Brigham, Emily P, Anderson, Julie A, Brook, Robert D, Calverley, Peter MA, Celli, Bartolome R, Cowans, Nicholas J, Crim, Courtney, Diserens, James E, Martinez, Fernando J, McCormack, Meredith C et al (show 5 more authors)
(2021)
Challenging the obesity paradox: extreme obesity and COPD mortality in the SUMMIT trial.
ERJ OPEN RESEARCH, 7 (3).
pp. 902-2020.
Abstract
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<sup>-2</sup>, normal: 20-25 kg·m<sup>-2</sup>, overweight: 25- <30 kg·m<sup>-2</sup>, obese class I: 30- <35 kg·m<sup>-2</sup>, class II: 35- <40 kg·m<sup>-2</sup> and class III: ≥40 kg·m<sup>-2</sup>), 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 <i>via</i> 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<sup>-2</sup>, suggesting that obesity may not remain protective at the extremes in this population.
Item Type: | Article |
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Uncontrolled Keywords: | Chronic Obstructive Pulmonary Disease, Clinical Research, Prevention, Lung, Nutrition, Obesity, Cardiovascular, Cancer, 3 Good Health and Well Being |
Divisions: | Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences |
Depositing User: | Symplectic Admin |
Date Deposited: | 14 Jan 2022 12:55 |
Last Modified: | 17 Mar 2024 12:30 |
DOI: | 10.1183/23120541.00902-2020 |
Open Access URL: | https://doi.org/10.1183/23120541.00902-2020 |
Related URLs: | |
URI: | https://livrepository.liverpool.ac.uk/id/eprint/3146819 |