Association Between the Visceral Fat‐to‐Muscle Ratio and Severe Exacerbation of COPD: A Prospective Cohort Study

ABSTRACT Background and Objective An imbalanced fat and muscle mass ratio might impact exacerbation of chronic obstructive pulmonary disease (COPD). We investigated the association of visceral fat‐to‐muscle ratio (VMR) with severe COPD exacerbation requiring hospitalisation. Methods This prospective cohort study in COPD patients was performed along with the Xinjiang Multi‐Ethnic Cohort study between May 2018 and December 2023. Baseline VMR was calculated from visceral fat area and muscle mass measured by bioelectrical impedance analysis. Numbers of COPD exacerbation hospitalizations were monitored. Associations between various variables and exacerbation were assessed by logistics regression and Zero‐inflated Poisson regression analyses. Results A total of 631 COPD patients were included, with 186 (29.48%) and 304 (48.18%) severe COPD exacerbation within 1 and 5 years, respectively. Compared with body mass index and other obesity indicators, VMR had stronger associations with severe exacerbation. A higher VMR was associated with increased risks of 1‐year and 5‐year exacerbation (odds ratio [OR] = 1.34 and 1.44, respectively). The subgroup female and overweight individuals showed a strong association (female OR = 1.89 and 1.99, overweight OR = 1.80 and 1.88, for 1 and 5‐year exacerbation, respectively). The number of COPD exacerbation increased by 46% for each one‐point VMR increase. These results remained unchanged in the sensitivity analyses after removing underweight patients or smoke influence, as well as in the competing risk analysis when considering other causes for death. Conclusion VMR was a risk factors of severe COPD exacerbation. Proactive assessment of VMR might be helpful to guide management of COPD patients.