Recategorisation of body mass index to achieve andrological predictive power: a study in more than 20 000 patients

2020 ◽  
Vol 32 (7) ◽  
pp. 648 ◽  
Author(s):  
Nicolás Ramírez ◽  
Rosa Inés Molina ◽  
Andrea Tissera ◽  
Eugenia Mercedes Luque ◽  
Pedro Javier Torres ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Analysis Of Variance ◽  
Predictive Power ◽  
Linear Models ◽  
Semen Quality ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Chi Squared ◽  
Underweight Patients

The aim of this study was to recategorise body mass index (BMI) in order to classify patients according to their risk of semen abnormalities. Patients (n=20563) presenting at an andrology laboratory were classified into five groups according to BMI: underweight (BMI <20kg m−2), normal weight (BMI 20–24.9kg m−2), overweight (BMI 25–29.9kg m−2), obese (BMI 30–39.9kg m−2) and morbidly obese (BMI >40kg m−2). Semen quality was evaluated to determine: (1) differences between groups using analysis of variance (ANOVA); (2) the chances of semen abnormalities (using generalised linear models, Chi-squared tests and odds ratios); (3) reference BMI values with andrological predictive power (multivariate conglomerate analyses and multivariate analysis of variance (MANOVA)); and (4) expected values of abnormalities for each new group resulting from BMI recategorisation. Morbidly obese and underweight patients exhibited the highest decrease in semen quality and had higher chances of semen abnormalities. The smallest number of sperm abnormalities was found at a BMI of 27kg m−2. Four reference values were identified, recategorising BMI into four groups according to their risk of semen abnormalities (from lowest to highest risk): Group1,BMI between 20 and 32kg m−2; Group2, BMI <20 and BMI >32–37kg m−2; Group3, BMI >37–42kg m−2; and Group4, BMI >42kg m−2. A BMI <20 or >32kg m−2 is negatively associated with semen quality; these negative associations on semen quality increase from a BMI >37kg m−2 and increase even further for BMI >42kg m−2. The BMI recategorisation in this study has andrological predictive power.

Appendicitis, Body Mass Index, and CT: Is CT More Valuable for Obese Patients than Thin Patients?

2011 ◽  
Vol 77 (4) ◽  
pp. 471-475 ◽  
Author(s):  
Courtney A. Coursey ◽  
Rendon C. Nelson ◽  
Ricardo D. Moreno ◽  
Mayur B. Patel ◽  
Craig A. Beam ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Negative Appendectomy ◽  
Obese Patients ◽  
Procedure Code ◽  
Preoperative Ct ◽  
The Difference ◽  
Underweight Patients

The purpose of our study is to determine whether body mass index (BMI = weight in kg/height in meters2) was related to the rate of negative appendectomy in patients who underwent preoperative CT. A surgical database search performed using the procedure code for appendectomy identified 925 patients at least 18 years of age who underwent urgent appendectomy between January 1998 and September 2007. BMI was computed for the 703 of these 925 patients for whom height and weight information was available. Patients were stratified based on body mass index (BMI 15-18.49 = underweight; 18.5-24.9 = normal weight; 25–29.9 = overweight; 30-39.9 = obese; > 40 = morbidly obese). Negative appendectomy rates were computed. Negative appendectomy rates for patients who did and did not undergo preoperative CT were 27 per cent and 50 per cent for underweight patients, 10 per cent and 15 per cent for normal weight patients, 12 per cent and 17 per cent for overweight patients, 7 per cent and 30 per cent for obese patients, and 10 per cent and 100 per cent for morbidly obese patients. The difference in negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT as compared with patients in the same BMI category who did not undergo preoperative CT was statistically significant ( P ≤ 0.001). The negative appendectomy rates for overweight patients, obese patients, and morbidly obese patients who underwent preoperative CT were significantly lower than for patients in these same BMI categories who did not undergo preoperative CT.

scholarly journals Does Body Mass Index Affect Mortality in Coronary Surgery?

2016 ◽  
Vol 10 (1) ◽  
pp. 240-245 ◽  
Author(s):  
Aristotle D. Protopapas
Keyword(s):  
Body Mass Index ◽  
Morbid Obesity ◽  
Body Mass ◽  
Artery Bypass ◽  
Normal Weight ◽  
The Body ◽  
Morbidly Obese ◽  
Coronary Surgery ◽  
Crude Mortality ◽  
Underweight Patients

Introduction: The Body Mass Index (BMI) quantifies nutritional status and classifies humans as underweight, of normal weight, overweight, mildly obese, moderately obese or morbidly obese. Obesity is the excessive accumulation of fat, defined as BMI higher than 30 kg/m2. Obesity is widely accepted to complicate anaesthesia and surgery, being a risk factor for mediastinitis after coronary artery bypass grafting (CABG). We sought the evidence on operative mortality of CABG between standard BMI groups. Materials and Methodology: A simple literature review of papers presenting the mortality of CABG by BMI group: Underweight (BMI ≤ 18.49 kg/m2), normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0–29.9 kg/m2), mild obesity (BMI 30.0–34.9 kg/m2), moderate obesity (BMI 35.0–39.9 kg/m2), or morbid obesity (BMI ≥ 40.0 kg/m2). Results: We identified 18 relevant studies with 1,027,711 patients in total. Their variability in size of samples and choice of BMI groups precluded us from attempting inferential statistics. The overall cumulative mortality was 2.7%. Underweight patients had by far the highest mortality (6.6%). Overweight patients had the lowest group mortality (2.1%). The group mortality for morbidly obese patients was 3.44%. Discussion: Patients with extreme BMI’s undergoing CABG (underweight ones more than morbidly obese) suffer increased crude mortality. This simple observation indicates that under nutrition and morbid obesity need be further explored as risk factors for coronary surgery.

scholarly journals ASSOCIATION OF GASTROESOPHAGEAL REFLUX SYMPTOMS (FREQUENCY AND SEVERITY) WITH BODY MASS INDEX IN FEMALES WITH GASTROESOPHAGEAL REFLUX DISEASE

2020 ◽  
Vol 11 (3) ◽  
pp. 9-16
Author(s):  
Arshad Rabbani ◽  
Benish Adil ◽  
Ramsha Ghazal Arshad
Keyword(s):  
Body Mass Index ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Body Mass ◽  
Reflux Disease ◽  
Hormone Replacement ◽  
Normal Weight ◽  
Morbidly Obese ◽  
Cross Sectional ◽  
Reflux Symptoms

ABSTRACT BACKGROUND & OBJECTIVE: Overweight individuals have a greater tendency to develop gastroesophageal reflux disease (GERD). This study aims at comparing gastroesophageal reflux symptoms (frequency and severity) in females with different body mass index (BMI) categories. METHODOLOGY: This cross-sectional comparative research study was conducted over duration of 8 months. Both indoor and outdoor patients of medical unit – II Benazir Bhutto Hospital, Rawalpindi, fulfilling the inclusion criteria i.e. females 30-55 years of age with confirmed diagnosis of GERD and informed consent were included. Subjects with history of cigarette smoking, diabetes, use of postmenopausal hormone replacement therapy (HRT), anti-hypertensive or asthma medication were all excluded. Data were collected via proforma and analyzed on SPSS version 17. RESULTS: Among 360 enrolled women, 08 (2.2%) subjects were underweight, 109 (30.3%) had normal BMI, 151 (41.9%) were overweight, 88 (24.4%) subjects were obese and 04 (1.1%) belonged to morbidly obese group. Among 109 subjects with normal BMI, 53 (48.6%) had mild, 40 (36.69%) moderate, 13 (11.9%) severe and 03 (2.75%) very severe GERD. Among 151 overweight subjects, 37 (24.50%) were with mild severity, 64 (42.38%) with moderate, 35 (23.17%) severe and 15 (9.93%) had very severe GERD. Among 04 morbidly obese subjects, 02 (50%) had severe while remaining 02 (50%) had very severe GERD (p=0.000). CONCLUSION: Association of GERD symptoms and BMI were found in both normal and overweight women. Reflux symptoms may be exacerbated or even caused by moderate weight gain in people with normal weight.

Abstract 15842: Body Mass Index in Covid-19: An Independent Risk Factor for Severe Infections

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jeanne du Fay de Lavallaz ◽  
Setri Fugar ◽  
Joanne Michelle M Gomez ◽  
Sean Swearingen ◽  
Gianna Bosco ◽  
...  
Keyword(s):  
Body Mass ◽  
Normal Weight ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Multivariable Logistic Regression Analysis ◽  
Morbidly Obese ◽  
Class Iii ◽  
Obesity Class ◽  
Increased Risk ◽  
Underweight Patients

Introduction: The coronavirus disease 2019 (COVID-19) led to a global pandemic. Comorbidities such as hypertension, diabetes mellitus, elevated cholesterol, cardiac/pulmonary diseases, and obesity were postulated as prognostic factors for a worse outcome. Hypothesis: Obese COVID-19 patients have a worse prognosis. Methods: From March to June 2020, we obtained data on all patients ≥18 y.o. who were admitted with a positive COVID-19 test at the Rush System, Chicago. Multivariable logistic regression analysis was performed between predictors and a composite outcome of intubation and in-hospital mortality. Results: Among the 1345 admitted patients, 69 (5%) were underweight (BMI<18.5kg/m2), 365 (27%) of normal weight (BMI 18.5-25kg/m2), 405 (30%) overweight (BMI 25-30kg/m2), 258 (19%) of obesity class I (BMI 30-35kg/m2), 119 (9%) of obesity class II (BMI 35-40kg/m2) and 129 (10%) of obesity class III (BMI >40kg/m2). In a multivariable model assessing the risk for the in-hospital death or intubation, underweight patients showed decreased risk (odds ratio (OR) 0.31) while obesity class III patients showed increased risk (OR 1.68, Figure 1) when compared to normal BMI. When accounting for obesity classes, male sex, atrial fibrillation and coronary artery disease were also independent predictors adverse outcomes. Conclusions: Consistent with previous research, morbidly obese patients had a higher risk for a worse outcome, even when accounting for numerous comorbidities. Underweight patients appeared to be protected. Higher body mass leads to inherent changes in lung function, increased risk of thrombosis, greater viral replication, higher release of adipokines and higher inflammation. Inversely, fewer adipocytes could possibly limit the risk for cytokine storm by reducing the amount of proinflammatory factors released. Figure: Odds ratios with 95% confidence intervals for the outcome of death or intubation in all COVID-19 positive admitted patients.

scholarly journals Effect of Body Mass Index on Outcomes of Peritoneal Dialysis Patients in India

2014 ◽  
Vol 34 (4) ◽  
pp. 399-408 ◽  
Author(s):  
Narayan Prasad ◽  
Archana Sinha ◽  
Amit Gupta ◽  
Raj Kumar Sharma ◽  
Dharmendra Bhadauria ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Peritoneal Dialysis ◽  
Body Mass ◽  
Patient Survival ◽  
Normal Weight ◽  
Obese Patients ◽  
Reference Category ◽  
Technique Survival ◽  
Patients With Diabetes ◽  
Underweight Patients

ObjectivesWe studied the effect of body mass index (BMI) at peritoneal dialysis (PD) initiation on patient and technique survival and on peritonitis during follow-up.MethodsWe followed 328 incident patients on PD (176 with diabetes; 242 men; mean age: 52.6 ± 12.6 years; mean BMI: 21.9 ± 3.8 kg/m2) for 20.0 ± 14.3 months. Patients were categorized into four BMI groups: obese, ≥25 kg/m2; overweight, 23 – 24.9 kg/m2; normal, 18.5 – 22.9 kg/m2(reference category); and underweight, <18.5 kg/m2. The outcomes of interest were compared between the groups.ResultsOf the 328 patients, 47 (14.3%) were underweight, 171 (52.1%) were normal weight, 53 (16.2%) were overweight, and 57 (17.4%) were obese at commencement of PD therapy. The crude hazard ratio (HR) for mortality ( p = 0.004) and the HR adjusted for age, subjective global assessment, comorbidities, albumin, diabetes, and residual glomerular filtration rate ( p = 0.02) were both significantly greater in the underweight group than in the normal-weight group. In comparison with the reference category, the HR for mortality was significantly greater for underweight PD patients with diabetes [2.7; 95% confidence interval (CI): 1.5 to 5.0; p = 0.002], but similar for all BMI categories of nondiabetic PD patients. Median patient survival was statistically inferior in underweight patients than in patients having a normal BMI. Median patient survival in underweight, normal, overweight, and obese patients was, respectively, 26 patient–months (95% CI: 20.9 to 31.0 patient–months), 50 patient–months (95% CI: 33.6 to 66.4 patient–months), 57.7 patient–months (95% CI: 33.2 to 82.2 patient–months), and 49 patient–months (95% CI: 18.4 to 79.6 patient–months; p = 0.015). Death-censored technique survival was statistically similar in all BMI categories. In comparison with the reference category, the odds ratio for peritonitis occurrence was 1.8 (95% CI: 0.9 to 3.4; p = 0.086) for underweight patients; 1.7 (95% CI: 0.9 to 3.2; p = 0.091) for overweight patients; and 3.4 (95% CI: 1.8 to 6.4; p < 0.001) for obese patients.ConclusionsIn our PD patients, mean BMI was within the normal range. The HR for mortality was significantly greater for underweight diabetic PD patients than for patients in the reference category. Death-censored technique survival was similar in all BMI categories. Obese patients had a greater risk of peritonitis.

scholarly journals Body mass index and treatment survival in patients with RA starting treatment with TNFα-inhibitors: long-term follow-up in the real-life METEOR registry

RMD Open ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e001203
Author(s):  
Sytske Anne Bergstra ◽  
Cornelia F Allaart ◽  
David Vega-Morales ◽  
Marieke De Buck ◽  
Elizabeth Murphy ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Cox Regression ◽  
Real Life ◽  
Class Ii ◽  
Normal Weight ◽  
Regression Analyses ◽  
Obesity Class ◽  
Underweight Patients

ObjectivesTo study whether there is an association between body mass index (BMI) category and survival of various tumour necrosis factor inhibitors (TNFi) in rheumatoid arthritis (RA) patients in a real-life longitudinal international registry.MethodsData from 5230 patients with RA starting treatment with any TNFi were selected from the METEOR registry. Patients were divided into six BMI categories: 3.7% underweight, BMI<18.5 kg/m2; 46% normal weight, BMI 18.5–25 kg/m2; 32% pre-obesity, BMI 25–30 kg/m2; 13% obesity class I, BMI 30–35 kg/m2; 3.4% obesity class II, BMI 35–40 kg/m2; and 1.6% obesity class III, BMI >40 kg/m2. Time on treatment in the different BMI categories was compared for all TNFi combined and for the infliximab, adalimumab and etanercept separately, using Kaplan–Meier curves and Cox regression analyses. Cox regression analyses were adjusted for potential confounders, with follow-up censored at 5000 days.ResultsPatients in obesity class II (HR 1.28, 95% CI 1.06 to 1.54) and III (HR 1.67, 95% CI 1.29 to 2.18) and underweight patients (HR 1.30, 95% CI 1.07 to 1.58) showed statistically significantly shorter TNFi survival than normal weight patients. The effect in underweight patients was strongest for infliximab (HR 1.82, 95% CI 1.20 to 2.76), the effect in overweight patients was strongest for infliximab (category II (HR 1.49, 95% CI 0.98 to 2.26); category III (HR 1.46, 95% CI 0.79 to 2.71)) and etanercept (category II (HR 1.27 95% CI 0.98 to 1.65); category III (HR 1.79, 95% CI 1.25 to 2.55)). No significant effect modification from reported pain was found.ConclusionBoth underweight and overweight patients discontinued TNFi treatment earlier than normal weight patients, without evidence of reported pain as the main determinant. It remains uncertain what determines TNFi survival in individual patients.

Body mass index and human sperm quality: neither one extreme nor the other

2017 ◽  
Vol 29 (4) ◽  
pp. 731 ◽  
Author(s):  
E. M. Luque ◽  
A. Tissera ◽  
M. P. Gaggino ◽  
R. I. Molina ◽  
A. Mangeaud ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Sperm Quality ◽  
Sperm Count ◽  
Sperm Concentration ◽  
Normal Weight ◽  
Semen Parameters ◽  
Morbidly Obese ◽  
Epididymal Maturation ◽  
Increased Risk

The aim of the present study was to investigate the still contentious association between body mass index (BMI) and seminal quality. To this end, 4860 male patients (aged 18–65 years; non-smokers and non-drinkers), were classified according to BMI as either underweight (UW; BMI <20 kg m–2; n = 45), normal weight (NW; BMI 20–24.9 kg m–2; n = 1330), overweight (OW; BMI 25–29.9 kg m–2; n = 2493), obese (OB; BMI 30–39.9 kg m–2; n = 926) or morbidly obese (MOB; BMI ≥40 kg m–2; n = 57). Conventional semen parameters and seminal concentrations of fructose, citric acid and neutral α-glucosidase (NAG) were evaluated. The four parameters that reflect epididymal maturation were significantly lower in the UW and MOB groups compared with NW, OW and OB groups: sperm concentration, total sperm count (103.3 ± 11.4 and 121.5 ± 20.6 and vs 157.9 ± 3.6, 152.4 ± 2.7 or 142.1 ± 4.3 spermatozoa ejaculate–1 respectively, P < 0.05), motility (41.8 ± 2.5 and 42.6 ± 2.6 vs 47.8 ± 0.5, 48.0 ± 0.4 or 46.3 ± 0.6 % of motile spermatozoa respectively, P < 0.05) and NAG (45.2 ± 6.6 and 60.1 ± 7.9 vs 71.5 ± 1.9, 64.7 ± 1.3 or 63.1 ± 2.1 mU ejaculate-1 respectively, P < 0.05). Moreover, the percentage of morphologically normal spermatozoa was decreased in the MOB group compared with the UW, NW, OW and OB groups (4.8 ± 0.6% vs 6.0 ± 0.8%, 6.9 ± 0.1%, 6.8 ± 0.1 and 6.4 ± 0.2%, respectively; P < 0.05). In addition, men in the MOB group had an increased risk (2.3- to 4.9-fold greater) of suffering oligospermia and teratospermia (P < 0.05). Both morbid obesity and being underweight have a negative effect on sperm quality, particularly epididymal maturation. These results show the importance of an adequate or normal bodyweight as the natural best option for fertility, with both extremes of the BMI scale as negative prognostic factors.

scholarly journals Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients

2018 ◽  
Vol 12 (8) ◽  
pp. 207-216 ◽  
Author(s):  
Katie B. Tellor ◽  
Steffany N. Nguyen ◽  
Amanda C. Bultas ◽  
Anastasia L. Armbruster ◽  
Nicholas A. Greenwald ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
International Normalized Ratio ◽  
Hospitalized Patients ◽  
Morbidly Obese ◽  
Weekly Dose ◽  
Obese Patients ◽  
Significant Difference ◽  
Underweight Patients ◽  
The Impact

Background: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI. Methods: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization). Exclusion criteria included: age under 18 years, pregnancy, INR (goal 2.5–3.5), and warfarin thromboprophylaxis post orthopedic surgery. The primary outcome was mean total weekly dose (TWD) of warfarin based on weight classification: underweight (BMI <18 kg/m2), normal/overweight (BMI 18–29.9 kg/m2), obese (BMI 30–39.9 kg/m2), and morbidly obese (BMI ⩾ 40 kg/m2). Data were extracted from two community hospitals in reverse chronologic order during July 2015–June 2013 until both study institutions evaluated 100 patients per cohort in each BMI classification or until all patients had been evaluated within the prespecified timeframe. Results: A total of 585 patients were included in cohort A (26 underweight, 200 normal/overweight, 200 obese, 159 morbidly obese). There was a statistically significant difference in TWD as determined by one-way analysis of variance ( p < 0.05). A Tukey post hoc test revealed a statistically significantly higher TWD in morbidly obese (41.5 mg) compared with underweight (25.6 mg, p < 0.05), normal/overweight (28.8 mg, p < 0.05) and obese patients (32.4 mg, p < 0.05). In cohort B, 379 patients were evaluated (9 underweight, 166 normal/overweight, 152 obese, 52 morbidly obese). Overall, 191 patients had a therapeutic INR on discharge (88.9% underweight, 52.4% normal/overweight, 44.1% obese, 55.8% morbidly obese, p = 0.035). Of those, there was a statistically significant difference in TWD ( p = 0.021) with a higher TWD in the morbidly obese (41 mg) compared with underweight patients (24.4 mg, p = 0.017). Conclusions: Based on the results of this study, morbidly obese patients may require higher TWD to obtain and maintain a therapeutic INR.

Association Between Body Mass Index, Physical Activity, and Health-Related Quality of Life in Canadian Adults

2016 ◽  
Vol 24 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Alina Cohen ◽  
Joseph Baker ◽  
Chris I. Ardern
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Body Mass Index ◽  
Body Mass ◽  
Linear Models ◽  
Normal Weight ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Background:Obesity is associated with impairments in health-related quality of life (HRQL), whereas physical activity (PA) is a promoter of HRQL.Purpose:The aim of this study was to investigate the interaction between BMI and PA with HRQL in younger and older Canadian adults.Methods:Data from the 2012 annual component of the Canadian Community Health Survey (N = 48,041; = 30 years) were used to capture self-reported body mass index (BMI-kg/m2), PA (kcal/kg/day, KKD), and HRQL. Interactions between PA and age on the BMI and HRQL relationship were assessed using general linear models and logistic regression.Results:Those younger (younger: μ = 0.79 ± 0.02; older: μ = 0.70 ± 0.02) and more active (active: μ = 0.82 ± 0.02; moderately active: μ = 0.77 ± 0.03; inactive: μ = 0.73 ± 0.01) reported higher HRQL. Older inactive underweight, normal weight, and overweight adults have lower odds of high HRQL.Conclusion:PA was associated with higher HRQL in younger adults. In older adults, BMI and PA influenced HRQL.

scholarly journals The J-Shaped Relationship Between Body Mass Index and Mortality in Patients With Covid-19: A Systematic Review and Dose-Response Meta-Analysis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A28-A29
Author(s):  
Khulood Bukhari ◽  
Huei-Kai Huang ◽  
Duan-Pei Hung ◽  
Carol Chiung-Hui Peng ◽  
Ming-Chieh Shih ◽  
...  
Keyword(s):  
Systematic Review ◽  
Body Mass Index ◽  
Body Mass ◽  
Dose Response ◽  
Meta Analysis ◽  
Normal Weight ◽  
Cochrane Library ◽  
Severe Illness ◽  
Underweight Patients ◽  
The Relationship

Abstract Introduction: Several studies have linked obesity to more severe illness and higher mortality in COVID-19 patients. However, the relationship between being underweight and COVID-19 mortality remains inconclusive. Previous dose-response meta-analyses did not enroll or specifically analyze the underweight population. Herein, we conducted a systematic review and dose-response meta-analysis to investigate the relationship between body mass index (BMI) and mortality in both obese and underweight patients with COVID-19. Methods: We searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases from inception until August 12, 2020 using the keywords “COVID-19,” “body mass index,” “obesity,” “overweight”, and “underweight.” Three reviewers independently assessed the relevant articles, including the title, abstract, and full text, to identify eligible studies. We performed a two-stage random-effects dose-response meta-analysis, including only studies with at least three quantitative classifications for BMI. The nonlinear trend was evaluated using a restricted cubic splines model with three-knots at the 10th, 50th, and 90th percentiles. A sensitivity analysis was conducted by pooling only those studies which specifically evaluated underweight patients (BMI&lt;18.5 kg/m2). Results: Thirteen studies comprising 25,828 patients were included in the analysis. In the linear model, the mortality of patients with COVID-19 increased by 1.5% for each 1-kg/m2 increase in BMI (pooled relative risk [RR] =1.015, 95% confidence interval [CI] =1.004−1.027). However, a significant non-linear relationship between BMI and mortality was observed (Wald test: Pnon-linearity&lt;0.001). We demonstrated a J-shaped curve, indicating that both underweight and obese patients had a higher mortality than those with normal weight. Interestingly, overweight patients (BMI, 25−30 kg/m2) seemed to have the lowest mortality risk. Using a BMI of 15 kg/m2 as the reference, the RRs of mortality decreased with BMI, and this trend continued until BMI of approximately 28 kg/m2 (RR=0.743, 95% CI=0.576−0.959). The relationship between BMI and mortality was then reversed, and an upward trend was observed when BMI exceeded 30 kg/m2; the RRs (95% CI) at BMIs 30, 35, 40, and 45 kg/m2 were 0.745 (0.570−0.974), 0.841 (0.643−1.100), 1.082 (0.850−1.377), and 1.457 (1.129−1.879), respectively. Conclusion: This study is the first dose-response meta-analysis that showed both underweight and obese COVID-19 patients are at higher risk of increased mortality. A J-curve relationship was demonstrated between BMI and COVID-19 mortality.

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