EAL

Recommendations Summary

Search Plan and Results

Evidence Analysis Question(s)

What effect does body weight have on mortality outcomes in adults with COPD?

What effect does body weight have on lung function outcomes in adults with COPD?

What effect does body composition have on lung function outcomes in adults with COPD?

What effect does body composition have on mortality outcomes in adults with COPD?

Date of Literature Review

December 2017

Inclusion Criteria

Age

Adults 18 years and older.

Setting

All settings, except critical care.

Health Status

With or without supplemental oxygen

With or without home bilevel positive airway pressure (BiPAP).

Nutrition-Related Problem or Condition

COPD, COPD with comorbid conditions (studies that include COPD with comorbidities must focus on COPD)

All COPD stages and source of diagnosis.

Study Design Preferences

Randomized controlled trials (RCT) or clinical controlled studies

Large non-randomized observational studies

Cohort, case-control studies.

Intervention

If lung function was a primary outcome, it must be measured by spirometry

Primary aim of study was body weight or composition in relation to COPD outcome

Body weight or composition is the primary independent variable outcome (not the primary predictor)

Body weight or composition was not included as a confounder

BMI in body mass index, airflow obstruction, dyspnea and exercise capacity (BODE) must be reported separately from other components of BODE.

Outcomes

Includes one or both outcomes of interest:

Mortality

Lung function or respiratory impairment.

Year Range

2005 to December 31, 2017. (Original year range included studies published in 2000 through December 31, 2017. Studies published prior to 2005 were later excluded by the workgroup.)

Size of Study Groups

Sample size must equal 10 for each study group (e.g., 10 patients in intervention group and 10 patients in control or comparison group).

Authorship

If an author is included on more than one review article or primary research article that is similar in content, the most recent review or article will be accepted and earlier versions will be rejected

If an author is included on more than on review article or primary research article and the content is different, then both reviews may be accepted.

Language

English.

Subjects

Human.

Publication

Published in a peer-reviewed journal.

Exclusion Criteria

Age: Young adults up to 18 years of age, infants, children and adolescents

Setting: Critical care (e.g., intensive care unit)

Health status: Mechanical ventilation.

Nutrition-Related Problem or Condition

Fibrosis (without COPD)

Sarcoidosis (without COPD)

Asthma (without COPD)

Asthma-COPD Overlap Syndrome

Chronic Systemic Inflammatory Syndrome (without COPD)

Lung condition that is not COPD

Prevention of COPD in cohort of patients with no COPD

No comorbid conditions excluded. Studies that include COPD with comorbidities that do not focus on COPD are excluded.

Study Designs

Review article; meta-analysis (relevant review articles will be hand-searched)

Not a research study

Poster session

Commentary

Letter to editor

“Grey” literature: Technical reports from government agencies or scientific research groups, working papers from research groups or committees, white papers, position papers, abstracts, conference reports or pre-prints.

Cross-sectional studies (Originally, cross-sectional studies were included, but the workgroup later excluded them).

Intervention

Body weight or composition was only included as a covariate in a regression model (regression that leads to relative risk of COPD or COPD severity vs. length of stay, mortality, etc.)

Body weight or composition was not the primary independent variable outcome (not the primary predictor)

Body weight or composition was included as a confounder and therefore not powered to assess relationships between body weight or composition and COPD outcomes

BMI in BODE was not reported separately from other components of BODE

Not a measure of body composition (e.g., muscle strength, bone density).

Outcomes

Does not report on at least one outcome of interest.

Size of Study Groups

Less than 10 subjects for each study group

Subject number is unclear or not reported.

Year Range

Published prior to 2005.

Authorship

Studies by same author similar in content.

Language

Not in English.

Subjects

Animal studies.

Publication

Not published in a peer-reviewed journal.

Search Terms: Search Vocabulary

Condition

COPD.

Population

Adults.

Intervention or Treatment

Body weight, body mass index; BMI; weight change; weight reduction; weight gain, weight loss

Waist circumference; body mass; lean body mass; fat free mass; lean body weight; body fat, body composition.

Electronic Databases

Pubmed
3, 163 citations, removed duplicates and 3, 205 added to Rayyan (in addition to 185 already there)
Updated February 16 to December 31, 2017
439 new records retrieved.

(((((((((((((("fat free mass" or "lean body mass" or "lean body weight" or "fat free body weight" or "waist circumference" or "weight changes"[Title/Abstract] OR "weight loss"[Title/Abstract] OR "weight gain"[Title/Abstract] OR "body weight"[Title/Abstract] OR "body mass index"[Title/Abstract] OR bmi[Title/Abstract] OR "body composition"[Title/Abstract] OR "body fat"[Title/Abstract]))) OR (("Weight Loss"[Mesh]) OR "Waist Circumference"[Mesh])) OR (("Body Composition"[Mesh] OR "Body Weight"[Mesh] OR"Body Weight Changes"[Mesh] or "Body Mass Index"[Mesh])))) AND ((((("Pulmonary Disease, Chronic Obstructive"[Mesh]) OR "COPD, Severe Early-Onset" [Supplementary Concept]) OR "Lung Diseases, Obstructive"[Mesh])) OR ((("Chronic Obstructive Pulmonary Disease"[Title/Abstract]) OR copd[Title/Abstract]) OR "Obstructive lung Disease"[Title/Abstract])))) AND ( "2000/01/01"[PDat] : "2017/12/31"[PDat] ) AND English[lang]))))) AND ( "2000/01/01"[PDat] : "2017/12/31"[PDat] ) AND English[lang]))) AND ((("Adult"[Mesh] or "adult"[Title/Abstract] or "adults"[Title/Abstract)) NOT (animals [mh] NOT humans [mh]))

Embase
4, 375 citations, removed Medline records, 402 citations uploaded to Rayyan
February 16 to December 31, 2017
Retrieved 553 articles, 64 unique articles

exp body weight/ or exp weight reduction/ or exp weight gain/

exp body mass/ or exp waist circumference/ or exp body fat/ or exp body distribution/ or exp body composition/

((weight adj1 (body or change* or loss* or gain*)) or (body adj1 (fat or mass or composition)) or (waist adj1 circumference) or (mass adj1 (fat or lean)) or bmi).ti, ab.

or/1-3

exp chronic obstructive lung disease/

(obstructive adj1 ((lung or pulmonary) adj1 disease*)).ti, ab.

copd.ti, ab.

or/5-7

exp adult/

adult*.ti, ab.

or/9-10

animal/ not human/

11 not 12

4 and 8 and 13

limit 14 to (english language and yr="2000 -Current")

limit 15 to exclude medline journal.

CINAHL
1, 058 articles, 229 unique records

((MH "Body Weight+") OR (MH "Body Weight Changes+") OR (MH "Body Composition+") OR (MH "Waist Circumference") OR (MH "Waist-Hip Ratio") ) OR TI ( ((weight n1 (body or change* or loss* or gain*)) or (body n1 (fat or mass or composition)) or (waist n1 circumference) or (mass n1 (fat or lean)) or bmi) ) OR AB ( ((weight n1 (body or change* or loss* or gain*)) or (body n1 (fat or mass or composition)) or (waist n1 circumference) or (mass n1 (fat or lean)) or bmi))

List of Included Articles

Abston E, Comellas A, Reed RM, Kim V, Wise RA, Brower R, Fortis S, Beichel R, Bhatt S, Zabner J, Newell J, Hoffman EA, Eberlein M. Higher BMI is associated with higher expiratory airflow normalised for lung volume (FEF25-75/FVC) in COPD. BMJ Open Respir Res. 2017 Oct 13; 4 (1): e000231. doi: 10.1136/bmjresp-2017-000231. eCollection 2017. PMID: 29071083.
Baccioglu A, Gulbay BE, Acican T. Body composition in patients with stable chronic obstructive pulmonary disease: comparison with malnutrition in healthy smokers. Eurasian J Med. 2014 Oct; 46 (3): 169-175. doi: 10.5152/eajm.2014.46. Epub 2014 Aug 26. PMID: 25610320.
Dimov D, Tacheva T, Koychev A, Ilieva V, Prakova G, Vlaykova T. Obesity in Bulgarian patients with chronic obstructive pulmonary disease. Chron Respir Dis. 2013; 10 (4): 215-222. doi: 10.1177/1479972313504940. Epub 2013 Sep 26. PMID: 24072750.
Galesanu RG, Bernard S, Marquis K, Lacasse Y, Poirier P, Bourbeau J, Maltais F. Obesity in chronic obstructive pulmonary disease: is fatter really better? Can Respir J. 2014 Sep-Oct; 21 (5): 297-301. Epub 2014 May 2. PMID: 24791257.
Hallin R, Gudmundsson G, Suppli Ulrik C, et al. Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD). Respir Med. 2007; 101 (9): 1, 954-1, 960. PMID: 17532198 DOI: 10.1016/j.rmed.2007.04.009.
Jiang J, Zhao J, Yuan Y, Di S. Risk factors associated with acute exacerbation of chronic obstructive pulmonary disease: A retrospective analysis in 4624 patients. Biomedical Research. 2017; 28 (9): 3, 855-3, 859.
Koul PA, Dar HA, Jan RA, Shah S, Khan UH. Two-year mortality in survivors of acute exacerbations of chronic obstructive pulmonary disease: A North Indian study. Lung India. 2017 Nov-Dec; 34 (6): 511-516. doi: 10.4103/lungindia.lungindia_41_17. PMID: 29098995.
Lainscak M, von Haehling S, Doehner W, Sarc I, Jeric T, Ziherl K, Kosnik M, Anker SD, Suskovic S. Body mass index and prognosis in patients hospitalized with acute exacerbation of chronic obstructive pulmonary disease. J Cachexia Sarcopenia Muscle. 2011 Jun; 2 (2): 81-86. Epub 2011 Mar 1. PMID: 21766053.
Marti S, Muñoz X, Rios J, Morell F, Ferrer J.Body weight and comorbidity predict mortality in COPD patients treated with oxygen therapy. Eur Respir J. 2006 Apr; 27 (4): 689-696. PMID: 16585077.
O'Donnell DE, Deesomchok A, Lam YM, Guenette JA, Amornputtisathaporn N, Forkert L, Webb KA. Effects of BMI on static lung volumes in patients with airway obstruction. Chest. 2011 Aug; 140 (2): 461-468. doi: 10.1378/chest.10-2582. Epub 2011 Feb 10. PMID: 21310838.
Piquet J, Chavaillon JM, David P, Martin F, Blanchon F, Roche N; French College of General Hospital Respiratory Physicians (CPHG). High-risk patients following hospitalisation for an acute exacerbation of COPD. Eur Respir J. 2013 Oct; 42 (4): 946-955. doi: 10.1183/09031936.00180312. Epub 2013 Jan 24. PMID: 23349446.
Pothirat C, Phetsuk N, Deesomchok A, Theerakittikul T, Bumroongkit C, Liwsrisakun C, Inchai J. Clinical characteristics, management in real world practice and long-term survival among COPD patients of Northern Thailand COPD club members. J Med Assoc Thai. 2007 Apr; 90 (4): 653-662. PMID: 17487118.
Qiu T, Tang YJ, Xu ZB, Xu D, Xiao J, Zhang MK, Feng YL, Wang K. Association between body mass index and pulmonary function of patients with chronic obstructive pulmonary disease. Chin Med J (Engl). 2009 May 5; 122 (9): 1, 110-1, 111. No abstract available. PMID: 19493450.
Ranieri P, Bianchetti A, Margiotta A, Virgillo A, Clini EM, Trabucchi M. redictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation. J Am Geriatr Soc. 2008 May; 56 (5): 909-913. doi: 10.1111/j.1532-5415.2008.01683.x. Epub 2008 Apr 1. PMID: 18384582.
Rutten EP, Calverley PM, Casaburi R, Agusti A, Bakke P, Celli B, Coxson HO, Crim C, Lomas DA, Macnee W, Miller BE, Rennard SI, Scanlon PD, Silverman EK, Tal-Singer R, Vestbo J, Watkins ML, Wouters EF. Changes in body composition in patients with chronic obstructive pulmonary disease: do they influence patient-related outcomes? Ann Nutr Metab. 2013; 63 (3): 239-247. doi: 10.1159/000353211. Epub 2013 Nov 7. PMID: 24216978.
Schols AM, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005 Jul; 82 (1): 53-59. PMID: 16002800.
Slinde F, Grönberg A, Engström CP, Rossander-Hulthén L, Larsson S. Body composition by bioelectrical impedance predicts mortality in chronic obstructive pulmonary disease patients. Respir Med. 2005 Aug; 99 (8): 1, 004-1, 009. Epub 2005 Apr 12. PMID: 15950141.
Tsimogianni AM, Papiris SA, Stathopoulos GT, Manali ED, Roussos C, Kotanidou A. Predictors of outcome after exacerbation of chronic obstructive pulmonary disease. J Gen Intern Med. 2009 Sep; 24 (9): 1, 043-1, 048. doi: 10.1007/s11606-009-1061-2. Epub 2009 Jul 14. PMID: 19597892.
Uh ST, Lee JY, Koo SM, Kim YK, Kim KU, Park JS, Park SW, Jang AS, Kim DJ, Choi JS, Na JO, Suh KH, Kim YH, Park CS. The Survival Rate of Korean Patients with COPD with or without Acute Exacerbations. Tuberc Respir Dis. 2011 Jun; 70 (6): 474-481.
Yamauchi Y, Hasegawa W, Yasunaga H, Sunohara M, Jo T, Takami K, Matsui H, Fushimi K, Nagase T. Paradoxical association between body mass index and in-hospital mortality in elderly patients with chronic obstructive pulmonary disease in Japan. Int J Chron Obstruct Pulmon Dis. 2014 Dec 9; 9: 1, 337-1, 346. doi: 10.2147/COPD.S75175. eCollection 2014. PMID: 25525351.
Zapatero A, Barba R, Ruiz J, Losa JE, Plaza S, Canora J, Marco J. Malnutrition and obesity: influence in mortality and readmissions in chronic obstructive pulmonary disease patients. J Hum Nutr Diet. 2013 Jul; 26 Suppl 1: 16-22. doi: 10.1111/jhn.12088. Epub 2013 May 9. PMID: 23656492.

Articles Considered, but Excluded

List of Excluded Articles with Reason

The Body Weight and Composition topic consists of 568 excluded articles. Download the entire list of articles and reasons for exclusion.

Search Methods and Results

Identification

Articles Identified Through Database Searching: 9588
Additional Articles Identified Through Other Sources: 8

Screening

Articles Screened After Removing Duplicates: 4323
Articles Excluded During the Screening Process: 3733

Eligibility

Full-text Articles Assessed for Eligibility: 589
Full-text Articles Excluded: 568

Included

Articles Included in Qualitative Synthesis: 21
Articles Included in Quantitative Synthesis (Meta-analysis): 0