Association of cardiovascular health with COPD (NHANES 2007-2020): mediating potential of lean body mass

Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is a major global health concern, with lifestyle factors playing a crucial role in its prevention. This study aims to explore the relationship between Life's Crucial 9 (lc9) scores and COPD odds, and to assess the mediating potential of lean body mass (LBM) in this association.

Methods: This study used cross-sectional study to assess the association between lc9 score and COPD using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2020. Weighted multivariate regression analyses were performed to examine lc9 score on the odds of COPD after adjusting for confounders. The models were adjusted for age, gender, race/ethnicity, Marital status, education level, Family income-to-poverty ratio, LBM and Alcohol consumption status. The discrimination ability of lc9 on COPD odds was evaluated using (ROC) curve. Mediation analysis was used to investigate the mediating potential of LBM between lc9 and COPD odds. Subgroup analyses and interaction assessments were also performed.

Results: In Model 2, the results showed that for every 10-point change in the lc9 score, the odds of developing COPD decreased. The OR (95% CI) in the Moderate and High groups were OR = 0.37; 95% CI: 0.23, 0.59 and OR = 0.16; 95% CI: 0.09, 0.27 (P for trend < 0.001), respectively. In addition, the results for quartile subgroups were Q3, OR = 0.58; 95% CI: 0.42, 0.81), Q4, OR = 0.24; 95% CI: 0.16, 0.36) and P for trend < 0.001. This relationship was consistent across the total population, subgroup analyses, and sensitivity analyses. There was a nonlinear relationship between lc9 score and odds of COPD (P for Nonlinear = 0.022). The lc9 reduced the odds of COPD by increasing LBM. The lc9 is an suggestive predictor of COPD odds association.

Conclusions: Higher LC9 scores, particularly when accompanied by increased LBM levels, showed significant associations with reduced COPD risk in cross-sectional analyses.

Keywords: COPD; NHANES; lean body mass (LBM); life’s crucial 9 (LC9); mediating potential.

Figure 1

Flow chart of the screening process for the selection of the study population.

Figure 2

Nonlinear associations between the LC9 LE8 and LS7 scoring systems and the risk of COPD in the NHANES. The dashed line represents the threshold where the OR=1. The shaded area represents the 95% confidence interval. The histogram illustrates the population distribution of "LC9" "LE8" and "LS7" scores. LC9, Life's Crucial 9; LE8, Life's Essential 8; LS7, Life’s Simple 7; OR, Odds Ratio.

Figure 3

ROC curves for "LC9", "LE8" and "LS7" scoring systems. The figure displays AUC with 95% confidence intervals, sensitivity, specificity, and optimal threshold values. The diagonal line in both panels represents the line of no-discrimination (AUC = 0.5). Error bars indicate the confidence intervals at various points along the curve.

Figure 4

The mediation pathway analysis of the association between LC9 score and the risk of COPD through LBM. The arrows indicate the direction of relationships between the variables. DE, Direct Effect (the direct relationship between LC9 and COPD); IE, Indirect Effect (the influence on COPD mediated through LBM); Proportion of mediation = IE / (DE + IE); OR, Odds Ratio.