Body mass index and mortality of chronic obstructive pulmonary disease: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Jieyun , LUO Yifeng , WANG Xiaoling , ZHONG Zhimei , LI Qian , LI Bocheng ,  ZHANG Jianfeng

Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, P.R.China;

Corresponding author：

ZHANG Jianfeng, Email: zhangjianfeng930@163.com

Keywords：

BMI; COPD; Mortality; Meta-analysis; Systematical review; Cohort study

DOI：

10.7507/1672-2531.201903069

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Objectives To systematically review the association between body mass index (BMI) and mortality of chronic obstructive pulmonary disease (COPD).Methods PubMed, EMbase, The Cochrane Library, CNKI, WanFang Data and VIP databases were electronically searched to collect cohort studies on the association between BMI and mortality of COPD from inception to February, 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.Results A total of 14 cohort studies involving 494 060 COPD patients were included. The results of meta-analysis showed that, compared with patients having a normal weight, underweight individuals were associated with higher mortality (RR=1.40, 95%CI 1.15 to 1.71, P=0.000 8), whereas overweight (RR=0.65, 95%CI 0.54 to 0.79, P<0.000 1) and obese (RR=0.37, 95%CI 0.20 to 0.67, P=0.001) patients were associated with lower mortality.Conclusions Current evidence shows that underweight is associated with a higher risk of all-cause mortality among patients with COPD, whereas overweight and obese are associated with lower risk of all-cause mortality in these patients. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： ZHU Jieyun, LUO Yifeng, WANG Xiaoling, ZHONG Zhimei, LI Qian, LI Bocheng, ZHANG Jianfeng. Body mass index and mortality of chronic obstructive pulmonary disease: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2019, 19(7): 811-817. doi: 10.7507/1672-2531.201903069 Copy

1.	Hanson C, LeVan T. Obesity and chronic obstructive pulmonary disease: recent knowledge and future directions. Curr Opin Pulm Med, 2017, 23(2): 149-153.
2.	Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
3.	Zewari S, Vos P, van den Elshout F, et al. Obesity in COPD: Revealed and Unrevealed Issues. COPD, 2017, 14(6): 663-673.
4.	Yamauchi Y, Hasegawa W, Yasunaga H, et al. Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan. Int J Chron Obstruct Pulmon Dis, 2014, 9: 1337-1346.
5.	Stoll P, Foerster S, Virchow JC, et al. Overweight is a predictor of long-term survival in hospitalised patients with exacerbations of COPD. Respir Med, 2016, 116: 59-62.
6.	Spelta F, Fratta Pasini AM, Cazzoletti L, et al. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord, 2018, 23(1): 15-22.
7.	Cao C, Wang R, Wang J, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One, 2012, 7(8): e43892.
8.	Guo Y, Zhang T, Wang Z, et al. Body mass index and mortality in chronic obstructive pulmonary disease: A dose-response meta-analysis. Medicine (Baltimore), 2016, 95(28): e4225.
9.	葛建军. 体质指数与 COPD 患者生存预后关系的回顾性队列研究. 实用医学杂志, 2013, 29(10): 1686-1688.
10.	黄蕾, 何烨颖, 田德兴, 等. 慢性阻塞性肺疾病急性加重期患者营养风险与临床结局的关系研究. 中华临床医师杂志 (电子版), 2012, 6(16): 4638-4641.
11.	苗丽君, 张瑞霞, 王静, 等. 慢性阻塞性肺疾病患者长期预后与体质指数关系的研究. 中华老年医学杂志, 2014, 33(1): 35-38.
12.	Ringbaek TJ, Viskum K, Lange P. BMI and oral glucocorticoids as predictors of prognosis in COPD patients on long-term oxygen therapy. Chron Respir Dis, 2004, 1(2): 71-78.
13.	Marti S, Muñoz X, Rios J, et al. Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy. Eur Respir J, 2006, 27(4): 689-696.
14.	Yang L, Zhou M, Smith M, et al. Body mass index and chronic obstructive pulmonary disease-related mortality: a nationally representative prospective study of 220,000 men in China. Int J Epidemiol, 2010, 39(4): 1027-1036.
15.	Lainscak M, von Haehling S, Doehner W, et al. Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. J Cachexia Sarcopenia Muscle, 2011, 2(2): 81-86.
16.	Hallin R, Gudmundsson G, Suppli Ulrik C, et al. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD). Respir Med, 2007, 101(9): 1954-1960.
17.	Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J, 2005, 26(2): 234-241.
18.	Collins PF, Stratton RJ, Kurukulaaratchy R, et al. The ‘Obesity Paradox’ in chronic obstructive pulmonary disease. Thorax, 2010, 65(Suppl 4): A73-A74.
19.	Pothirat C, Phetsuk N, Deesomchok A, et al. Clinical characteristics, management in real world practice and long-term survival among COPD patients of Northern Thailand COPD club members. J Med Assoc Thai, 2007, 90(4): 653-662.
20.	Chailleux E, Laaban JP, Veale D. Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory. Chest, 2003, 123(5): 1460-1466.
21.	Chang CL, Sullivan GD, Karalus NC, et al. Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome. Intern Med J, 2007, 37(4): 236-241.
22.	顾景范. 《中国居民营养与慢性病状况报告 (2015)》解读. 营养学报, 2016, 38(6): 525-529.
23.	朱琳琳, 方曼倩, 朱佳, 等. 新疆部分地区慢性阻塞性肺疾病患病率与体质量指数的相关性研究. 临床医学, 2014, (8): 1-3, 4.
24.	Zhou Y, Wang D, Liu S, et al. The association between BMI and COPD: the results of two population-based studies in Guangzhou, China. COPD, 2013, 10(5): 567-572.
25.	Chittal P, Babu AS, Lavie CJ. Obesity paradox: does fat alter outcomes in chronic obstructive pulmonary disease? COPD, 2015, 12(1): 14-18.
26.	Lavie CJ, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases and prognosis-the obesity paradox updated. Prog Cardiovasc Dis, 2016, 58(5): 537-547.
27.	Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol, 2002, 39(4): 578-584.
28.	唐福仙, 庞欣杰, 房小丽. 探讨体重指数对慢性阻塞性肺疾病的愈后是否存在影响. 数理医药学杂志, 2018, 31(4): 627-628.
29.	Wei YF, Tsai YH, Wang CC, et al. 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.
30.	Oelsner EC, Carr JJ, Enright PL, et al. Per cent emphysema is associated with respiratory and lung cancer mortality in the general population: a cohort study. Thorax, 2016, 71(7): 624-632.
31.	Wu Z, Yang D, Ge Z, et al. 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.
32.	Cravo J, Esquinas AM. Obesity and COPD exacerbations - it's not that simple. Respir Med, 2017, 125: 103.

1. Hanson C, LeVan T. Obesity and chronic obstructive pulmonary disease: recent knowledge and future directions. Curr Opin Pulm Med, 2017, 23(2): 149-153.
2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859): 2095-2128.
3. Zewari S, Vos P, van den Elshout F, et al. Obesity in COPD: Revealed and Unrevealed Issues. COPD, 2017, 14(6): 663-673.
4. Yamauchi Y, Hasegawa W, Yasunaga H, et al. Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan. Int J Chron Obstruct Pulmon Dis, 2014, 9: 1337-1346.
5. Stoll P, Foerster S, Virchow JC, et al. Overweight is a predictor of long-term survival in hospitalised patients with exacerbations of COPD. Respir Med, 2016, 116: 59-62.
6. Spelta F, Fratta Pasini AM, Cazzoletti L, et al. Body weight and mortality in COPD: focus on the obesity paradox. Eat Weight Disord, 2018, 23(1): 15-22.
7. Cao C, Wang R, Wang J, et al. Body mass index and mortality in chronic obstructive pulmonary disease: a meta-analysis. PLoS One, 2012, 7(8): e43892.
8. Guo Y, Zhang T, Wang Z, et al. Body mass index and mortality in chronic obstructive pulmonary disease: A dose-response meta-analysis. Medicine (Baltimore), 2016, 95(28): e4225.
9. 葛建军. 体质指数与 COPD 患者生存预后关系的回顾性队列研究. 实用医学杂志, 2013, 29(10): 1686-1688.
10. 黄蕾, 何烨颖, 田德兴, 等. 慢性阻塞性肺疾病急性加重期患者营养风险与临床结局的关系研究. 中华临床医师杂志 (电子版), 2012, 6(16): 4638-4641.
11. 苗丽君, 张瑞霞, 王静, 等. 慢性阻塞性肺疾病患者长期预后与体质指数关系的研究. 中华老年医学杂志, 2014, 33(1): 35-38.
12. Ringbaek TJ, Viskum K, Lange P. BMI and oral glucocorticoids as predictors of prognosis in COPD patients on long-term oxygen therapy. Chron Respir Dis, 2004, 1(2): 71-78.
13. Marti S, Muñoz X, Rios J, et al. Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy. Eur Respir J, 2006, 27(4): 689-696.
14. Yang L, Zhou M, Smith M, et al. Body mass index and chronic obstructive pulmonary disease-related mortality: a nationally representative prospective study of 220,000 men in China. Int J Epidemiol, 2010, 39(4): 1027-1036.
15. Lainscak M, von Haehling S, Doehner W, et al. Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. J Cachexia Sarcopenia Muscle, 2011, 2(2): 81-86.
16. Hallin R, Gudmundsson G, Suppli Ulrik C, et al. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD). Respir Med, 2007, 101(9): 1954-1960.
17. Gunen H, Hacievliyagil SS, Kosar F, et al. Factors affecting survival of hospitalised patients with COPD. Eur Respir J, 2005, 26(2): 234-241.
18. Collins PF, Stratton RJ, Kurukulaaratchy R, et al. The ‘Obesity Paradox’ in chronic obstructive pulmonary disease. Thorax, 2010, 65(Suppl 4): A73-A74.
19. Pothirat C, Phetsuk N, Deesomchok A, et al. Clinical characteristics, management in real world practice and long-term survival among COPD patients of Northern Thailand COPD club members. J Med Assoc Thai, 2007, 90(4): 653-662.
20. Chailleux E, Laaban JP, Veale D. Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory. Chest, 2003, 123(5): 1460-1466.
21. Chang CL, Sullivan GD, Karalus NC, et al. Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome. Intern Med J, 2007, 37(4): 236-241.
22. 顾景范. 《中国居民营养与慢性病状况报告 (2015)》解读. 营养学报, 2016, 38(6): 525-529.
23. 朱琳琳, 方曼倩, 朱佳, 等. 新疆部分地区慢性阻塞性肺疾病患病率与体质量指数的相关性研究. 临床医学, 2014, (8): 1-3, 4.
24. Zhou Y, Wang D, Liu S, et al. The association between BMI and COPD: the results of two population-based studies in Guangzhou, China. COPD, 2013, 10(5): 567-572.
25. Chittal P, Babu AS, Lavie CJ. Obesity paradox: does fat alter outcomes in chronic obstructive pulmonary disease? COPD, 2015, 12(1): 14-18.
26. Lavie CJ, De Schutter A, Parto P, et al. Obesity and prevalence of cardiovascular diseases and prognosis-the obesity paradox updated. Prog Cardiovasc Dis, 2016, 58(5): 537-547.
27. Gruberg L, Weissman NJ, Waksman R, et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol, 2002, 39(4): 578-584.
28. 唐福仙, 庞欣杰, 房小丽. 探讨体重指数对慢性阻塞性肺疾病的愈后是否存在影响. 数理医药学杂志, 2018, 31(4): 627-628.
29. Wei YF, Tsai YH, Wang CC, et al. 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.
30. Oelsner EC, Carr JJ, Enright PL, et al. Per cent emphysema is associated with respiratory and lung cancer mortality in the general population: a cohort study. Thorax, 2016, 71(7): 624-632.
31. Wu Z, Yang D, Ge Z, et al. 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.
32. Cravo J, Esquinas AM. Obesity and COPD exacerbations - it's not that simple. Respir Med, 2017, 125: 103.

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