The impact of obesity on chronic oedema/lymphoedema of the leg – An international multicenter cross-sectional study (LIMPRINT)

Background: /Objectives: Obesity and chronic oedema/lymphoedema are two distinct but related conditions, rarely investigated together. The aim was to study the impact of increased weight on chronic oedema and related factors. Subjects/Methods: A cross-sectional study (2014-2017), in 38 centers, nine countries. Patients with clinically confirmed chronic oedema/lymphoedema of the leg were included. Normal weight was judged as BMI 20-30, obesity BMI 30-40 or morbidly obese BMI >40. Factors were tested for an association with increased weight, using a multivariable model. Results: : In total 7397 patients were included; 43% being normal weight, 36% obese and 21% morbidly obese. Patients with increased weight had significantly more advanced stages of chronic oedema (ISL stage III; the most advanced form); affecting 14% of normal weight, 18% in obesity and 39% in morbid obesity (p<0.001). Ten factors were independently associated with increased weight: diabetes (OR 2.4), secondary lymphoedema (OR 2.7), cellulitis/erysipelas within 12 months (OR 1.2), bilateral lymphoedema (OR 3.6), compression therapy (OR 2.1), increased swelling duration (1-2 years OR 1.3, 2-5 years OR 2.5, 5-10 years OR 3.6, >10 years OR 3.5) decreased mobility (walking with aid OR 1.9, being chair bound OR 1.2) and age (reference <45 years; 45-64 years OR 1.5, 75-84 years OR 0.6, 85+ years OR 0.2). Increased weight was associated with a lower presentation of peripheral arterial disease (OR 0.7) and poorer chronic oedema control (OR 0.8). Patients with obesity/morbid obesity had a lower function, appearance and more severe symptoms as assessed by LYMQOL and lower quality of life using EuroQol. Conclusions: : Obesity negatively impacts chronic oedema, leading to more advanced stages. Achieving good control of swelling with compression is more difficult in these patients. Increased awareness of chronic oedema/lymphoedema as a complication of obesity is important for early detection and for developing effective strategies to prevent and manage them.