. This was attributed to obese patients reporting fewer 30–day readmissions than non–obese patients. The heart failure patients with normal BMI exhibited the strongest link with 30–day readmissions. An advanced research was warranted in a larger cohort, with a broader geography.

Methods

• The enrollment consisted of patients admitted to a university hospital between 01/01/13 and 12/31/13 with a primary diagnosis of heart failure.
• Relevant data was extracted through a chart review.
• With the aid of patient zip codes in the USDA Food Access Research Atlas, patients who resided in areas with low access to fresh food or food deserts were identified.
• Low-access areas were defined as regions where ≥ 33% of the population live > 1 mile (in urban areas) or > 10 miles (in rural areas) from a supermarket.
• Food deserts reported additional stipulation of areas where median income was ≤ 80% of statewide median.
• The World Health Organization definitions of obesity classified the patients as obese (BMI ≥ 30) or non-obese (BMI < 29.9) and also further stratified as underweight (BMI < 18.5), normal (BMI 18.5-24.9), overweight (BMI 25-29.9) obesity class I (BMI 30-34.9), obesity class II (BMI 35-39.9), or obesity class III (BMI ≥ 40).
• The regression analysis compared 30-day readmission, in-hospital mortality, and length of stay for obese or non-obese heart failure patients on the basis of their access to fresh food.

Results

• 2063 patient encounters were noted (54.5% male, 43.7% African American, 47.2% heart failure with reduced ejection fraction, 39.9% obese) of which 1039 resided in adequate fresh food access areas.
• 1024 patients combined lived in low access or food desert areas with similar demographics within each group.
• Obesity displayed a link with living in a food desert (RR 1.26, P = .036).
• Living in a food desert correlated with a higher 30-day readmission rate for non-obese patients compared to obese patients (RR 1.96 vs. 0.51, P = .032).
• When stratified, patients of normal BMI patients reported higher rates of 30-day readmissions in low access areas (RR 1.50, P = .032) and food deserts (RR 2.30, P = .005).
• A trend was observed towards fewer readmissions with increasing obesity class but it was not statistically notable.
• There was no link between underweight or overweight patients and readmissions.
• No variation was seen in the in-patient mortality or length of stay between obese and non-obese patients irrespective of food access.