Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Nov 27;33(174):230261.
doi: 10.1183/16000617.0261-2023. Print 2024 Oct.

The impact of body mass index on mortality in COPD: an updated dose-response meta-analysis

Eric Daniel Tenda  1   2   3 , Joshua Henrina  4   3 , Andry Setiadharma  4 , Immanuel Felix  5 , Mira Yulianti  4 , Ceva Wicaksono Pitoyo  4 , Sze Shyang Kho  6 , Melvin Chee Kiang Tay  7 , Dyah S Purnamasari  5 , Czeresna Heriawan Soejono  8 , Siti Setiati  8   9
Affiliations
Meta-Analysis

The impact of body mass index on mortality in COPD: an updated dose-response meta-analysis

Eric Daniel Tenda et al. Eur Respir Rev. .

Abstract

Background and objective: The obesity paradox is a well-established clinical conundrum in COPD patients. This study aimed to provide an updated analysis of the relationship between body mass index (BMI) and mortality in this population.

Methods: A systematic search was conducted through Embase, PubMed, and Web of Science. International BMI cut-offs were employed to define underweight, overweight and obesity. The primary outcome was all-cause mortality, and the secondary outcome was respiratory and cardiovascular mortality.

Results: 120 studies encompassed a total of 1 053 272 patients. Underweight status was associated with an increased risk of mortality, while overweight and obesity were linked to a reduced risk of mortality. A nonlinear U-shaped relationship was observed between BMI and all-cause mortality, respiratory mortality and cardiovascular mortality. Notably, an inflection point was identified at BMI 28.75 kg·m-2 (relative risk 0.83, 95% CI 0.80-0.86), 30.25 kg·m-2 (relative risk 0.51, 95% CI 0.40-0.65) and 27.5 kg·m-2 (relative risk 0.76, 95% CI 0.64-0.91) for all-cause, respiratory and cardiovascular mortality, respectively, and beyond which the protective effect began to diminish.

Conclusion: This study augments the existing body of evidence by confirming a U-shaped relationship between BMI and mortality in COPD patients. It underscores the heightened influence of BMI on respiratory and cardiovascular mortality compared to all-cause mortality. The protective effect of BMI was lost when BMI values exceeded 35.25 kg·m-2, 35 kg·m-2 and 31 kg·m-2 for all-cause, respiratory and cardiovascular mortality, respectively.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: All authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis [14] flow diagram depicting the study's selection process. PECO: population, exposure, comparison and outcomes.
FIGURE 2
FIGURE 2
Summary of risk of bias analysis using the Quality in Prognosis Studies signalling tool.
FIGURE 3
FIGURE 3
Summary of meta-analysis between the underweight body mass index (BMI) category versus normal BMI as reference. AECOPD: acute exacerbation of COPD; DL: DerSimonian and Laird
FIGURE 4
FIGURE 4
Summary of meta-analysis between the overweight body mass index (BMI) category versus normal BMI as reference. AECOPD: acute exacerbation of COPD; DL: DerSimonian and Laird.
FIGURE 5
FIGURE 5
Summary of meta-analysis between the obese body mass index (BMI) category versus normal BMI as reference. AECOPD: acute exacerbation of COPD; DL: DerSimonian and Laird.
FIGURE 6
FIGURE 6
Summary of meta-analysis per 1 kg·m−2 increment in body mass index. DL: DerSimonian and Laird.
FIGURE 7
FIGURE 7
Dose–response meta-analysis between body mass index (BMI) and mortality. a) All-cause mortality, b) respiratory mortality, c) cardiovascular mortality.
See this image and copyright information in PMC

References

    1. Celli BR, Wedzicha JA. Update on clinical aspects of chronic obstructive pulmonary disease. N Engl J Med 2019; 381: 1257–1266. doi:10.1056/NEJMra1900500 - DOI - PubMed
    1. Hashemi SY, Momenabadi V, Faramarzi A, et al. . Trends in burden of chronic obstructive pulmonary disease in Iran, 1995–2015: findings from the Global Burden of Disease study. Arch Public Health 2020; 78: 45. doi:10.1186/s13690-020-00426-x - DOI - PMC - PubMed
    1. Moberg M, Vestbo J, Martinez G, et al. . Validation of the i-BODE index as a predictor of hospitalization and mortality in patients with COPD participating in pulmonary rehabilitation. COPD 2014; 11: 381–387. doi:10.3109/15412555.2013.836171 - DOI - PubMed
    1. Iyer AS, Dransfield MT. The “obesity paradox” in chronic obstructive pulmonary disease: can it be resolved? Ann Am Thorac Soc 2018; 15: 158–159. doi:10.1513/AnnalsATS.201711-901ED - DOI - PMC - PubMed
    1. Guo Y, Zhang T, Wang Z, et al. . Body mass index and mortality in chronic obstructive pulmonary disease: a dose–response meta-analysis. Medicine 2016; 95: e4225. doi:10.1097/MD.0000000000004225 - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources