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Multicenter Study
. 2019 Oct;74(10):958-964.
doi: 10.1136/thoraxjnl-2019-213349. Epub 2019 Aug 21.

The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study

Magnus Pär Ekström  1 , Anders Blomberg  2 , Göran Bergström  3 , John Brandberg  4 , Kenneth Caidahl  5 , Gunnar Engström  6 , Jan Engvall  7 , Maria Eriksson  8 , Klas Gränsbo  9 , Tomas Hansen  10 , Tomas Jernberg  11 , Lars Nilsson  12 , Ulf Nilsson  12 , Anna-Carin Olin  13 , Lennart Persson  14 , Annika Rosengren  3 , Martin Sandelin  15 , Magnus Sköld  16   17 , Johan Sundström  17 , Eva Swahn  14 , Stefan Söderberg  12 , Hanan A Tanash  18 , Kjell Torén  19 , Carl Johan Östgren  14 , Eva Lindberg  20
Affiliations
Multicenter Study

The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study

Magnus Pär Ekström et al. Thorax. 2019 Oct.

Abstract

Introduction: Breathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.

Methods: This population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.

Results: We included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness.

Conclusion: Breathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.

Keywords: dyspnoea; lung function; lung volume; sex; weight.

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Conflict of interest statement

Competing interests: SS reports being an advisory board member and receiving speakers honoraria from Actelion, Bayer, MSD, outside the submitted work. Dr Olin reports having a patent WO2009045163 (Collection and measurement of exhaled particles) and being a chairholder and board member of PExA AB, outside the submitted work. JS reports advisory board work for Itrim, outside the submitted work.

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