Is age-related decline in lean mass and physical function accelerated by obstructive lung disease or smoking?

Abstract

Background: and aims Cross-sectional studies suggest that obstructive lung disease (OLD) and smoking affect lean mass and mobility. A study was undertaken to investigate whether OLD and smoking accelerate the ageing-related decline in lean mass and physical functioning.

Methods: 260 patients with OLD (mean±SD forced expiratory volume in 1 s (FEV1) 63±18% predicted), 157 smoking controls (FEV(1) 95±16% predicted), 866 former-smoking controls (FEV1 100±16% predicted) and 891 never-smoking controls (FEV1 104±17% predicted) participating in the Health, Aging and Body Composition (ABC) Study were studied. At baseline the mean age was 74±3 years and participants reported no functional limitations. Baseline and 7-year longitudinal data of body composition (by dual-energy x-ray absorptiometry), muscle strength (by hand and leg dynamometry) and Short Physical Performance Battery (SPPB) were investigated.

Results: Compared with never-smoking controls, patients with OLD and smoking controls had a significantly lower weight, fat mass, lean mass and bone mineral content (BMC) at baseline (p<0.05). While the loss of weight, fat mass, lean mass and strength was comparable between patients with OLD and never-smoking controls, the SPPB declined 0.12 points/year faster in men with OLD (p=0.01) and BMC declined 4 g/year faster in women with OLD (p=0.02). In smoking controls only lean mass declined 0.1 kg/year faster in women (p=0.03) and BMC 8 g/year faster in men (p=0.02) compared with never-smoking controls.

Conclusions: Initially well-functioning older adults with mild-to-moderate OLD and smokers without OLD have a comparable compromised baseline profile of body composition and physical functioning, while 7-year longitudinal trajectories are to a large extent comparable to those observed in never-smokers without OLD. This suggests a common insult earlier in life related to smoking.

Figure 1. Flow chart of participant selection at baseline

ATS, American Thoracic Society; FEV₁, forced expiratory volume in 1 s; FVC, forced vital capacity; LLN, lower limit of normal; OLD, obstructive lung disease.

Figure 2. Baseline characteristics of body composition and physical functioning in men and women

Data are mean ± SE. * p < 0.05. OLD, Obstructive Lung Disease; SPPB, Short Physical Performance Battery.

Figure 2. Baseline characteristics of body composition and physical functioning in men and women

Data are mean ± SE. * p < 0.05. OLD, Obstructive Lung Disease; SPPB, Short Physical Performance Battery.

Figure 3. Longitudinal course of body composition and physical functioning according to obstructive lung disease and smoking status in men*

* Lines represent the mean predicted values adjusted for time, age, site, race, diabetes, cardiovascular disease, depression, physical activity, oral steroid use, calcium suppletion, vitamin D suppletion, time², age x time, race x time, site x time, diabetes x time, cardiovascular disease x time, depression x time and physical activity x time, oral steroid use x time, calcium suppletion x time and vitamin D suppletion x time. # Intercept significantly different from never-smoking controls, p<0.05. ¶ Slope significantly different from never-smoking controls, p<0.05. OLD, Obstructive Lung Disease; SPPB, Short Physical Performance Battery.

Figure 3. Longitudinal course of body composition and physical functioning according to obstructive lung disease and smoking status in men*

* Lines represent the mean predicted values adjusted for time, age, site, race, diabetes, cardiovascular disease, depression, physical activity, oral steroid use, calcium suppletion, vitamin D suppletion, time², age x time, race x time, site x time, diabetes x time, cardiovascular disease x time, depression x time and physical activity x time, oral steroid use x time, calcium suppletion x time and vitamin D suppletion x time. # Intercept significantly different from never-smoking controls, p<0.05. ¶ Slope significantly different from never-smoking controls, p<0.05. OLD, Obstructive Lung Disease; SPPB, Short Physical Performance Battery.

Figure 4. Longitudinal course of body composition and physical functioning according to obstructive lung disease and smoking status in women*

* Lines represent the mean predicted values adjusted for time, age, site, race, diabetes, cardiovascular disease, depression, physical activity, oral steroid use, calcium suppletion, vitamin D suppletion, time², age x time, race x time, site x time, diabetes x time, cardiovascular disease x time, depression x time and physical activity x time, oral steroid use x time, calcium suppletion x time and vitamin D suppletion x time. # Intercept significantly different from never-smoking controls, p<0.05. ¶ Slope significantly different from never-smoking controls, p<0.05. OLD, Obstructive Lung Disease; SPPB, Short Physical Performance Battery.

Figure 4. Longitudinal course of body composition and physical functioning according to obstructive lung disease and smoking status in women*

* Lines represent the mean predicted values adjusted for time, age, site, race, diabetes, cardiovascular disease, depression, physical activity, oral steroid use, calcium suppletion, vitamin D suppletion, time², age x time, race x time, site x time, diabetes x time, cardiovascular disease x time, depression x time and physical activity x time, oral steroid use x time, calcium suppletion x time and vitamin D suppletion x time. # Intercept significantly different from never-smoking controls, p<0.05. ¶ Slope significantly different from never-smoking controls, p<0.05. OLD, Obstructive Lung Disease; SPPB, Short Physical Performance Battery.