Response by Mariscalco and Murphy to Letters Regarding Article, “Body Mass Index and Mortality Among Adults Undergoing Cardiac Surgery: A Nationwide Study With a Systematic Review and Meta-Analysis”
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We fully agree with Shi and colleagues that body mass index (BMI) is a surrogate of the body fat composition. Other potential aspects of body composition such as visceral fat or fat distribution were not explored in our analysis.1 Waist circumference and waist-to-hip ratio, which are measures of visceral adiposity,2 are not recorded in the United Kingdom National Adult Cardiac Surgery Audit registry (version 4.1.2).3 To address this potential source of bias, we evaluated the interaction between elevated BMI and the metabolic syndrome on the primary outcome, mortality. This …