{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T23:38:59Z","timestamp":1793144339886,"version":"4.5.0"},"reference-count":133,"publisher":"European Respiratory Society (ERS)","issue":"174","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2024,4,16]]},"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and objective<\/jats:title>\n                    <jats:p>The obesity paradox is a well-established clinical conundrum in COPD patients. This study aimed to provide an updated analysis of the relationship between body mass index (BMI) and mortality in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic search was conducted through Embase, PubMed, and Web of Science. International BMI cut-offs were employed to define underweight, overweight and obesity. The primary outcome was all-cause mortality, and the secondary outcome was respiratory and cardiovascular mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      120 studies encompassed a total of 1\u2009053\u2009272 patients. Underweight status was associated with an increased risk of mortality, while overweight and obesity were linked to a reduced risk of mortality. A nonlinear U-shaped relationship was observed between BMI and all-cause mortality, respiratory mortality and cardiovascular mortality. Notably, an inflection point was identified at BMI 28.75\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      (relative risk 0.83, 95% CI 0.80\u20130.86), 30.25\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      (relative risk 0.51, 95% CI 0.40\u20130.65) and 27.5\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      (relative risk 0.76, 95% CI 0.64\u20130.91) for all-cause, respiratory and cardiovascular mortality, respectively, and beyond which the protective effect began to diminish.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study augments the existing body of evidence by confirming a U-shaped relationship between BMI and mortality in COPD patients. It underscores the heightened influence of BMI on respiratory and cardiovascular mortality compared to all-cause mortality. The protective effect of BMI was lost when BMI values exceeded 35.25\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      , 35\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      and 31\u2005kg\u00b7m\n                      <jats:sup>\u22122<\/jats:sup>\n                      for all-cause, respiratory and cardiovascular mortality, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/16000617.0261-2023","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T04:31:07Z","timestamp":1732681867000},"page":"230261","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":43,"title":["The impact of body mass index on mortality in COPD: an updated dose\u2013response meta-analysis"],"prefix":"10.1183","volume":"33","author":[{"given":"Eric Daniel","family":"Tenda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3763-2661","authenticated-orcid":false,"given":"Joshua","family":"Henrina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andry","family":"Setiadharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4903-8056","authenticated-orcid":false,"given":"Immanuel","family":"Felix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Yulianti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceva Wicaksono","family":"Pitoyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1457-9231","authenticated-orcid":false,"given":"Sze Shyang","family":"Kho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8122-6559","authenticated-orcid":false,"given":"Melvin Chee Kiang","family":"Tay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyah S.","family":"Purnamasari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Czeresna Heriawan","family":"Soejono","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siti","family":"Setiati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"81","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"key":"2024122400074516000_33.174.230261.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1900500"},{"key":"2024122400074516000_33.174.230261.2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13690-020-00426-x","article-title":"Trends in burden of chronic obstructive pulmonary disease in Iran, 1995\u20132015: findings from the Global Burden of Disease study","volume":"78","author":"Hashemi","year":"2020","journal-title":"Arch Public Health"},{"key":"2024122400074516000_33.174.230261.3","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2013.836171"},{"key":"2024122400074516000_33.174.230261.4","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1513\/AnnalsATS.201711-901ED","article-title":"The \u201cobesity paradox\u201d in chronic obstructive pulmonary disease: can it be resolved?","volume":"15","author":"Iyer","year":"2018","journal-title":"Ann Am Thorac Soc"},{"key":"2024122400074516000_33.174.230261.5","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000004225"},{"key":"2024122400074516000_33.174.230261.6","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-4-201302190-00009"},{"key":"2024122400074516000_33.174.230261.7","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.1411"},{"key":"2024122400074516000_33.174.230261.8","doi-asserted-by":"publisher","DOI":"10.1186\/2046-4053-2-71"},{"key":"2024122400074516000_33.174.230261.9","doi-asserted-by":"publisher","DOI":"10.1001\/jama.280.19.1690"},{"key":"2024122400074516000_33.174.230261.10","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"2024122400074516000_33.174.230261.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4597"},{"key":"2024122400074516000_33.174.230261.12","unstructured":"Deeks JJ , Higgins JPT , Altman DG . 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