Elevated Body Mass Index Aggravates Histopathological Changes and Postoperative Recurrence Risk in Nasal Polyps

OBJECTIVE: This study aimed to investigate the association between body mass index (BMI) and histopathological features and postoperative recurrence risk of chronic rhinosinusitis with nasal polyps (CRSwNP). STUDY DESIGN: A retrospective clinical study. SETTING: Recurrent group and nonrecurrent group. METHODS: We recruited CRSwNP patients who underwent functional endoscopic sinus surgery and classified them into three groups based on BMI: normal weight, overweight, and obesity. All patients were followed for 3 years and divided into recurrence and nonrecurrence groups. The histopathological features and the impact of BMI on the risk of postoperative recurrence were analyzed through comparative analysis. RESULTS: A total of 577 CRSwNP patients completed the follow-up, with 197 experiencing postoperative recurrence. Recurrence rates, tissue eosinophil counts, and interleukin (IL)-5 and IL-17A expression levels were significantly higher in the overweight and obesity groups compared to the normal weight group. Additionally, within the overweight and obesity groups, patients with recurrence had elevated tissue eosinophil counts and IL-5 and IL-17A levels compared to the other two groups. Notably, tissues collected during revision surgery showed increased eosinophil counts, IL-5 and IL-17A levels compared to baseline, particularly in obese patients. Both logistic regression analyses and Kaplan-Meier curves indicated that overweight and obesity were associated with an increased risk of CRSwNP recurrence. CONCLUSION: Elevated BMI presented significant impacts on the histopathological changes and the risk of postoperative recurrence in CRSwNP patients. Overweight and obesity aggravated tissue eosinophil infiltration, and IL-5 and IL-17A expressions contributing to the recurrent mechanisms of CRSwNP.