Higher Visceral Fat-to-Muscle Ratio Linked to Severe COPD Exacerbations and Heart Risks: Study Shows

The research was conducted as part of the Xinjiang Multi-Ethnic Cohort study, spanning from May 2018 to December 2023. It included 631 patients diagnosed with COPD. At baseline, participants underwent bioelectrical impedance analysis to assess visceral fat and muscle mass, from which VMR was calculated. Over the study period, researchers tracked severe COPD exacerbations that required hospitalization and evaluated the relationship between VMR and these exacerbations using logistic regression and zero-inflated Poisson regression models.

The study revealed the following findings:

• Patients with a higher visceral fat-to-muscle ratio (VMR) had a significantly increased risk of experiencing severe COPD exacerbations during both one-year and five-year follow-up periods.
• Each unit increase in VMR was linked to a 34% higher risk of hospitalization due to COPD exacerbation within one year and a 44% increase over five years.
• VMR proved to be a more reliable predictor of severe exacerbations compared to conventional metrics like body mass index (BMI) and other obesity-related measures.
• Subgroup analyses showed that the association between elevated VMR and exacerbation risk was especially marked in women and individuals classified as overweight.
• In women, the odds of having a severe exacerbation rose by 89% within one year and by 99% over five years for every one-unit rise in VMR.
• Among overweight participants, each unit increase in VMR corresponded to an 80% increased risk of exacerbation at one year and 88% at five years.
• Additional analysis indicated that for every one-point increase in VMR, the number of COPD exacerbations rose by 46%.
• These associations remained consistent even after controlling for potential confounding factors like smoking history and removing underweight individuals from the analysis.
• The results were further validated through sensitivity analyses and remained unchanged even when considering competing risks, such as deaths from causes unrelated to COPD.
• Although the study's main focus was on severe COPD exacerbations, it also referenced related findings where elevated VMR levels were associated with greater cardiovascular risks in COPD patients.
• In those cases, each standard deviation increase in VMR was tied to a 50% higher likelihood of experiencing a major adverse cardiovascular event (MACE), and patients in the highest VMR quartile had a five-fold greater risk of MACE compared to those in the lowest quartile.

The authors concluded that VMR is a valuable risk indicator for COPD exacerbations. Proactively measuring and monitoring VMR could help clinicians better identify high-risk patients and tailor interventions to reduce hospitalizations and improve outcomes in COPD management.

Reference:

Li, Y., Wang, L., Li, Z., Luo, T., Sun, Q., Lynn, H. S., & Dai, J. (2025). Association Between the Visceral Fat-to-Muscle Ratio and Severe Exacerbation of COPD: A Prospective Cohort Study. Respirology, 30(5), 398-407. https://doi.org/10.1111/resp.14883