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Multicenter Study
. 2021 Aug;160(2):582-594.
doi: 10.1016/j.chest.2021.03.058. Epub 2021 Apr 15.

Adiposity and Interstitial Lung Abnormalities in Community-Dwelling Adults: The MESA Cohort Study

Michaela R Anderson  1 , John S Kim  2 , Matthew Allison  3 , Jon T Giles  4 , Eric A Hoffman  5 , Jingzhong Ding  6 , R Graham Barr  7 , Anna Podolanczuk  8
Affiliations
Multicenter Study

Adiposity and Interstitial Lung Abnormalities in Community-Dwelling Adults: The MESA Cohort Study

Michaela R Anderson et al. Chest. 2021 Aug.

Abstract

Background: Obesity is associated with restrictive ventilatory defects and a faster rate of decline in FVC. This association is not exclusively mediated by mechanical factors and may reflect direct pulmonary injury by adipose-derived mediators.

Research question: Is adipose tissue involved in the pathogenesis of interstitial lung disease (ILD)?

Study design and methods: We evaluated the association of CT measures of pericardial, abdominal visceral, and abdominal subcutaneous adipose tissue with high-attenuation areas (HAAs) and interstitial lung abnormalities (ILAs) in a large multicenter cohort study of community-dwelling adults, using multivariable-adjusted models. We secondarily evaluated the association of adipose depot size with FVC and biomarkers of obesity and inflammation.

Results: In fully adjusted models, every doubling in pericardial adipose tissue volume was associated with a 63.4-unit increase in HAA (95% CI, 55.5-71.3), 20% increased odds of ILA (95% CI, -2% to 50%), and a 5.5% decrease in percent predicted FVC (95% CI, -6.8% to -4.3%). IL-6 levels accounted for 8% of the association between pericardial adipose tissue and HAA. Every doubling in visceral adipose tissue area was associated with a 41.5-unit increase in HAA (95% CI, 28.3-54.7), 30% increased odds of ILA (95% CI, -10% to 80%), and a 5.4% decrease in percent predicted FVC (95% CI, -6.6% to -4.3%). IL-6 and leptin accounted for 17% and 18%, respectively, of the association between visceral adipose tissue and HAA.

Interpretation: Greater amounts of pericardial and abdominal visceral adipose tissue were associated with CT measures of early lung injury and lower FVC in a cohort of community-dwelling adults. Adipose tissue may represent a modifiable risk factor for ILD.

Keywords: IL-6; high-attenuation areas; interstitial lung abnormalities; interstitial lung disease; leptin; obesity.

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Figures

Figure 1
Figure 1
Associations between pericardial adipose tissue volume and (A) high-attenuation areas (P for association, <.001; P for nonlinearity, .02), (B) interstitial lung abnormalities (P for association, <.001; P for nonlinearity, .43), and (C) FVC (P for association, < .001; P for nonlinearity, .02). Association between abdominal visceral adipose tissue area and (D) high-attenuation areas (P for association, .002; P for nonlinearity, .13), (E) interstitial lung abnormalities (P for association, .04; P for nonlinearity, .15), and (F) FVC (P for association, .001; P for nonlinearity, .001). Models are adjusted for age, sex, and smoking status. Thick dotted black line represents the effect estimates. Surrounding thin lines represent 95% CIs. Vertical lines along the x axis each represent a single study subject.
Figure 1
Figure 1
Associations between pericardial adipose tissue volume and (A) high-attenuation areas (P for association, <.001; P for nonlinearity, .02), (B) interstitial lung abnormalities (P for association, <.001; P for nonlinearity, .43), and (C) FVC (P for association, < .001; P for nonlinearity, .02). Association between abdominal visceral adipose tissue area and (D) high-attenuation areas (P for association, .002; P for nonlinearity, .13), (E) interstitial lung abnormalities (P for association, .04; P for nonlinearity, .15), and (F) FVC (P for association, .001; P for nonlinearity, .001). Models are adjusted for age, sex, and smoking status. Thick dotted black line represents the effect estimates. Surrounding thin lines represent 95% CIs. Vertical lines along the x axis each represent a single study subject.
Figure 1
Figure 1
Associations between pericardial adipose tissue volume and (A) high-attenuation areas (P for association, <.001; P for nonlinearity, .02), (B) interstitial lung abnormalities (P for association, <.001; P for nonlinearity, .43), and (C) FVC (P for association, < .001; P for nonlinearity, .02). Association between abdominal visceral adipose tissue area and (D) high-attenuation areas (P for association, .002; P for nonlinearity, .13), (E) interstitial lung abnormalities (P for association, .04; P for nonlinearity, .15), and (F) FVC (P for association, .001; P for nonlinearity, .001). Models are adjusted for age, sex, and smoking status. Thick dotted black line represents the effect estimates. Surrounding thin lines represent 95% CIs. Vertical lines along the x axis each represent a single study subject.
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