Influence of diet and obesity on COPD development and outcomes

Figures & data

Table 1 World Health Organization body mass index (BMI) classifications

Category	BMI
Severe thinness	<16.0
Moderate thinness	16.0–16.9
Mild thinness	17.0–18.49
Normal range	18.5–24.9
Overweight	≥25.0
Preobese	25.0–29.9
Obese class I	30.0–34.9
Obese class II	35.0–39.9
Obese class III	≥40

Note: Reproduced with permission of the publisher from World Health Organization. Obesity and overweight. 2013. Available from: http://apps.who.int/bmi/index.jsp?introPage=intro_3.html. Accessed December 6, 2013.¹

Table 2 Studies investigating the “obesity paradox” in COPD

Study	Design	Sample	Length of follow-up	Primary outcome	Results
Landbo et al^Citation8	Prospective cohort (the Copenhagen City Heart Study)	1,218 men and 914 women aged 21–89 years with airway obstruction (FEV1: FVC ratio <0.70)	17 years	Mortality from COPD and all causes	In severe COPD, all-cause mortality decreased as BMI increased (RR 0.62, 95% CI 0.41–0.94; P<0.001 for BMI >30 compared to BMI of 20–24.9)
Jee et al^Citation59	Prospective cohort	1,213,829 Koreans aged 30–95 years	12 years	Body weight and risk of death	The risk of death from respiratory causes decreased progressively with increasing BMI; however, too few subjects had a BMI above 30 for evaluation of obesity
Hallin et al^Citation58	Prospective multicenter study	261 hospitalized patients with COPD	2 years after hospitalization	Mortality	Lowest mortality was in overweight patients (BMI 25–30)
McGhan et al^Citation57	Prospective cohort	51,353 patients who were discharged after an exacerbation of COPD in the VA health care system	5 years	Rates of rehospitalization for COPD and death from all causes	Obesity was associated with a reduction in the risk of death (HR 0.76, 95% CI 0.70–0.82)
Lainscak et al^Citation56	Retrospective chart review	968 patients hospitalized due to acute exacerbation of COPD	3.26 years	Mortality and acute exacerbation of COPD	Higher BMI was independently predictive of survival, with each unit increase in BMI associated with 5% lower chance of death. Optimal BMI was in the overweight category
Cao et al^Citation55	Meta-analysis	Included 22 studies comprising 21,150 participants with COPD	NA	Mortality	Overweight (RR 0.47, 95% CI 0.33–0.68) and obesity (RR 0.59, 95% CI 0.38–0.91) was associated with lower mortality
Zapatero et al^Citation54	Retrospective chart review	313,233 patients admitted with COPD as the primary diagnosis	NA	In-hospital mortality and readmission within 30 days	Obese patients showed a lower in-hospital mortality risk (OR 0.52, 95% CI 0.49–0.55) when compared to nonobese patients

Abbreviations: COPD, chronic obstructive pulmonary disease; RR, relative risk; CI, confidence interval; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; BMI, body mass index; VA, Veterans Affairs; HR, hazard ratio; NA, not available; OR, odds ratio.

World Health OrganizationObesity and overweight2013 Available from: http://apps.who.int/bmi/index.jsp?introPage=intro_3.htmlAccessed December 6, 2013

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