Division of Respirology and Critical Care, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Indonesian Medical Education and Research Institute, Faculty of Medicine University of Indonesia, Jakarta, Indonesia.
Eur Respir Rev. 2024 Nov 27;33(174). doi: 10.1183/16000617.0261-2023. Print 2024 Oct.
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.
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.
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 (relative risk 0.83, 95% CI 0.80-0.86), 30.25 kg·m (relative risk 0.51, 95% CI 0.40-0.65) and 27.5 kg·m (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.
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, 35 kg·m and 31 kg·m for all-cause, respiratory and cardiovascular mortality, respectively.
肥胖悖论是 COPD 患者中一个公认的临床难题。本研究旨在对该人群中体重指数（BMI）与死亡率之间的关系进行最新分析。
通过 Embase、PubMed 和 Web of Science 进行系统检索。采用国际 BMI 切点定义消瘦、超重和肥胖。主要结局是全因死亡率，次要结局是呼吸和心血管死亡率。
共纳入 120 项研究，总计 1053272 例患者。消瘦与死亡率增加相关，而超重和肥胖与死亡率降低相关。BMI 与全因死亡率、呼吸死亡率和心血管死亡率之间呈非线性 U 型关系。值得注意的是，在 BMI 为 28.75kg·m（相对风险 0.83，95%CI 0.80-0.86）、30.25kg·m（相对风险 0.51，95%CI 0.40-0.65）和 27.5kg·m（相对风险 0.76，95%CI 0.64-0.91）时，全因、呼吸和心血管死亡率分别出现拐点，超过该点后保护作用开始减弱。
本研究通过证实 COPD 患者 BMI 与死亡率之间呈 U 型关系，增加了现有证据。它强调了 BMI 对呼吸和心血管死亡率的影响高于全因死亡率。当 BMI 值分别超过全因、呼吸和心血管死亡率的 35.25kg·m、35kg·m 和 31kg·m 时，BMI 的保护作用丧失。
