High body mass index and the risk of acute exacerbations in chronic obstructive pulmonary disease: A meta-analysis and systematic review

Abstract

Abstract Background Emerging studies indicated the beneficial role of overweight and obesity regarding the prognosis of chronic obstructive pulmonary disease (COPD). However, it’s controversial that whether high body mass index (BMI) has been associated with the risk of acute exacerbations in COPD. Methods Pubmed, Cochrane Library and Embase database were searched up to March 2023. All studies reported the relationship between BMI and the COPD exacerbation risk were included. The quality assessment was performed using the Newcastle Ottawa scale. The meta-analysis was carried out using Review Manager 5.4 software and StataMP 18.0 . Results A total of 10 studies involving 50573 participants with COPD were included. There were no statistical differences in the acute exacerbation risk for the comparison of high BMI vs. non-high BMI group (relative risks, RRs:1.01, 95%CI:0.94–1.07, p = 0.88) and high BMI vs. normal weight group (RRs: 1.01 95%CI: 0.94–1.05, p = 0.9). Further comparisons of subgroups of high BMI including overweight, obesity, Class I obesity and extreme obesity compared to normal weight group also showed no statistical differences. However, a lower risk of COPD exacerbation was discovered when comparing high weight with underweight group (RRs:0.76, 95%CI: 0.63–0.92, p = 0.005). Moreover, high weight group was associated with a lower risk of severe exacerbations of COPD compared to normal weight group (RRs:0.83, 95%CI:0.79–0.88, P < 0.001), but not differ in the risk of frequent COPD exacerbations compared to normal weight subjects (RR:0.91, 95%CI:0.79–1.05, P = 0.19). Conclusion The present study showed that high BMI group including overweight and obesity plays neither a beneficial nor a disadvantage role on the risk of acute exacerbations in COPD patients compared to normal weight counterparts. However, high BMI induced a lower risk of severe COPD exacerbations compared to the normal weight group and a lower risk of COPD exacerbations compared to underweight subjects.