Metabolically healthy obesity heightens respiratory, cardiac complication odds in COPD
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Key takeaways:
- Between 2016 and 2020, researchers reported a significant rise in metabolically healthy obesity.
- Hospitalized older adults with this obesity faced higher odds for pulmonary hypertension and respiratory failure.
BOSTON — Older adults hospitalized for an acute COPD exacerbation with vs. without metabolically healthy obesity were more likely to experience respiratory and cardiac complications, according to data presented at the CHEST Annual Meeting.
“The study highlights the importance of screening for metabolically healthy obesity in elderly COPD patients,” Arshad Ali Mohd, MBBS, physician and researcher at Deccan College of Medical Sciences in India, told Healio. “For clinicians, it means that even patients who appear metabolically healthy but have obesity may still be at higher risk for complications like respiratory failure and pulmonary hypertension.
“Knowing these risks can help clinicians create better treatment plans and promote lifestyle changes to reduce the impact of metabolically healthy obesity on COPD,” Mohd continued.
Using data from the 2016 to 2020 National Inpatient Sample, Mohd and colleagues evaluated 221,700 hospitalizations among older patients for an acute exacerbation of COPD to find out how metabolically healthy obesity impacts the likelihood for several adverse outcomes/complications: all-cause mortality, respiratory failure, mechanical ventilation, pulmonary hypertension and heart failure with reduced ejection.
A small proportion of the hospitalizations (5.7%) involved a patient with metabolically healthy obesity (median age, 71 years; 6.6% women), whereas the remaining admissions involved patients without this type of obesity (median age, 73 years; 4.6% women).
Between 2016 and 2020, researchers reported a significant rise in metabolically healthy obesity (5.1% to 6.5%), as well as in the outcomes of respiratory failure (30.8% to 45.3%), mechanical ventilation (2.7% to 5.2%) and pulmonary hypertension (9.1% to 10.8%).
“One surprising finding was the significant increase in the prevalence of metabolically healthy obesity among elderly patients hospitalized with acute exacerbation of COPD,” Mohd told Healio.
Nearly half (49%) of patients with metabolically healthy obesity reported smoking, which was significantly greater than the 45% of patients without obesity who reported smoking.
Further, depression was more frequently reported among those with vs. without metabolically healthy obesity (15.9% vs. 11.8%).
Other comorbidities appearing in significantly greater proportions of patients with vs. without metabolically healthy obesity included autoimmune conditions (5.7% vs. 3.7%) and hypothyroidism (17.2% vs. 12.1%), according to the abstract.
Adjusting for comorbidities and patient features, researchers observed significantly heightened odds among those with vs. without metabolically healthy obesity for:
- pulmonary hypertension (adjusted OR = 1.73; 95% CI, 1.48-2.01);
- heart failure with reduced ejection (aOR = 1.43; 95% CI, 1.25-1.77);
- mechanical ventilation (aOR = 1.32; 95% CI, 1.03-1.69); and
- respiratory failure (aOR = 1.31; 95% CI, 1.21-1.43).
The two groups did not significantly differ in the odds for all-cause mortality or the odds for pulmonary embolism, according to the abstract.
“Despite the increased risk of respiratory and cardiac complications associated with metabolically healthy obesity, it did not significantly impact overall mortality in these patients,” Mohd told Healio. “This suggests that while metabolically healthy obesity presents certain health risks, its influence on mortality is more complex and warrants further investigation.”
In terms of health care resource utilization, patients with metabolically healthy obesity had longer hospitalization durations than patients without this type of obesity (4 vs. 3 days). Mohd and colleagues also found greater hospital expenses with vs. without metabolically healthy obesity ($31,248 vs. $25,696).
“Our findings advocate for a multidisciplinary approach in managing COPD patients with metabolically healthy obesity,” Mohd told Healio. “Addressing both COPD and obesity-related metabolic factors could lead to better patient outcomes and help reduce health care resource utilization.”
Looking ahead, Mohd said a deeper dive is needed into the mechanisms behind the associations found.
“Future studies will need to explore the mechanisms linking metabolically healthy obesity with the increased risks we observed, particularly in respiratory and cardiac complications,” Mohd told Healio. “Additionally, long-term, prospective studies are needed to assess the impact of lifestyle interventions, such as diet and physical activity, on outcomes in metabolically healthy obesity patients with COPD.”
For more information:
Arshad Ali Mohd, MBBS, can be reached at ali.mohdarshad29@gmail.com.