Impact of Body Mass Index on Risk of Exacerbation in Patients With COPD: A Systematic Review and Meta-Analysis

Overview

Journal Chronic Obstr Pulm Dis

Date 2024 Aug 30

PMID 39213382

Authors

Mei Wang

Xiaowei Ni

Fuan Yu

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this review is to synthesize current evidence of the association between body mass index (BMI) categories and the risk of exacerbation in patients with chronic obstructive pulmonary disease (COPD).

Methods: A systematic search was conducted across 3 electronic databases: PubMed, Embase, and Scopus. Eligible studies must have reported on the association between BMI (either as continuous or categorical) and risk of COPD exacerbation, as defined according to recognized clinical criteria. Observational studies (cohort, case-control, cross-sectional) were eligible for inclusion. The Newcastle Ottawa Scale (NOS) was used to evaluate the methodological quality. Combined effect sizes were reported as relative risk (RR) and corresponding 95% confidence intervals (CI).

Results: A total of 11 studies were included. Of them, 4 studies were prospective, 4 were retrospective cohorts in design, 2 were cross-sectional studies, and one study was a secondary data analysis from a randomized trial. Compared to patients with a normal BMI, underweight patients had an increased risk of COPD exacerbation (RR 1.90, 95% CI: 1.03, 3.48; N=7, I=94.2%). Overweight and obese BMI status was associated with a similar risk of exacerbation.

Conclusion: Our findings report that underweight, but not overweight or obese patients, have an increased risk of COPD exacerbation, compared to individuals with a normal BMI. This differential association emphasizes the need for nuanced investigations into the underlying mechanisms of the impact of BMI on the course of COPD. Further research is needed to inform personalized interventions and improve COPD management strategies.

Citing Articles

Glucose-Lowering Medications and Risk of Chronic Obstructive Pulmonary Disease Exacerbations in Patients With Type 2 Diabetes.

Ray A, Paik J, Wexler D, Sreedhara S, Bykov K, Feldman W JAMA Intern Med. 2025; .

PMID: 39928303 PMC: 11811870. DOI: 10.1001/jamainternmed.2024.7811.

References

Do J, Park C, Lee Y, Yoon K . Association between underweight and pulmonary function in 282,135 healthy adults: A cross-sectional study in Korean population. Sci Rep. 2019; 9(1):14308. PMC: 6778122. DOI: 10.1038/s41598-019-50488-3. View

Wu Z, Yang D, Ge Z, Yan M, Wu N, Liu Y . Body mass index of patients with chronic obstructive pulmonary disease is associated with pulmonary function and exacerbations: a retrospective real world research. J Thorac Dis. 2018; 10(8):5086-5099. PMC: 6129899. DOI: 10.21037/jtd.2018.08.67. View

Guo Y, Zhang T, Wang Z, Yu F, Xu Q, Guo W . Body mass index and mortality in chronic obstructive pulmonary disease: A dose-response meta-analysis. Medicine (Baltimore). 2016; 95(28):e4225. PMC: 4956822. DOI: 10.1097/MD.0000000000004225. View

Anzueto A . Impact of exacerbations on COPD. Eur Respir Rev. 2010; 19(116):113-8. PMC: 9682573. DOI: 10.1183/09059180.00002610. View

Wei Y, Tsai Y, Wang C, Kuo P . Impact of overweight and obesity on acute exacerbations of COPD - subgroup analysis of the Taiwan Obstructive Lung Disease cohort. Int J Chron Obstruct Pulmon Dis. 2017; 12:2723-2729. PMC: 5602448. DOI: 10.2147/COPD.S138571. View

S Ellulu M, Patimah I, Khazaai H, Rahmat A, Abed Y . Obesity and inflammation: the linking mechanism and the complications. Arch Med Sci. 2017; 13(4):851-863. PMC: 5507106. DOI: 10.5114/aoms.2016.58928. View

Putcha N, Anzueto A, Calverley P, Celli B, Tashkin D, Metzdorf N . Mortality and Exacerbation Risk by Body Mass Index in Patients with COPD in TIOSPIR and UPLIFT. Ann Am Thorac Soc. 2021; 19(2):204-213. PMC: 8867355. DOI: 10.1513/AnnalsATS.202006-722OC. View

Macleod M, Papi A, Contoli M, Beghe B, Celli B, Wedzicha J . Chronic obstructive pulmonary disease exacerbation fundamentals: Diagnosis, treatment, prevention and disease impact. Respirology. 2021; 26(6):532-551. DOI: 10.1111/resp.14041. View

Khan S, Ning H, Wilkins J, Allen N, Carnethon M, Berry J . Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity. JAMA Cardiol. 2018; 3(4):280-287. PMC: 5875319. DOI: 10.1001/jamacardio.2018.0022. View

10.

Chen S, Kuhn M, Prettner K, Yu F, Yang T, Barnighausen T . The global economic burden of chronic obstructive pulmonary disease for 204 countries and territories in 2020-50: a health-augmented macroeconomic modelling study. Lancet Glob Health. 2023; 11(8):e1183-e1193. PMC: 10369014. DOI: 10.1016/S2214-109X(23)00217-6. View

11.

Wedzicha J, Seemungal T . COPD exacerbations: defining their cause and prevention. Lancet. 2007; 370(9589):786-96. PMC: 7134993. DOI: 10.1016/S0140-6736(07)61382-8. View

12.

Kang J, Han K, Kim M . Severity of underweight affects the development of nontuberculous mycobacterial pulmonary disease; a nationwide longitudinal study. Sci Rep. 2022; 12(1):17180. PMC: 9558037. DOI: 10.1038/s41598-022-21511-x. View

13.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

14.

Parameswaran K, Todd D, Soth M . Altered respiratory physiology in obesity. Can Respir J. 2006; 13(4):203-10. PMC: 2683280. DOI: 10.1155/2006/834786. View

15.

Shin S, Kwon S, Kim V, Silverman E, Kim T, Kim D . Association of body mass index and COPD exacerbation among patients with chronic bronchitis. Respir Res. 2022; 23(1):52. PMC: 8900381. DOI: 10.1186/s12931-022-01957-3. View

16.

Adeloye D, Song P, Zhu Y, Campbell H, Sheikh A, Rudan I . Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis. Lancet Respir Med. 2022; 10(5):447-458. PMC: 9050565. DOI: 10.1016/S2213-2600(21)00511-7. View

17.

Rodriguez-Hernandez H, Simental-Mendia L, Rodriguez-Ramirez G, Reyes-Romero M . Obesity and inflammation: epidemiology, risk factors, and markers of inflammation. Int J Endocrinol. 2013; 2013:678159. PMC: 3652163. DOI: 10.1155/2013/678159. View

18.

Colak Y, Afzal S, Lange P, Nordestgaard B . High body mass index and risk of exacerbations and pneumonias in individuals with chronic obstructive pulmonary disease: observational and genetic risk estimates from the Copenhagen General Population Study. Int J Epidemiol. 2016; 45(5):1551-1559. DOI: 10.1093/ije/dyw051. View

19.

Norazman C, Adznam S, Jamaluddin R . Malnutrition as Key Predictor of Physical Frailty among Malaysian Older Adults. Nutrients. 2020; 12(6). PMC: 7352933. DOI: 10.3390/nu12061713. View

20.

Iheanacho I, Zhang S, King D, Rizzo M, Ismaila A . Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis. 2020; 15:439-460. PMC: 7049777. DOI: 10.2147/COPD.S234942. View