Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts

Menglu Liu; Kaibo Mei; Lixia Xie; Jianyong Ma; Peng Yu; Siquan Niu; Ya Xu; Yujie Zhao; Xiao Liu

doi:10.7717/peerj.11855

Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts

PeerJ. 2021 Jul 21:9:e11855. doi: 10.7717/peerj.11855. eCollection 2021.

Authors

Menglu Liu^#¹, Kaibo Mei^#², Lixia Xie³, Jianyong Ma⁴, Peng Yu⁵, Siquan Niu¹, Ya Xu¹, Yujie Zhao¹, Xiao Liu^{6

7

8}

Affiliations

¹ Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China.
² Anesthesiology Department,, the People's Hospital of Shanggrao, Shangrao, Jiangxi, China.
³ Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
⁴ Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, Oh, China.
⁵ Department of Endocrine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
⁶ Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
⁷ Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China.
⁸ Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou, China.

^# Contributed equally.

Abstract

Background: Whether overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF.

Methods: The PubMed, Cochrane Library, and EMBASE databases were searched for revelant studies (randomized controlled trials (RCTs), cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF.

Results: Thirty-five publications involving 33,271 cases/141,442 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, 95% CI [1.21-1.61]; P < 0.001), but not being underweight (RR: 1.44, 95% CI [0.90-2.30]; P = 0.13) or being overweight (RR: 1.03, 95% CI [0.95-1.11]; P = 0.48) was associated with an increased risk of POAF. In the exposure-effect analysis (BMI) was 1.09 (95% CI [1.05-1.12]; P < 0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (P_nonlinearity = 0.44); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. Additionally, waist obesity or visceral adiposity index was associated with the risk of POAF.

Conclusion: Based on the current evidence, our findings showed that high body mass index or abdominal adiposity was independently associated with an increased risk of POAF, while underweight or overweight might not significantly increase the POAF risk.

Keywords: Atrial fibrillation; Body mass index; Meta-analysis; Risk factor.

Grants and funding

This work was supported by the National Natural Science Foundation of China (No. 81760050, 81760048) and the Jiangxi Provincial Natural Science Foundation for Youth Scientific Research (No. 20192ACBL21037). We acknowledge the grant support from Guangzhou Science Technology Bureau (202102010007). There was no additional external funding received for this study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.