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. 2022 Jan-Dec:19:14799731221139294.
doi: 10.1177/14799731221139294.

Body mass index across adulthood and the development of airflow obstruction and emphysema

Ruth E Trethewey  1   2 , Nicole L Spartano  3 , Ramachandran S Vasan  3 , Martin G Larson  3 , George T O'Connor  3 , Dale W Esliger  1   2 , Emily S Petherick  1   2 , Michael C Steiner  1   2   4   5
Affiliations

Body mass index across adulthood and the development of airflow obstruction and emphysema

Ruth E Trethewey et al. Chron Respir Dis. 2022 Jan-Dec.

Abstract

Background: Low body mass index (BMI) is associated with COPD, but temporal relationships between airflow obstruction (AO) development and emphysematous change are unclear. We investigated longitudinal changes in BMI, AO, and lung density throughout adulthood using data from the Framingham Offspring Cohort (FOC).

Methods: BMI trajectories were modelled throughout adulthood in 4587 FOC participants from Exam 2 (mean age = 44), through Exam 9 (mean age = 71), in AO participants and non-AO participants (AO n = 1036), determined by spirometry, using fractional polynomial growth curves. This process was repeated for low lung density (LLD) and non LLD participants (LLD n = 225) determined by Computed Tomography. Spirometry decline was compared separately between tertiles of BMI in those aged <40 years and associations between fat and lean mass (measured using Dual Energy X-ray Absorptiometry, DEXA) and development of AO and LLD were also assessed. Additional analyses were performed with adjustment for smoking volume.

Results: The BMI trajectory from 30 years of age was visually lower in the AO group than both non-AO smokers (non-<AO-S) and non-AO non-smokers (non-AO-N). Similarly, BMI trajectories were visually lower in participants with LLD throughout adulthood compared to normal lung density smokers and non-smokers. Differences remained after adjustment for smoking volume. The lowest BMI tertile in ages <40 years was associated with the steepest subsequent decline in FEV1/FVC ratio in both sexes.

Conclusion: Mean BMI is lower throughout adulthood in AO and LLD participants. Lower BMI is associated with a steeper decline in the ratio of FEV1/FVC. These findings suggest body mass may precede and potentially have a role in the development of COPD lung pathophysiology.

Keywords: Airway obstruction; BMI; COPD; body composition; lean mass; lung pathology.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of participant inclusion and group allocation for the four different analyses used to examine the relationship between BMI and spirometry indices (a) and lung density (b). n: number of participants; m: men; BMI: body mass index; CT: computed tomogram.
Figure 2.
Figure 2.
Fractional polynomial models for BMI across adulthood for those who did and did not develop airflow obstruction in (a) men and (b) women and for those with and without low lung density at lung CT in (c) men and (d) women. BMI: body mass index; CT: computed tomogram; kg: kilograms; m: metre.
Figure 3.
Figure 3.
The change in FEV1, FVC and FEV1/FVC Ratio with age for tertiles of BMI (Figs a, c, e: Males. Figs b, d, f: Females). FEV1 and FVC are expressed as the percent predicted at age 25. The ratio of FEV1/FVC was calculated using the absolute values. FEV1: Forced Expiratory Volume in 1, FVC: Forced Vital Capacity, BMI: body mass index. Tertiles of BMI are based on individuals’ mean BMI below age 40 (low, middle and high tertiles).
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