Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants

Jamal Rahmani; Arezoo Haghighian Roudsari; Hiba Bawadi; Jacqueline Thompson; Razieh Khalooei Fard; Cain Clark; Paul M Ryan; Marjan Ajami; Fatemeh Rahimi Sakak; Ammar Salehisahlabadi; Hebatullah M Abdulazeem; Mohammad Reza Jamali; Jalaledin Mirzay Razaz

doi:10.1016/j.thromres.2020.05.014

Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants

Thromb Res. 2020 Aug:192:64-72. doi: 10.1016/j.thromres.2020.05.014. Epub 2020 May 15.

Affiliations

¹ Department of Community Nutrition, Student Research Committee, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran.
³ College of Health Sciences, QU-Health, Qatar University, Doha, Qatar.
⁴ Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, United Kingdom.
⁵ Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁶ Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, United Kingdom.
⁷ School of Medicine, University College Cork, Cork, Ireland.
⁸ Arab Diploma in Family Medicine, AICPD, Egypt.
⁹ Students' Research Committee, Department of Clinical Nutrition School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
¹⁰ Department of Food and Nutrition Policy and Planning, National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran. Electronic address: jmrazaz2018@gmail.com.

PMID: 32454303
DOI: 10.1016/j.thromres.2020.05.014

Abstract

Background: The relationship between body mass index (BMI) and risk of venous thromboembolism (VTE) and pulmonary embolism (PE) is a controversial issue. This dose-response meta-analysis was performed to investigate the association between BMI and risk of VTE and PE incidence based on cohort studies.

Method: A comprehensive systematic search was conducted up to August 2019 in MEDLINE/PubMed, SCOPUS, and Cochrane. DerSimonian and Laird random-effects models were run to estimate combined hazard ratios (HRs) with 95% confidence intervals (CIs). Dose-response analysis was also carried out based on BMI values.

Results: Eleven articles with 16 arms and 3,910,747 participants were eligible for inclusion in this systematic review and meta-analysis. Pooled results showed a positive association between BMI and risk of VTE in the obese participants compared to participants classified in the normal BMI category (HR: 1.62, 95% CI: 1.29-2.04, I² = 95%). Furthermore, results showed a significant association between lower BMI (underweight versus normal BMI category) and reduced risk of PE (HR: 0.80, 95% CI: 0.70-0.92, I² = 9%) and higher risk of PE in obese versus normal BMI participants (HR: 2.24, 95% CI: 1.93-2.60, I² = 0%). There was a significant linear relationship between BMI and risk of VTE (p < 0.001) and PE (p < 0.001).

Conclusions: This systematic review and dose-response meta-analysis with 3,910,747 participants highlights obesity as a significant risk factor related to the incidence of VTE and PE.

Keywords: Body mass index; Pulmonary embolism; Venous thromboembolism.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Body Mass Index
Cohort Studies
Humans
Pulmonary Embolism* / epidemiology
Pulmonary Embolism* / etiology
Risk Factors
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology