The negative association between weight-adjusted-waist index and lung functions: NHANES 2007-2012

Abstract

Obesity is a common public health issue worldwide, and its negative impact on lung function has garnered widespread attention. This study sought to investigate the possible association between a new obesity metric, the weight-adjusted waist index (WWI), and lung functions, providing a basis for the monitoring and protection of lung functions. We conducted a cross-sectional evaluation, analyzing data from adults in the U.S. gathered through the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012. To explore the correlation between WWIs and lung functions, we utilized a multivariate logistic regression model with appropriate weighting to ensure accuracy. Smooth curve fitting also helped to confirm the linear nature of this relationship. Subgroup analyses were conducted to confirm the uniformity and dependability of the results. Our study included data from 13,805 adults in the United States. Multivariate linear regression analysis revealed that, in the fully adjusted model, higher WWIs were negatively correlated with forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC, peak expiratory flow rate (PEF), and forced expiratory flow rate (FEF) 25%-75% (β = -0.63; 95% confidence interval [CI] [-0.71, -0.55]; β = -0.55; 95% CI [-0.62, -0.48]; β = -0.02; 95% CI [-0.03, -0.01]; β = -1.44; 95% CI [-1.65, -1.23]; β = -0.52; 95% CI [-0.65, -0.39], respectively). Additionally, when analyzing the WWI as a categorical variable, a significant downward trend in the FVC, FEV1, PEF, and FEF 25%-75% was observed from Q2 to Q4 as the WWI increased (trend P < 0.05). Subgroup analysis showed stronger associations between WWI and lung functions, particularly among younger, non-Hispanic white, male participants, and current smokers. Our results indicate that elevated WWI is strongly associated with declining lung functions, demonstrating the importance of long-term monitoring and tracking of WWIs.

Fig 1. Study flowchart.

WWI: Weight-adjusted waist index; NHANES: National Survey of the National Center for Health Statistics.

Fig 2. Association between WWI and lung functions for Model III.

Adjusted for age, sex, race/ethnicity, BMI, PIR, weight, HDL, LDL, triglyceride, total cholesterol, serum cotinine levels, physical activity, smoking status, alcohol consumption, asthma, coronary heart disease, congestive heart failure, stroke, diabetes mellitus, and hypertension. The solid crimson line signifies the smooth curve fitting among the variables. Azure bands indicate the 95% confidence interval stemming from the fit. WWI: Weight-adjusted waist index; FEV1: Forced expiratory volume in 1 s; FVC: Forced vital capacity; FEV1/FVC: Ratio of FEV1 to FVC; PEF: Peak expiratory flow rate; FEF 25–75%: Forced expiratory flow between 25 and 75% of FVC.

Fig 3. Subgroup analysis for the association between WWI and lung functions for Model III.

Adjusted for age, sex, race/ethnicity, BMI, PIR, weight, HDL, LDL, triglyceride, total cholesterol, serum cotinine levels, physical activity, smoking status, alcohol consumption, asthma, coronary heart disease, congestive heart failure, stroke, diabetes mellitus, and hypertension. CI: Confidence interval. WWI: Weight-adjusted waist index; FEV1: Forced expiratory volume in 1 s; FVC: Forced vital capacity; FEV1/FVC: Ratio of FEV1 to FVC; PEF: Peak expiratory flow rate; FEF 25–75%: Forced expiratory flow between 25 and 75% of FVC.