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. 2021 Jul 21:9:e11855.
doi: 10.7717/peerj.11855. eCollection 2021.

Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts

Menglu Liu #  1 , Kaibo Mei #  2 , Lixia Xie  3 , Jianyong Ma  4 , Peng Yu  5 , Siquan Niu  1 , Ya Xu  1 , Yujie Zhao  1 , Xiao Liu  6   7   8
Affiliations

Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts

Menglu Liu et al. PeerJ. .

Abstract

Background: Whether overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF.

Methods: The PubMed, Cochrane Library, and EMBASE databases were searched for revelant studies (randomized controlled trials (RCTs), cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF.

Results: Thirty-five publications involving 33,271 cases/141,442 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, 95% CI [1.21-1.61]; P < 0.001), but not being underweight (RR: 1.44, 95% CI [0.90-2.30]; P = 0.13) or being overweight (RR: 1.03, 95% CI [0.95-1.11]; P = 0.48) was associated with an increased risk of POAF. In the exposure-effect analysis (BMI) was 1.09 (95% CI [1.05-1.12]; P < 0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity = 0.44); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. Additionally, waist obesity or visceral adiposity index was associated with the risk of POAF.

Conclusion: Based on the current evidence, our findings showed that high body mass index or abdominal adiposity was independently associated with an increased risk of POAF, while underweight or overweight might not significantly increase the POAF risk.

Keywords: Atrial fibrillation; Body mass index; Meta-analysis; Risk factor.

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Conflict of interest statement

The authors declare there are no competing interests.

Figures

Figure 1
Figure 1. Overview of the research strategy.
RR, risk ratio.
Figure 2
Figure 2. Forest plot of the categorical analysis of the impact of body mass index on POAF.
POAF: postoperative atrial fibrillation after cardiac surgery.
Figure 3
Figure 3. Forest plot of the association between body mass index and POAF and exposure-effect analysis, per five units.
POAF: postoperative atrial fibrillation after cardiac surgery.
Figure 4
Figure 4. Nonlinear exposure-effect analysis of body mass index and POAF.
The solid and dashed lines represent the estimated relative risk and the 95% confidence interval, respectively. POAF: postoperative atrial fibrillation after cardiac surgery.
See this image and copyright information in PMC

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