U-shaped relationship between weight-adjusted waist index and acute exacerbation of chronic obstructive pulmonary disease in critically ill patients

Mengyuan Qiao; Yingyang Li; Pan Liu; Yanhua Liu; Niuniu Sun; Mengzhen Qin; Haiyan Wang

doi:10.1016/j.hrtlng.2025.06.007

U-shaped relationship between weight-adjusted waist index and acute exacerbation of chronic obstructive pulmonary disease in critically ill patients

Heart Lung. 2025 Jun 26:74:42-48. doi: 10.1016/j.hrtlng.2025.06.007. Online ahead of print.

Authors

Mengyuan Qiao¹, Yingyang Li², Pan Liu¹, Yanhua Liu¹, Niuniu Sun¹, Mengzhen Qin³, Haiyan Wang⁴

Affiliations

¹ School of nursing, Henan University of Science and Technology, Luoyang 471023, China.
² The First Affiliated Hospital of Henan University of Science and Technology, Luoyang 471003, China.
³ People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China.
⁴ People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China. Electronic address: 15660638558@163.com.

PMID: 40578019
DOI: 10.1016/j.hrtlng.2025.06.007

Abstract

Background: The relationship between obesity and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has long been a topic of interest, and the newly introduced weight-adjusted waist circumference index (WWI) has better stability in differentiating between visceral fat and muscle mass. However, the relationship between WWI and AECOPD is unclear.

Objective: To investigate the potential relationship between WWI and AECOPD in critically ill patients.

Methods: A total of 986 participants with COPD were included in the present study. The relationship between WWI and AECOPD was explored using logistic regression, subgroup analyses, smoothed curve fitting, and threshold effect analysis models.

Results: As a continuous variable, the risk of AECOPD increased by 23.0 % for each unit increase in WWI. When WWI was used as a categorical variable, the risk of AECOPD increased by 62 % at the fourth quartile of WWI compared with the first quartile. In the adjusted model, potential nonlinear relationships were analyzed by smoothed curve fitting and saturated threshold effects, and a U-shaped relationship between WWI and risk of AECOPD was found, with an inflection point of 9.77. Before the inflection point, WWI was negatively associated with AECOPD; after the inflection point, they were positively associated. In the subgroup analyses, the relationship between WWI and AECOPD risk remained stable after adjustment for all covariates considered.

Conclusion: There is a U-shaped relationship between WWI and AECOPD, with both lower and higher levels of WWI increasing the risk of disease progression in patients with AECOPD.

Keywords: Critical care; U-shaped relationship; Visceral obesity; Weight-adjusted waist index.