Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2014

Open Access 01-12-2014 | Research article

Obesity survival paradox in pneumonia: a meta-analysis

Authors: Wei Nie, Yi Zhang, Sun Ha Jee, Keum Ji Jung, Bing Li, Qingyu Xiu

Published in: BMC Medicine | Issue 1/2014

Login to get access

Abstract

Background

It is unclear whether an ‘obesity survival paradox’ exists for pneumonia. Therefore, we conducted a meta-analysis to assess the associations between increased body mass index (BMI), pneumonia risk, and mortality risk.

Methods

Cohort studies were identified from the PubMed and Embase databases. Summary relative risks (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using a random effects model.

Results

Thirteen cohort studies on pneumonia risk (n = 1,536,623), and ten cohort studies on mortality (n = 1,375,482) were included. Overweight and obese individuals were significantly associated with an increased risk of pneumonia (RR = 1.33, 95% CI 1.04 to 1.71, P = 0.02, I 2  = 87%). In the dose–response analysis, the estimated summary RR of pneumonia per 5 kg/m2 increase in BMI was 1.04 (95% CI 1.01 to 1.07, P = 0.01, I 2  = 84%). Inversely, overweight and obese subjects were significantly associated with reduced risk of pneumonia mortality (RR = 0.83, 95% CI 0.77 to 0.91, P < 0.01, I 2  = 34%). The estimated summary RR of mortality per 5 kg/m2 increase in BMI was 0.95 (95% CI 0.93 to 0.98, P < 0.01, I 2  = 77%).

Conclusions

This meta-analysis suggests that an ‘obesity survival paradox’ exists for pneumonia. Because this meta-analysis is based on observational studies, more studies are required to confirm the results.
Appendix
Available only for authorised users
Literature
1.
Baskin ML, Ard J, Franklin F, Allison DB: Prevalence of obesity in the United States. Obes Rev. 2005, 6: 5-7. 10.1111/j.1467-789X.2005.00165.x.CrossRefPubMed
2.
Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, MacInnis RJ, Moore SC, Tobias GS, Anton-Culver H, Freeman LB, Beeson WL, Clipp SL, English DR, Folsom AR, Freedman DM, Giles G, Hakansson N, Henderson KD, Hoffman-Bolton J, Hoppin JA, Koenig KL, Lee IM, Linet MS, Park Y, Pocobelli G, Schatzkin A, Sesso HD, Weiderpass E, Willcox BJ, Wolk A, et al: Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010, 363: 2211-2219. 10.1056/NEJMoa1000367.CrossRefPubMed
3.
Lavie CJ, Milani RV, Ventura HO: Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009, 53: 1925-1932. 10.1016/j.jacc.2008.12.068.CrossRefPubMed
4.
Narayan KM, Boyle JP, Thompson TJ, Gregg EW, Williamson DF: Effect of BMI on lifetime risk for diabetes in the U.S. Diabetes Care. 2007, 30: 1562-1566. 10.2337/dc06-2544.CrossRefPubMed
5.
Lavie CJ, Alpert MA, Arena R, Mehra MR, Milani RV: Impact of obesity and the obesity paradox on prevalence and prognosis in heart failure. JACC Heart Failure. 2013, 1: 93-102. 10.1016/j.jchf.2013.01.006.CrossRefPubMed
6.
De Schutter A, Lavie CJ, Milani RV: The impact of obesity on risk factors and prevalence and prognosis of coronary heart disease—the obesity paradox. Prog Cardiovasc Dis. 2014, 56: 401-408. 10.1016/j.pcad.2013.08.003.CrossRefPubMed
7.
Carnethon MR, De Chavez PJ, Biggs ML, Lewis CE, Pankow JS, Bertoni AG, Golden SH, Liu K, Mukamal KJ, Campbell-Jenkins B, Dyer AR: Association of weight status with mortality in adults with incident diabetes. JAMA. 2012, 308: 581-590.PubMedPubMedCentral
8.
Delgado-Rodríguez M, Medina-Cuadros M, Martínez-Gallego G, Sillero-Arenas M: Usefulness of intrinsic surgical wound infection risk indices as predictors of postoperative pneumonia risk. J Hosp Infect. 1997, 35: 269-276. 10.1016/S0195-6701(97)90220-6.CrossRefPubMed
9.
Baik I, Curhan GC, Rimm EB, Bendich A, Willett WC, Fawzi WW: A prospective study of age and lifestyle factors in relation to community-acquired pneumonia in US men and women. Arch Intern Med. 2000, 160: 3082-3088. 10.1001/archinte.160.20.3082.CrossRefPubMed
10.
Newell MA, Bard MR, Goettler CE, Toschlog EA, Schenarts PJ, Sagraves SG, Holbert D, Pories WJ, Rotondo MF: Body mass index and outcomes in critically injured blunt trauma patients: weighing the impact. J Am Coll Surg. 2007, 204: 1056-1061. 10.1016/j.jamcollsurg.2006.12.042.CrossRefPubMed
11.
Yap CH, Zimmet A, Mohajeri M, Yii M: Effect of obesity on early morbidity and mortality following cardiac surgery. Heart Lung Circ. 2007, 16: 31-36. 10.1016/j.hlc.2006.09.007.CrossRefPubMed
12.
Dossett LA, Heffernan D, Lightfoot M, Collier B, Diaz JJ, Sawyer RG, May AK: Obesity and pulmonary complications in critically injured adults. Chest. 2008, 134: 974-980. 10.1378/chest.08-0079.CrossRefPubMedPubMedCentral
13.
Mannino DM, Davis KJ, Kiri VA: Chronic obstructive pulmonary disease and hospitalizations for pneumonia in a US cohort. Respir Med. 2009, 103: 224-229. 10.1016/j.rmed.2008.09.005.CrossRefPubMed
14.
Kornum JB, Nørgaard M, Dethlefsen C, Due KM, Thomsen RW, Tjønneland A, Sørensen HT, Overvad K: Obesity and risk of subsequent hospitalisation with pneumonia. Eur Respir J. 2010, 36: 1330-1336. 10.1183/09031936.00184209.CrossRefPubMed
15.
Morgan OW, Bramley A, Fowlkes A, Freedman DS, Taylor TH, Gargiullo P, Belay B, Jain S, Cox C, Kamimoto L, Fiore A, Finelli L, Olsen SJ, Fry AM: Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A(H1N1) disease. PLoS One. 2010, 5: e9694-10.1371/journal.pone.0009694.CrossRefPubMedPubMedCentral
16.
Blumentals WA, Nevitt A, Peng MM, Toovey S: Body mass index and the incidence of influenza-associated pneumonia in a UK primary care cohort. Influenza Other Respir Viruses. 2012, 6: 28-36. 10.1111/j.1750-2659.2011.00262.x.CrossRefPubMed
17.
Kwong JC, Campitelli MA, Rosella LC: Obesity and respiratory hospitalizations during influenza seasons in Ontario, Canada: a cohort study. Clin Infect Dis. 2011, 53: 413-421. 10.1093/cid/cir442.CrossRefPubMedPubMedCentral
18.
Viasus D, Paño-Pardo JR, Pachón J, Campins A, López-Medrano F, Villoslada A, Fariñas MC, Moreno A, Rodríguez-Baño J, Oteo JA, Martínez-Montauti J, Torre-Cisneros J, Segura F, Gudiol F, Carratalà J, Novel Influenza A (H1N1) Study Group of the Spanish Network for Research in Infectious Diseases (REIPI): Factors associated with severe disease in hospitalized adults with pandemic (H1N1) 2009 in Spain. Clin Microbiol Infect. 2011, 17: 738-746. 10.1111/j.1469-0691.2010.03362.x.CrossRefPubMed
19.
Phung D, Wang Z: Risk of pneumonia in relation to body mass index in Australian Aboriginal people. Epidemiol Infect. 2013, 141: 2497-2502. 10.1017/S0950268813000605.CrossRefPubMed
20.
LaCroix AZ, Lipson S, Miles TP, White L: Prospective study of pneumonia hospitalizations and mortality of U.S. older people: the role of chronic conditions, health behaviors, and nutritional status. Public Health Rep. 1989, 104: 350-360.PubMedPubMedCentral
21.
Salive ME, Satterfield S, Ostfeld AM, Wallace RB, Havlik RJ: Disability and cognitive impairment are risk factors for pneumonia-related mortality in older adults. Public Health Rep. 1993, 108: 314-322.PubMedPubMedCentral
22.
Lange P, Vestbo J, Nyboe J: Risk factors for death and hospitalization from pneumonia. A prospective study of a general population. Eur Respir J. 1995, 8: 1694-1698. 10.1183/09031936.95.08101694.CrossRefPubMed
23.
Inoue Y, Koizumi A, Wada Y, Iso H, Watanabe Y, Date C, Yamamoto A, Kikuchi S, Inaba Y, Toyoshima H, Tamakoshi A: Risk and protective factors related to mortality from pneumonia among middleaged and elderly community residents: the JACC study. J Epidemiol. 2007, 17: 194-202. 10.2188/jea.17.194.CrossRefPubMed
24.
Takata Y, Ansai T, Soh I, Akifusa S, Sonoki K, Fujisawa K, Awano S, Kagiyama S, Hamasaki T, Nakamichi I, Yoshida A, Takehara T: Association between body mass index and mortality in an 80-year-old population. J Am Geriatr Soc. 2007, 55: 913-917. 10.1111/j.1532-5415.2007.01170.x.CrossRefPubMed
25.
Corrales-Medina VF, Valayam J, Serpa JA, Rueda AM, Musher DM: The obesity paradox in community-acquired bacterial pneumonia. Int J Infect Dis. 2011, 15: e54-e57. 10.1016/j.ijid.2010.09.011.CrossRefPubMed
26.
King P, Mortensen EM, Bollinger M, Restrepo MI, Copeland LA, Pugh MJ, Nakashima B, Anzueto A, Hitchcock NP: Impact of obesity on outcomes for patients hospitalised with pneumonia. Eur Respir J. 2013, 41: 929-934. 10.1183/09031936.00185211.CrossRefPubMed
27.
Kahlon S, Eurich DT, Padwal RS, Malhotra A, Minhas-Sandhu JK, Marrie TJ, Majumdar SR: Obesity and outcomes in patients hospitalized with pneumonia. Clin Microbiol Infect. 2013, 19: 709-716. 10.1111/j.1469-0691.2012.04003.x.CrossRefPubMed
28.
Singanayagam A, Singanayagam A, Chalmers JD: Obesity is associated with improved survival in community-acquired pneumonia. Eur Respir J. 2013, 42: 180-187. 10.1183/09031936.00115312.CrossRefPubMed
29.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB: Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000, 283: 2008-2012. 10.1001/jama.283.15.2008.CrossRefPubMed
30.
31.
Greenland S, Longnecker MP: Methods for trend estimation from summarized dose–response data, with applications to meta-analysis. Am J Epidemiol. 1992, 135: 1301-1309.PubMed
32.
Orsini N, Greenland S: A procedure to tabulate and plot results after flexible modeling of a quantitative covariate. Stata J. 2011, 11: 1-29.
33.
White IR: Multivariate random-effects meta-analysis. Stata J. 2009, 9: 40-56.
34.
Orsini N, Li R, Wolk A, Khudyakov P, Spiegelman D: Meta-analysis for linear and nonlinear dose–response relations: examples, an evaluation of approximations, and software. Am J Epidemiol. 2012, 175: 66-73. 10.1093/aje/kwr265.CrossRefPubMed
35.
Jee SH, Sull JW, Park J, Lee SY, Ohrr H, Guallar E, Samet JM: Body-mass index and mortality in Korean men and women. N Engl J Med. 2006, 355: 779-787. 10.1056/NEJMoa054017.CrossRefPubMed
36.
Phung DT, Wang Z, Rutherford S, Huang C, Chu C: Body mass index and risk of pneumonia: a systematic review and meta-analysis. Obes Rev. 2013, 14: 839-857. 10.1111/obr.12055.CrossRefPubMed
37.
Lagergren J: Influence of obesity on the risk of esophageal disorders. Nat Rev Gastroenterol Hepatol. 2011, 8: 340-347. 10.1038/nrgastro.2011.73.CrossRefPubMed
38.
Almirall J, Bolíbar I, Serra-Prat M, Roig J, Hospital I, Carandell E, Agustí M, Ayuso P, Estela A, Torres A, Community-Acquired Pneumonia in Catalan Countries (PACAP) Study Group: New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J. 2008, 31: 1274-1284. 10.1183/09031936.00095807.CrossRefPubMed
39.
Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT: Diabetes, glycemic control, and risk of hospitalization with pneumonia:a population-based case–control study. Diabetes Care. 2008, 31: 1541-1545. 10.2337/dc08-0138.CrossRefPubMedPubMedCentral
40.
Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E, Pilz S, Hiraki LT, Cooper JD, Dastani Z, Li R, Houston DK, Wood AR, Michaëlsson K, Vandenput L, Zgaga L, Yerges-Armstrong LM, McCarthy MI, Dupuis J, Kaakinen M, Kleber ME, Jameson K, Arden N, Raitakari O, Viikari J, Lohman KK, Ferrucci L, Melhus H, Ingelsson E, Byberg L, Lind L, Lorentzon M, et al: Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013, 10: e1001383-10.1371/journal.pmed.1001383.CrossRefPubMedPubMedCentral
41.
Aregbesola A, Voutilainen S, Nurmi T, Virtanen JK, Ronkainen K, Tuomainen TP: Serum 25-hydroxyvitamin D3 and the risk of pneumonia in an ageing general population. J Epidemiol Community Health. 2013, 67: 533-536. 10.1136/jech-2012-202027.CrossRefPubMed
42.
Mancuso P: Obesity and respiratory infections: does excess adiposity weigh down host defense?. Pulm Pharmacol Ther. 2013, 26: 412-419. 10.1016/j.pupt.2012.04.006.CrossRefPubMed
43.
Ozata M, Ozdemir IC, Licinio J: Human leptin deficiency caused by a missense mutation: multiple endocrine defects, decreased sympathetic tone, and immune system dysfunction indicate new targets for leptin action, greater central than peripheral resistance to the effects of leptin, and spontaneous correction of leptin-mediated defects. J Clin Endocrinol Metab. 1999, 84: 3686-3695. 10.1210/jcem.84.10.5999.CrossRefPubMed
44.
Myers MG, Leibel RL, Seeley RJ, Schwartz MW: Obesity and leptin resistance: distinguishing cause from effect. Trends Endocrinol Metab. 2010, 21: 643-651. 10.1016/j.tem.2010.08.002.CrossRefPubMedPubMedCentral
45.
Goel K, Lopez-Jimenez F, De Schutter A, Coutinho T, Lavie CJ: Obesity paradox in different populations: evidence and controversies. Future Cardiol. 2014, 10: 81-91. 10.2217/fca.13.84.CrossRefPubMed
46.
Puren AJ, Feldman C, Savage N, Becker PJ, Smith C: Patterns of cytokine expression in community-acquired pneumonia. Chest. 1995, 107: 1342-1349. 10.1378/chest.107.5.1342.CrossRefPubMed
47.
Mohamed-Ali V, Goodrick S, Bulmer K, Holly JM, Yudkin JS, Coppack SW: Production of soluble tumor necrosis factor receptors by human subcutaneous adipose tissue in vivo. Am J Physiol. 1999, 277: E971-E975.PubMed
48.
van de Garde EM, Oosterheert JJ, Bonten M, Kaplan RC, Leufkens HG: International classification of diseases codes showed modest sensitivity for detecting community-acquired pneumonia. J Clin Epidemiol. 2007, 60: 834-838. 10.1016/j.jclinepi.2006.10.018.CrossRefPubMed
Metadata
Title
Obesity survival paradox in pneumonia: a meta-analysis
Authors
Wei Nie
Yi Zhang
Sun Ha Jee
Keum Ji Jung
Bing Li
Qingyu Xiu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2014
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-12-61

Other articles of this Issue 1/2014

BMC Medicine 1/2014 Go to the issue

Commentary

The atrial fibrillation epidemic is approaching the physician's door: will mobile technology improve detection?

Research article

Drugs affecting the renin-angiotensin system and survival from cancer: a population based study of breast, colorectal and prostate cancer patient cohorts

Research article

There are no randomized controlled trials that support the United States Preventive Services Task Force guideline on screening for depression in primary care: a systematic review

Research article

Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion

Research article

The burden of disease in Spain: results from the global burden of disease study 2010

Commentary

Helping women to good health: breast cancer, omega-3/omega-6 lipids, and related lifestyle factors