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Trethewey RE, Spartano NL, Vasan RS, Larson MG, O’Connor GT, Esliger DW, Petherick ES, Steiner MC. Body mass index across adulthood and the development of airflow obstruction and emphysema. Chron Respir Dis 2022; 19:14799731221139294. [DOI: 10.1177/14799731221139294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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.
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Affiliation(s)
- Ruth E Trethewey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Nicole L Spartano
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - Ramachandran S Vasan
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - Martin G Larson
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - George T O’Connor
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Emily S Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Michael C Steiner
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- Centre for Exercise and Rehabilitation Services, Leicester, UK
- NIHR Leicester Biomedical Research Centre––Respiratory, University of Leicester, Leicester, UK
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Abstract
Approximately half of all patients with chronic obstructive pulmonary disease (COPD) attending pulmonary rehabilitation (PR) programmes are overweight or obese which negatively impacts upon dyspnoea and exercise tolerance particularly when walking. Within the obese population (without COPD), the observed heterogeneity in prognosis is in part explained by the variability in the risk of developing cardiovascular disease or diabetes (cardiometabolic risk) leading to the description of metabolic syndrome. In obesity alone, high-intensity aerobic training can support healthy weight loss and improve the constituent components of metabolic syndrome. Those with COPD, obesity and/or metabolic syndrome undergoing PR appear to do as well in traditional outcomes as their normal-weight metabolically healthy peers in terms of improvement of symptoms, health-related quality of life and exercise performance, and should therefore not be excluded. To broaden the benefit of PR, for this complex population, we should learn from the extensive literature examining the effects of exercise in obesity and metabolic syndrome discussed in this review and optimize the exercise strategy to improve these co-morbid conditions. Standard PR outcomes could be expanded to include cardiometabolic risk reduction to lower future morbidity and mortality; to this end exercise may well be the answer.
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Affiliation(s)
- Benjamin D James
- Department of Health Sciences, School of Medicine, University of Leicester, Leicester, UK
| | - Amy V Jones
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Ruth E Trethewey
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Rachael A Evans
- National Centre for Sport and Exercise Medicine, School of Sport Exercise and Health Sciences, Loughborough University, Loughborough, UK
- Centre of Exercise and Rehabilitation Science, Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- Health Sciences, University of Leicester, Leicester, UK
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