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. 2025 Mar;30(3):230-241.
doi: 10.1111/resp.14882. Epub 2025 Jan 26.

Lifetime Body Mass Index Trajectories and Contrasting Lung Function Abnormalities in Mid-Adulthood: Data From the Tasmanian Longitudinal Health Study

Gulshan B Ali  1 , Adrian J Lowe  1   2 , E Haydn Walters  1   3 , Jennifer L Perret  1 , Bircan Erbas  4 , Caroline J Lodge  1   2 , Gayan Bowatte  1 , Paul S Thomas  5 , Garun S Hamilton  6   7 , Bruce R Thompson  8 , David P Johns  1 , John L Hopper  1 , Michael J Abramson  9 , Dinh S Bui  1 , Shyamali C Dharmage  1   2
Affiliations

Lifetime Body Mass Index Trajectories and Contrasting Lung Function Abnormalities in Mid-Adulthood: Data From the Tasmanian Longitudinal Health Study

Gulshan B Ali et al. Respirology. 2025 Mar.

Abstract

Background and objective: The impact of lifetime body mass index (BMI) trajectories on adult lung function abnormalities has not been investigated previously. We investigated associations of BMI trajectories from childhood to mid-adulthood with lung function deficits and COPD in mid-adulthood.

Methods: Five BMI trajectories (n = 4194) from age 5 to 43 were identified in the Tasmanian Longitudinal Health Study. Lung function outcomes were defined using spirometry at 45 and 53 years. Associations between these BMI trajectories and lung function outcomes were investigated using multivariable regression.

Results: Compared to the average BMI trajectory, the child's average-increasing BMI trajectory was associated with greater FVC decline from 45 to 53 years (β = -178 mL; 95% CI -300.6, -55.4), lower FRC, ERV and higher TLco at 45 years, lower FVC (-227 mL; -345.3, -109.1) and higher TLco at 53 years. The High BMI trajectory was also associated with lower FRC, ERV and higher TLco at 45 years, while spirometric restriction (OR = 6.9; 2.3, 21.1) and higher TLco at 53 years. The low BMI trajectory was associated with an obstructive picture: lower FEV1 (-124 mL; -196.4, -51.4) and FVC (-91 mL; -173.4, -7.7), and FEV1/FVC (-1.2%; -2.2, -0.1) and higher ERV and lower TLco at 45 and 53 years. A similar pattern was found at 53 years. No associations were observed with spirometrically defined COPD.

Conclusion: Our findings revealed contrasting lung function abnormalities were associated with high, subsequently increasing, and low BMI trajectories. These results emphasise the importance of tracking changes in BMI over time and the need to maintain an average BMI trajectory (BMI-Z-score 0 at each time point) throughout life.

Keywords: COPD; body mass index trajectories; lifetime growth patterns; lifetime obesity; lung function decline; obesity trajectories; obstructive‐lung function; poor lung function; restrictive‐lung function.

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Conflict of interest statement

Bircan Erbas and Paul S. Thomas were Editorial Board members of Respirology at the time of peer review and co‐authors of this article. They were excluded from all editorial decision‐making related to the acceptance of this article for publication. M.J.A. holds investigator‐initiated grants for separate research from Pfizer, Boehringer‐Ingelheim and GSK. He has undertaken an unrelated consultancy for Sanofi. He has also got a speaker's fee from GSK. S.C.D., A.J.L., J.L.P., M.J.A., C.J.L. and D.S.B. declare they have received research funds from GSK's competitively awarded Investigator Sponsored Studies program for unrelated research. S.C.D., A.J.L. and M.J.A. declare they have received funds from Sanofi for unrelated research. A.J.L. also declares he has received donations of interventional product (EpiCeram) from Primus Pharmaceuticals for unrelated research. The other authors included in this study declare that they have no competing interests. All authors declare no funding from any organisation or no financial relationship with any organisation that could appear to have influenced the submitted work.

Figures

FIGURE 1
FIGURE 1
(a, b) Body mass index (Z‐score and mean BMI) trajectory classes across ages from 5 to 43 years.
FIGURE 2
FIGURE 2
Association of BMI trajectories with the lung function parameters at 45 years. Finding: Compared to the average trajectory, low BMI trajectory was associated with low FEV, FVC, and ratio. Adjusted: Sex, type of feeding in the first 3 months, no of siblings, chest illness, tonsillectomy, pneumonia, childhood food allergy, bronchitis, social class during childhood, mother's employment, mother's age, mother's asthma, mother's smoking, father's asthma, father's smoking, adulthood education, adulthood food allergy, height at 45 years, and age at 45 years.
FIGURE 3
FIGURE 3
Association of BMI trajectories with the lung function parameters at 53 years. Finding: Compared to the average trajectory, low BMI trajectory was associated with low FEV1 and FVC, while child average‐increasing BMI trajectory was associated with low FVC. Adjusted: sex, type of feeding in the first 3 months, no of siblings, chest illness, tonsillectomy, pneumonia, childhood food allergy, bronchitis, social class during childhood, mother's employment, mother's age, mother's asthma, mother's smoking, father's asthma, father's smoking, adulthood education, adulthood food allergy, height at 53, and age at 53 years.
FIGURE 4
FIGURE 4
Association of BMI trajectories with the lung function decline from 45 to 53 years. Finding: Compared to the average trajectory, child average‐increasing BMI trajectory was associated with greater FVC decline. Adjusted: Sex, type of feeding in the first 3 months, no of siblings, chest illness, tonsillectomy, pneumonia, childhood food allergy, bronchitis, social class during childhood, mother's employment, mother's age, mother's asthma, mother's smoking, father's asthma, father's smoking, adulthood education, adulthood food allergy, current employment, baseline lung function, change in height 45–53 and change in age 45–53.
FIGURE 5
FIGURE 5
Association of BMI trajectories (5–43 years) with the TLco and Static Lung Volumes at 45 years. Finding: Compared to the average trajectory, high and child average‐increasing BMI trajectories were associated with low FRC and ERV and high TLco. Adjusted: sex, type of feeding in the first 3 months, chest illness, tonsillectomy, pneumonia, childhood food allergy, bronchitis, social class during childhood, mother's employment, mother's age, mother's asthma, mother's smoking, father's asthma, father's smoking, adulthood education, adulthood food allergy height at 45 years and age at 45 year.
FIGURE 6
FIGURE 6
Association of BMI trajectories (5–43 years) with the TLco and IRV at 53 year. Finding: Compared to the average trajectory, high BMI trajectory was associated with high TLco. Adjusted: Sex, type of feeding in the first 3 months, chest illness, tonsillectomy, pneumonia, childhood food allergy, bronchitis, social class during childhood, mother's employment, mother's age, mother's asthma, mother's smoking, father's asthma, father's smoking, adulthood education, adulthood food allergy, height at 53 years and age at 53 years.
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