RT Journal Article
SR Electronic
T1 Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT trial
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00902-2020
DO 10.1183/23120541.00902-2020
VO 7
IS 3
A1 Emily P. Brigham
A1 Julie A. Anderson
A1 Robert D. Brook
A1 Peter M.A. Calverley
A1 Bartolome R. Celli
A1 Nicholas J. Cowans
A1 Courtney Crim
A1 James E. Diserens
A1 Fernando J. Martinez
A1 Meredith C. McCormack
A1 David E. Newby
A1 Julie Yates
A1 Jorgen Vestbo
A1 Tianshi David Wu
A1 Robert A. Wise
YR 2021
UL http://openres.ersjournals.com/content/7/3/00902-2020.abstract
AB Populations with COPD demonstrate higher survival in overweight and obese compared with normal weight; the “obesity paradox”. Relationships in less-severe COPD are unclear, as is the impact of cardiovascular risk, and few studies include individuals at extremes of obesity. We examined the relationship between body mass index (BMI; defined as underweight: <20 kg·m−2, normal: 20–25 kg·m−2, overweight: 25– <30 kg·m−2, obese class I: 30– <35 kg·m−2, class II: 35– <40 kg·m−2 and class III: ≥40 kg·m−2), morbidity, and mortality in the SUMMIT trial population (n=16 485), characterised by moderate COPD and heightened cardiovascular risk with a substantial proportion with class III obesity. The association between BMI category and time to event was modelled via proportional hazards (reference normal weight) adjusted for demographics and cardiorespiratory disease. Consistent with the paradox, underweight individuals demonstrated higher mortality (hazard ratio (HR) 1.31 (95% CI 1.04–1.64)), with lower mortality among overweight (HR 0.62 (95% CI 0.52–0.73)) and obese class I (HR 0.75 (95% CI 0.62–0.90)). However, mortality increased in obese class III (HR 1.36 (95% CI 1.00–1.86)). Death was primarily attributable to cardiovascular causes. Within a large, multinational cohort with moderate COPD and increased cardiovascular risk, the phenomenon of reduced mortality with obesity did not persist at BMI >40 kg·m−2, suggesting that obesity may not remain protective at the extremes in this population.In a population with moderate COPD, at heightened cardiovascular risk and containing a substantial proportion of individuals with BMI ≥40 kg/m2, BMI and mortality demonstrate a U-shaped (rather than J-shaped) relationship https://bit.ly/3hDztI6