ArticlePloS one
"Obesity Paradox" in Acute Respiratory Distress Syndrome: Asystematic Review and Meta-Analysis.
Article in PloS one. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 114 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
114 citing papers in PubMed, 5 syntheses or guidelines pooled it, 193 citations in OpenAlex.
- Obesity is associated with severe COVID-19 but not death: a dose-response meta-analysis.Epidemiology and infection · 2021Pooled it
- Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis.Frontiers in medicine · 2021Pooled it
- Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis.European journal of medical research · 2020Pooled it
- Pooled it
- COVID-19 infection and body weight: A deleterious liaison in a J-curve relationship.Obesity research & clinical practicePooled it
- Nationwide trends in incidence and in-hospital mortality of ARDS in Germany, 2008-2022.Scientific reports · 2026Article
- ECMO for patients with obesity: evidence and practice.Intensive care medicine · 2026Review
- Variation of the Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in a Multicenter Study of Critically Ill Patients with COVID-19 Living at Different Altitudes.Medical sciences (Basel, Switzerland) · 2026Article
- Obesity and respiratory diseases: mechanisms, phenotypes, and clinical implications.Diabetology & metabolic syndrome · 2026Review
- Diet-induced obesity alleviates epithelial damage in hyperoxic acute lung injury (HALI) in mice.Respiratory research · 2026Article
- Severe acute respiratory distress syndrome associated with human metapneumovirus infection in a morbidly obese adult.IDCases · 2026Article
- Ward-Based High-Flow Nasal Oxygen Therapy in Acute Respiratory Failure: A Retrospective Analysis of Long-Term Mortality.Respiration; international review of thoracic diseases · 2026Article
- Premorbid Metabolic Syndrome Is Associated with the Hypoinflammatory Phenotype in Acute Respiratory Distress Syndrome and Sepsis.American journal of respiratory and critical care medicine · 2025Article
- Body mass index, ventilator parameters, and mortality in acute respiratory distress syndrome: re-examining the obesity paradox.Journal of thoracic disease · 2025Article
- ICU predictive factors of fibrotic changes following COVID-19 related ARDS: a RECOVIDS substudy.Annals of intensive care · 2025Article
- One-Year Quality of Life Among Survivors of Hospitalization for Omicron Infection in Brazil: A Multicentre Prospective Cohort Study.Journal of medical virology · 2025Article
- Article
- Two Physiologic Latent Classes of Acute Hypoxemic Respiratory Failure in Sepsis Are Distinguished by Lung Mechanics and Gas Exchange.Critical care explorations · 2025Article
- Biomechanical implications of mass loading in a swine model of acute hypoxemic respiratory failure.Journal of applied physiology (Bethesda, Md. : 1985) · 2025Article
- Outcomes of overweight and obese critically ill patients with severe acute respiratory infection.The Journal of international medical research · 2025Article
54 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIt is unclear whether an "obesity paradox" exists in the respiratory system, especially in acute respiratory distress syndrome (ARDS) and acute lung injury (ALI). Previous studies have postulated a causal relation between obesity and ARDS/ALI but have lacked power to form a definitive conclusion.
objectiveTo investigate the relationships between obesity, ARDS/ALIrisk, and mortality.
methodsA systematic search current to April 2016 was performed in Pubmed, EMBASE, Medline, Cochrane databases to find relevant studies. All studies that estimate the effect of obesity in the morbidity and mortality of ARDS/ALI were included.
resultsA total of 24 studies including 9,187,248 subjects were analyzed. The combined results from 16 studies that examined the effect of obesity in morbidity of ARDS/ALI showed an89% increase in odds ratio(pooled odds ratios (OR) 1.89, 95% confidence intervals (CI) 1.45 to 2.47). In subgroup analysis, compared to normal weight, obesity was associated with an increased risk of ARDS/ALI (OR1.57, 95% CI 1.30-1.90 for obese (BMI30-39.9kg/m2); OR1.75, 95% CI 1.42-2.15 for obese(BMI≥30kg/m2); OR1.67, 95% CI 1.04-2.68 for morbid obese(BMI≥40kg/m2)). The combined results from 9 studies that examined the effect of obesity in mortality of ARDS/ALI had a pooled odds ratio(pooled OR 0.63, 95% CI 0.41 to 0.98). Inversely, obesity was significantly associated with reduced risk of ARDS/ALI mortality(OR0.88, 95% CI 0.78-1.00 for overweight(BMI≤18.5m2); OR0.74, 95% CI 0.64-0.84 for obese (BMI30-39.9kg/m2);OR0.84, 95% CI 0.75-0.94 for 60days mortality; OR0.38, 95% CI 0.22-0.66 for 90days mortality).
conclusionsOur data identify obesity as an important risk factor for the development of ARDS/ALI; however, ARDS/ALI outcomes are improved in this population when compared to individuals with a normal body mass index. This meta-analysis results supported ''obesity paradox" in ARDS/ALI.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.