Body composition and pulmonary function in cystic fibrosis

Saba Sheikh, Babette S Zemel, Virginia A Stallings, Ronald C Rubenstein, Andrea Kelly, Saba Sheikh, Babette S Zemel, Virginia A Stallings, Ronald C Rubenstein, Andrea Kelly

Abstract

Background: Lower body mass index (BMI) is associated with worse pulmonary function in cystic fibrosis (CF).

Hypothesis: lean body mass (LBM) is more strongly associated with pulmonary function than BMI is.

Methods: Anthropometrics, body composition by dual x-ray absorptiometry, and pulmonary function were determined in pancreatic insufficient CF (PI-CF) youth. Sex and age-adjusted Z-scores (BMI-Z, LBMI-Z, FMI-Z) were generated for CF and controls. (1) Associations of BMI-Z with LBMI-Z and FMI-Z and (2) age-adjusted associations of BMI-Z, LBMI-Z, and FMI-Z with FEV1%-predicted were tested.

Results: Two hundred eight PI-CF subjects had lower BMI-Z, LBMI-Z, and FMI-Z compared to 390 controls. BMI-Z was associated with lower LBMI-Z (p < 0.0001) in PI-CF. In females, LBMI-Z and BMI-Z were positively associated with FEV1%-predicted; this relationship did not persist for FMI-Z after adjustment for LBMI-Z. In males, only LBMI-Z and BMI-Z were associated with FEV1%-predicted.

Conclusion: In PI-CF youth, deficits in LBM were apparent. At lower BMI percentiles, BMI may not accurately depict LBM in PI-CF. In under-nourished PI-CF youth, this preservation of FM in preference to LBM is relevant since LBMI-Z, but not FMI-Z, is positively associated with FEV1%-predicted. Lean body mass index is more strongly associated with lung function compared to BMI, especially in the under-nourished child and adolescent with PI-CF.

Keywords: body mass index; fat mass index; lean body mass; lean body mass index; pancreatic insufficient.

Figures

Figure 1
Figure 1
(A) The association between LBMI-Z and BMI-Z among healthy controls and patients with CF. There is a positive association between LBMI-Z and BMI-Z in all patients. Patients with CF have lower LBMI-Z for BMI-Z compared to controls. (B) The association between FMI-Z and BMI-Z among healthy controls and patients with CF. There is a positive association between BMI-Z and FMI-Z in all patients that is not altered in the presence of CF. Circles represent data points for controls and the solid line represents the fitted line for controls. Crosses represent data points for CF patients and the dashed line represents the fitted line for CF subjects.
Figure 2
Figure 2
(A) The associations between FEV1%-predicted and BMI-Z adjusted for age among males and females with CF. BMI-Z is positively associated with FEV1%-predicted in males (p < 0.0001) and females (p = 0.001) with CF. (B) The association between FEV1%-predicted and LBMI-Z adjusted for age among males and females with CF. LBMI-Z is positively associated with FEV1%-predicted in males (p < 0.0001) and females (p < 0.0001). (C) The association between FEV1%-predicted and FMI-Z adjusted for age among males and females with CF. No association between FEV1%-predicted and FMI-Z was found in males (p = 0.26) while FMI-Z was positively associated with FEV1%-predicted in females (p = 0.046) with CF.

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