Body weight and mortality in COPD: focus on the obesity paradox

Spelta, Francesco; Pasini, Anna Maria Fratta; Cazzoletti, Lucia; Ferrari, Marcello

doi:10.1007/s40519-017-0456-z

Cited by 122 publications

(114 citation statements)

References 74 publications

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“…Obesity is paradoxically associated with a better survival in patients with cardiovascular or renal disease, an observation characterised as the "obesity paradox" [89,90]. This paradox was also observed in COPD patients, as earlier studies reported a relationship between a low BMI and adverse prognosis in terms of mortality as well as rate and duration of hospitalisation [91,92], an association more evident in severe COPD [93]. Similarly, obese patients hospi-talised for acute exacerbation of COPD had a better outcome compared with those of normal weight; for every 1 kg/m 2 increase in BMI there was a 5 % decrease in mortality likelihood [94].…”

Section: Copd and Obesitymentioning

confidence: 90%

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview

Katsiki

Steiropoulos

Παπάνας

et al. 2019

Exp Clin Endocrinol Diabetes

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Chronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular risk. The present narrative review considers the potential links between COPD and DM, such as systemic inflammation, oxidative stress, hypoxaemia and hyperglycaemia. The effects of antidiabetic drugs on lung function and COPD outcomes, as well as the possibility of common therapeutic modalities are also briefly considered. Further research is needed in this field to elucidate these relationships as well as their potential clinical implications in daily practice.

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Section: Copd and Obesitymentioning

confidence: 90%

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview

Katsiki

Steiropoulos

Παπάνας

et al. 2019

Exp Clin Endocrinol Diabetes

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“…This can contribute to the degree of weight change after the procedure. Spelta et al [22] raised awareness about the obesity paradox possibly present with COPD. According to their review, several studies have reported obesity to be a protective factor against allcause mortality, including COPD.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Lung Volume Reduction in Relation to Body Mass Index in Patients with Severe Heterogeneous Emphysema

et al. 2020

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Background: In chronic obstructive pulmonary disease (COPD), body mass index (BMI) is significantly lower in the emphysema-dominant type. Endoscopic lung volume reduction (ELVR) is an innovative way of treating severe emphysema. However, the specific associations of low BMI values and outcomes of ELVR is not well-studied. Objectives: We evaluated associations between initial BMI and changes in major outcomes after endobronchial valve (EBV) placement in patients with heterogeneous severe emphysema. Methods: In a retrospective cohort study, patients were divided into 2 groups based on their baseline BMI (higher BMI ≥21 kg/m 2 [n = 18] and lower BMI < 21 kg/m 2 [n = 63]). Demographics, procedure data, pulmonary function test and 6-min-walk test (6MWT), dyspnea score (according to the modified Medical Research Council [mMRC] scale), BODE (BMI, airflow obstruction, dyspnea, exercise capacity) index, and complications were recorded. After 6 months, changes in variables (dWeight and dBMI) were recorded. Results: Comparing the 2 groups, we found the following: a dWeight of-2.34 kg and +3.39 kg (p value < 0.01) and a dBMI of-0.74 and +1.99 kg/m 2 , in the higher BMI and lower BMI group, respectively (p value < 0.01). Changes in forced expiratory volume < 1 s (FEV 1), 6MWT, mMRC score, and BODE index were not statistically significant. The most common complication was pneumothorax. The lower BMI group experienced more complications than the higher BMI group (40 vs. 24%). Conclusion: Baseline BMI is relevant when selecting candidates for ELVR. Our results show that the COPD patients with a lower BMI gained a significant amount of weight, thus increasing their BMI after the procedure. The rate of complications was higher in the lower BMI group. These findings should alert physicians and encourage nutritional assessment in this population.

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“…Surprisingly, obese patients with COPD survive longer than patients with COPD who are not obese, despite the cardiovascular risk and inflammatory burden associated with obesity. This phenomenon is known as the "obesity paradox" [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Differences in the Outcome of Patients with COPD according to Body Mass Index

Miguel-Díez

Castro-Riera

et al. 2020

JCM

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Background: In chronic obstructive pulmonary disease (COPD), the “obesity paradox” is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). Methods: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. Results: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24–27.69; 27.70–31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit. Survival was lower in the quartile 1 of BMI with respect to each of the 2–4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03–1.09), low pulmonary function (HR 0.93; 95% CI 0.86–0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01–3.06), high Charlson (HR 1.32, 95% CI 1.18–1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08–3.69) were identified as risk factors independently associated with mortality. Conclusions: In COPD, low BMI conditions a lower survival, although not for having more acute events.

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Body weight and mortality in COPD: focus on the obesity paradox

Abstract: Level V: Narrative Review.

Cited by 122 publications

References 74 publications

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview

Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview

Endoscopic Lung Volume Reduction in Relation to Body Mass Index in Patients with Severe Heterogeneous Emphysema

Differences in the Outcome of Patients with COPD according to Body Mass Index

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