The Impact of Body Mass Index and Nutritional Status on Cardiac Electrophysiological Balance Using ICEB and ICEBc: A Cross-Sectional Approach

Background: The Index of Cardiac Electrophysiological Balance (ICEB) has emerged as a electrocardiographic marker reflecting the equilibrium between ventricular depolarization and repolarization. Although obesity is known to alter cardiac electrophysiology, the combined influence of body mass index (BMI) and objective nutritional status on ICEB and its heart rate-corrected form (ICEBc) remains insufficiently defined. This study aimed to investigate the associations between BMI categories, nutritional status, and cardiac electrophysiological balance. Methods: This cross-sectional study included 591 adult patients classified as normal-weight, overweight, or obese according to BMI. Electrophysiological assessment of ICEB (QT/QRS) and ICEBc (QTc/QRS) values was calculated from standard 12-lead electrocardiogram recordings. Participants’ nutritional status was analyzed using validated clinical indices such as the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Geriatric Nutritional Risk Index (GNRI) and Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score. Results: According to the results, both ICEB and ICEBc showed significant differences among BMI categories (p < 0.001). ICEB/ICEBc exhibited a non-linear distribution. The ICEB/ICEBc values were found to be minimum in the normal weight group at 4.22 ± 0.54/4.87 ± 0.66 and maximum in the obese group at 4.27 ± 0.51/4.99 ± 0.59. The ICEB/ICEBc value closest to the optimal physiological limits was found in the overweight group at 4.04 ± 0.53/4.59 ± 0.58. Higher ICEBc quartiles were accompanied by increased GNRI (120.9 ± 13.7, 129 ± 15.1, 130.5 ± 16.3, 131.8 ± 17.6, p < 0.001)and decreased HALP scores (59.7 ± 24.4, 56.1 ± 25.3, 55.2 ± 25.9, 51.1 ± 19.4, p: 0.025). Conclusion: The association between BMI and cardiac electrophysiological balance is non-linear and appears to be modulated by nutritional and inflammatory status. ICEBc may represent a more sensitive marker than ICEB for detecting subtle electrophysiological alterations related to obesity.