Xu Feng, Feng Yongwen, Li Jibo, Liu Xinlong, Liang Haoda, Tan Zhongsheng, Jiang Pan
Department of Intensive Care Unit, Shenzhen Guangming District People's Hospital, Shenzhen, Guangdong, China.
Department of Stomatology, Shenzhen Guangming District People's Hospital, Shenzhen, Guangdong, China.
NPJ Prim Care Respir Med. 2025 Apr 26;35(1):25. doi: 10.1038/s41533-025-00431-z.
Chronic respiratory diseases (CRD) are major contributors to mortality. The "obesity paradox" suggests that higher body mass index (BMI) may confer survival benefits in CRD patients. This study investigates the association between BMI and mortality risk in CRD patients, focusing on the mediating role of the triglyceride-glucose (TyG) index. A cross-sectional analysis of 7689 participants with CRD was conducted. Participants were categorized by BMI into <25.0, 25.0-29.9, 30.0-34.9, 35.0-39.9, and ≥40 kg/m. Outcomes included all-cause mortality, cardiovascular disease (CVD) mortality, and non-CVD mortality. Cox regression models assessed associations, and mediation analysis evaluated the role of the TyG index. Among 7689 CRD patients, higher BMI was associated with lower all-cause mortality (HR for BMI 25.0-29.9: 0.81, 95% CI 0.70-0.94; HR for BMI 30.0-34.9: 0.72, 95% CI 0.61-0.85; HR for BMI 35.0-39.9: 0.72, 95% CI 0.59-0.88; HR for BMI ≥ 40: 0.82, 95% CI 0.66-1.02) and non-CVD mortality (HR for BMI 25.0-29.9: 0.77, 95% CI 0.65-0.91; HR for BMI 30.0-34.9: 0.65, 95% CI 0.54-0.79; HR for BMI 35.0-39.9: 0.66, 95% CI 0.52-0.83; HR for BMI ≥ 40: 0.69, 95% CI 0.53-0.89), but not CVD mortality. The TyG index mediated a significant proportion of the association between BMI and mortality (mediation effects: -22.39 to -18.49%). Kaplan-Meier survival curves and restricted cubic spline regression further illustrated the significant associations between BMI and all-cause mortality and non-CVD mortality, while no significant association was observed for CVD mortality. Higher BMI is associated with lower mortality risk in CRD patients, particularly for non-CVD causes, mediated by the TyG index. This highlights the potential role of insulin resistance in the "obesity paradox" and suggests that metabolic health interventions may improve outcomes in CRD.
慢性呼吸道疾病（CRD）是导致死亡的主要原因。“肥胖悖论”表明，较高的体重指数（BMI）可能对CRD患者的生存有益。本研究调查了CRD患者中BMI与死亡风险之间的关联，重点关注甘油三酯-葡萄糖（TyG）指数的中介作用。对7689名CRD参与者进行了横断面分析。参与者按BMI分为<25.0、25.0-29.9、30.0-34.9、35.0-39.9和≥40 kg/m²。结局包括全因死亡率、心血管疾病（CVD）死亡率和非CVD死亡率。Cox回归模型评估关联，中介分析评估TyG指数的作用。在7689名CRD患者中，较高的BMI与较低的全因死亡率（BMI 25.0-29.9的HR：0.81，95%CI 0.70-0.94；BMI 30.0-34.9的HR：0.72，95%CI 0.61-0.85；BMI 35.0-39.9的HR：0.72，95%CI 0.59-0.88；BMI≥40的HR：0.82，95%CI 0.66-1.02）和非CVD死亡率（BMI 25.0-29.9的HR：0.77，95%CI 0.65-0.91；BMI 30.0-34.9的HR：0.65，95%CI 0.54-0.79；BMI 35.0-39.9的HR：0.66，95%CI 0.52-0.83；BMI≥40的HR：0.69，95%CI 0.53-0.89）相关，但与CVD死亡率无关。TyG指数介导了BMI与死亡率之间相当比例的关联（中介效应：-22.39%至-18.49%）。Kaplan-Meier生存曲线和受限立方样条回归进一步说明了BMI与全因死亡率和非CVD死亡率之间的显著关联，而未观察到BMI与CVD死亡率之间的显著关联。较高的BMI与CRD患者较低的死亡风险相关，尤其是对于非CVD原因，由TyG指数介导。这突出了胰岛素抵抗在“肥胖悖论”中的潜在作用，并表明代谢健康干预可能改善CRD的结局。
