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Obesity Paradox and Lung Cancer Mortality: The Contributing Roles of Airflow Limitation and Pre-COPD

  • 0The University of Auckland Faculty of Medical and Health Sciences, Auckland, Auckland, New Zealand; roberty@adhb.govt.nz.
Annals of the American Thoracic Society +

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September 23, 2025

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September 23, 2025

View abstract on PubMed

Summary

This summary is machine-generated.

The obesity paradox, where higher BMI correlates with lower lung cancer mortality, is largely explained by respiratory conditions. Airflow limitation and COPD, prevalent at lower BMIs, increase lung cancer death risk, attenuating the paradox.

Area Of Science

  • Pulmonary Medicine
  • Oncology
  • Epidemiology

Background

  • The
  • obesity paradox
  • (increased BMI associated with reduced lung cancer mortality) lacks a clear explanation.
  • Potential factors include sex, smoking, diabetes mellitus (DM), and study biases.
  • This study investigates the role of respiratory comorbidities.

Purpose Of The Study

  • To determine if respiratory comorbidities contribute to the obesity paradox in lung cancer mortality.

Main Methods

  • Secondary analysis of 18,463 high-risk individuals from the National Lung Screening Trial (NLST).
  • Examined factors influencing lung cancer mortality using stratification and regression models.
  • Assessed respiratory comorbidities based on lung function and clinical history.

Main Results

  • Increasing BMI correlated with decreased lung cancer and respiratory mortality.
  • Higher BMI showed decreased airflow limitation but increased Pre-COPD and DM prevalence.
  • Airflow limitation, Pre-COPD, and DM independently predicted increased lung cancer death, particularly at lower BMIs. Removing these comorbidities attenuated the obesity paradox.

Conclusions

  • The obesity paradox in lung cancer mortality among high-risk smokers is significantly influenced by respiratory comorbidities.
  • Airflow limitation and COPD/DM, prevalent at lower BMIs, increase lung cancer mortality risk, thereby explaining the paradox.

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