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. 2025 Apr 13;26(1):143.
doi: 10.1186/s12931-025-03211-y.

Antigravity muscle density on computed tomography and health-related independence in normal weight patients with chronic obstructive pulmonary disease

Satoru Terada  1   2 , Naoya Tanabe  3   4 , Tomoki Maetani  1 , Yusuke Shiraishi  1 , Kunihiko Terada  2 , Hiroshi Shima  1 , Tsuyoshi Oguma  1   5 , Ryo Sakamoto  6 , Megumi Kanasaki  7 , Izuru Masuda  8 , Atsuyasu Sato  1 , Susumu Sato  9 , Toyohiro Hirai  1
Affiliations

Antigravity muscle density on computed tomography and health-related independence in normal weight patients with chronic obstructive pulmonary disease

Satoru Terada et al. Respir Res. .

Abstract

Background: Low body mass index (BMI) is a prognostic factor, and skeletal muscle adiposity may affect mortality irrespective of BMI in patients with chronic obstructive pulmonary disease (COPD). However, the association between muscle adiposity and healthy life expectancy in normal-weight patients remains unestablished.

Objective: To examine whether lower chest computed tomography (CT)-assessed erector spinae muscle density (ESMD), which represents antigravity muscle adiposity, is associated with subsequent loss of health-related independence in normal-weight patients with COPD.

Methods: The ESMD lower limit of normal (LLN) was determined in 194 healthy subjects undergoing lung cancer screening CT. In a prospective cohort of patients with COPD undergoing baseline inspiratory/expiratory CT, the onset of loss of health-related independence, requiring long-term nursing facility or home nursing/medical care, was recorded over 5 years.

Results: Smokers with COPD (n = 199) were divided into 4 groups on the basis of BMI and the ESMD-LLN: underweight (n = 22), normal-weight with (n = 40) and without (n = 81) low ESMD, and overweight (n = 56). Greater airway wall thickening was associated with BMI-independent low ESMD. A multivariable Cox proportional hazards model including only normal-weight patients with COPD (n = 121) indicated that low ESMD was independently associated with a higher loss-of-independence rate after adjusting for FEV1, COPD assessment test score, and a smaller cross-sectional area of erector spinae muscles (hazard ratio [95% confidence interval] = 3.21 [1.30-7.89]).

Conclusion: Low antigravity muscle density could reflect airway wall thickening and shorten healthy life expectancy in normal-weight patients with COPD.

Keywords: Airway wall thickness; Chronic obstructive pulmonary disease; Computed tomography; Healthy life expectancy; Skeletal muscle.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All components of this study were performed in accordance with the Declaration of Helsinki. The use of the Takeda cohort was approved by the ethics committees of Kyoto University Hospital and Takeda Hospital (approval no. R2751-2 and no. 2019, respectively), and written informed consent was waived because of the retrospective analysis of the data. The Kyoto-Himeji cohort was approved by the ethics committees of Kyoto University Hospital (approval no. C1311), and written informed consent was obtained from each patient. This cohort was registered with the University Hospital Medical Information Network (UMIN000028387, registration date August 1st, 2017). Consent for publication: Consent was obtained directly from the patients. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Body mass index categories and erector spinae muscle abnormality in patients with COPD. A. Distribution of overweight, normal-weight, and underweight patients with COPD in the Kyoto–Himeji cohort. Overweight: body mass index (BMI) ≥ 25 kg/m2; normal weight: BMI ≥ 18.5 kg/m2; underweight: BMI < 18.5 kg/m2. B.: The prevalence of erector spinae muscle (ESM) abnormalities, such as low ESM area (ESMA) and density (ESMD) among patients with COPD stratified by BMI. C, D. Representative normal-weight patients with low and normal ESMD despite similar ESMA
Fig. 2
Fig. 2
Loss of health-related independence over five years in patients categorized according to body mass index and erector spinae muscle density. (A) All patients with COPD were categorized into underweight, normal-weight, and overweight patients. (B) Normal-weight patients were divided into those with low and normal ESMD. (C) Normal-weight patients were divided into those with low and normal ESMA. The median follow-up period was 48 months. Loss of health-related independence was defined as either (1) living in a long-term care facility, (2) needing nursing care under a government certificate, or (3) experiencing acute death due to rapid deterioration
See this image and copyright information in PMC

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