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Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan

BACKGROUND AND OBJECTIVE: The prevalence and mortality of chronic obstructive pulmonary disease (COPD) in elderly patients are increasing worldwide. Low body mass index (BMI) is a well-known prognostic factor for COPD. However, the obesity paradox in elderly patients with COPD has not been well eluc...

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Autores principales: Yamauchi, Yasuhiro, Hasegawa, Wakae, Yasunaga, Hideo, Sunohara, Mitsuhiro, Jo, Taisuke, Takami, Kazutaka, Matsui, Hiroki, Fushimi, Kiyohide, Nagase, Takahide
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2014
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266240/
https://www.ncbi.nlm.nih.gov/pubmed/25525351
http://dx.doi.org/10.2147/COPD.S75175
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author Yamauchi, Yasuhiro
Hasegawa, Wakae
Yasunaga, Hideo
Sunohara, Mitsuhiro
Jo, Taisuke
Takami, Kazutaka
Matsui, Hiroki
Fushimi, Kiyohide
Nagase, Takahide
author_facet Yamauchi, Yasuhiro
Hasegawa, Wakae
Yasunaga, Hideo
Sunohara, Mitsuhiro
Jo, Taisuke
Takami, Kazutaka
Matsui, Hiroki
Fushimi, Kiyohide
Nagase, Takahide
author_sort Yamauchi, Yasuhiro
collection PubMed
description BACKGROUND AND OBJECTIVE: The prevalence and mortality of chronic obstructive pulmonary disease (COPD) in elderly patients are increasing worldwide. Low body mass index (BMI) is a well-known prognostic factor for COPD. However, the obesity paradox in elderly patients with COPD has not been well elucidated. We investigated the association between BMI and in-hospital mortality in elderly COPD patients. METHODS: Using the Diagnosis Procedure Combination database in Japan, we retrospectively collected data for elderly patients (>65 years) with COPD who were hospitalized between July 2010 and March 2013. We performed multivariable logistic regression analysis to compare all-cause in-hospital mortality between patients with BMI of <18.5 kg/m(2) (underweight), 18.5–22.9 kg/m(2) (low–normal weight), 23.0–24.9 kg/m(2) (high–normal weight), 25.0–29.9 kg/m(2) (overweight), and ≥30.0 kg/m(2) (obesity) with adjustment for patient backgrounds. RESULTS: In all, 263,940 eligible patients were identified. In-hospital mortality was 14.3%, 7.3%, 4.9%, 4.3%, and 4.4%, respectively, in underweight, low–normal weight, high–normal weight, overweight, and obese patients. Underweight patients had a significantly higher mortality than low–normal weight patients (odds ratio [OR]: 1.55, 95% confidence interval [CI]: 1.48–1.63), whereas lower mortality was associated with high–normal weight (OR: 0.76, CI: 0.70–0.82), overweight (OR: 0.73, CI: 0.66–0.80), and obesity (OR: 0.67, CI: 0.52–0.86). Higher mortality was significantly associated with older age, male sex, more severe dyspnea, lower level of consciousness, and lower activities of daily living. CONCLUSION: Overweight and obese patients had a lower mortality than low–normal weight patients, which supports the obesity paradox.
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spelling pubmed-42662402014-12-18 Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan Yamauchi, Yasuhiro Hasegawa, Wakae Yasunaga, Hideo Sunohara, Mitsuhiro Jo, Taisuke Takami, Kazutaka Matsui, Hiroki Fushimi, Kiyohide Nagase, Takahide Int J Chron Obstruct Pulmon Dis Original Research BACKGROUND AND OBJECTIVE: The prevalence and mortality of chronic obstructive pulmonary disease (COPD) in elderly patients are increasing worldwide. Low body mass index (BMI) is a well-known prognostic factor for COPD. However, the obesity paradox in elderly patients with COPD has not been well elucidated. We investigated the association between BMI and in-hospital mortality in elderly COPD patients. METHODS: Using the Diagnosis Procedure Combination database in Japan, we retrospectively collected data for elderly patients (>65 years) with COPD who were hospitalized between July 2010 and March 2013. We performed multivariable logistic regression analysis to compare all-cause in-hospital mortality between patients with BMI of <18.5 kg/m(2) (underweight), 18.5–22.9 kg/m(2) (low–normal weight), 23.0–24.9 kg/m(2) (high–normal weight), 25.0–29.9 kg/m(2) (overweight), and ≥30.0 kg/m(2) (obesity) with adjustment for patient backgrounds. RESULTS: In all, 263,940 eligible patients were identified. In-hospital mortality was 14.3%, 7.3%, 4.9%, 4.3%, and 4.4%, respectively, in underweight, low–normal weight, high–normal weight, overweight, and obese patients. Underweight patients had a significantly higher mortality than low–normal weight patients (odds ratio [OR]: 1.55, 95% confidence interval [CI]: 1.48–1.63), whereas lower mortality was associated with high–normal weight (OR: 0.76, CI: 0.70–0.82), overweight (OR: 0.73, CI: 0.66–0.80), and obesity (OR: 0.67, CI: 0.52–0.86). Higher mortality was significantly associated with older age, male sex, more severe dyspnea, lower level of consciousness, and lower activities of daily living. CONCLUSION: Overweight and obese patients had a lower mortality than low–normal weight patients, which supports the obesity paradox. Dove Medical Press 2014-12-09 /pmc/articles/PMC4266240/ /pubmed/25525351 http://dx.doi.org/10.2147/COPD.S75175 Text en © 2014 Yamauchi et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Yamauchi, Yasuhiro
Hasegawa, Wakae
Yasunaga, Hideo
Sunohara, Mitsuhiro
Jo, Taisuke
Takami, Kazutaka
Matsui, Hiroki
Fushimi, Kiyohide
Nagase, Takahide
Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan
title Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan
title_full Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan
title_fullStr Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan
title_full_unstemmed Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan
title_short Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan
title_sort paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in japan
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266240/
https://www.ncbi.nlm.nih.gov/pubmed/25525351
http://dx.doi.org/10.2147/COPD.S75175
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