Effect of Body Mass Index on Lung Function in Chinese Patients with Chronic Obstructive Pulmonary Disease: A Multicenter Cross-Sectional Study

Jing Zhu, Zhiling Zhao, Bin Wu, Zhihong Shi, Qingrong Nie, Zhen Fu, Zhaofu Zeng, Weihua Hu, Minglin Dong, Mengqing Xiong, Ke Hu, Jing Zhu, Zhiling Zhao, Bin Wu, Zhihong Shi, Qingrong Nie, Zhen Fu, Zhaofu Zeng, Weihua Hu, Minglin Dong, Mengqing Xiong, Ke Hu

Abstract

Objective: The aim of this study was to explain "obesity paradox" in chronic obstructive pulmonary disease (COPD) by evaluating the effect of body mass index (BMI) on lung function in Chinese patients with COPD.

Methods: A total of 1644 patients diagnosed with COPD were recruited from four Chinese tertiary hospitals and were divided into four groups including underweight, normal weight, overweight and obese according to BMI classification standard. The medical data of these patients were collected and used for the multiple linear regression analyses.

Results: After adjustment for age, sex, educational level, economic status, smoking status, alcohol consumption, duration of COPD history, events of acute exacerbation in previous year, hypertension, diabetes mellitus, cardiovascular disease, cerebrovascular disease and osteoporosis, BMI had a curvilinear correlation with the forced expiratory volume in the first second (FEV1) in patients with Global Initiative for Obstructive Lung Disease (GOLD) 1-2 grade (first-order coefficient β, 0.09; 95% CI, 0.03-0.16; second-order coefficient β, -0.002; 95% CI, -0.003--0.001; P<0.01). However, BMI had a positive correlation with FEV1 in patients with GOLD 3-4 grade (β, 0.01; 95% CI, 0.008-0.017; P<0.01) when BMI was used as a quantitative variable. When BMI was used as a qualitative variable, only FEV1 in overweight group with GOLD 1-2 grade was significantly higher than that of normal weight group (P<0.01). Interestingly, both overweight and obese groups had higher FEV1 in GOLD 3-4 grade compared with normal weight group (β, 0.06; 95% CI, 0.02-0.11; β, 0.11; 95% CI, 0.04-0.18; P<0.01). The effect of BMI on predicted percentage of FEV1 (FEV1%) was similar to that of FEV1 in different GOLD grades.

Conclusion: Obesity only had a protective effect on lung function in COPD patients with GOLD 3-4 grade rather than GOLD 1-2 grade.

Trial registry: ClinicalTrials.gov, No.: NCT03182309, URL: www.clinicaltrials.gov.

Keywords: obesity; overweight.

Conflict of interest statement

The authors declare that they have no conflicts of interest for this work.

© 2020 Zhu et al.

Figures

Figure 1
Figure 1
The differences in FVC, FEV1, FEV1% and FEV1/FVC% of the four groups of patients with COPD (A–D). Statistical analysis was performed using one-way ANOVA test. The data were represented as mean values ±SD. #p<0.05 indicating the statistical difference between overweight group with COPD and underweight or normal weight group. *p<0.05 indicating the statistical difference between obese group with COPD and underweight or normal weight group.
Figure 2
Figure 2
The effect of BMI on lung function in the patients with COPD. Statistical analysis was performed using multiple linear regression analysis. (A and B) BMI used as the quantitative and qualitative variable to assess the relation between BMI and FEV1. (C and D) BMI used as the quantitative variable to assess the relation between BMI and FEV1% or FVC. *p<0.05 vs normal weight group.
Figure 3
Figure 3
The effect of BMI on FEV1 in GOLD grade of COPD patients. Statistical analysis was performed using multiple linear regression analysis. (A and B) BMI used as the quantitative and qualitative variable to assess the relation of BMI and FEV1 in GOLD 1–2 grade. (C and D) BMI used as the quantitative and qualitative variable to assess the relation between BMI and FEV1 in GOLD 3–4 grade. *p<0.05 indicating the significant difference compared to normal weight group.
Figure 4
Figure 4
The effect of BMI on FEV1% and FVC in GOLD grade of COPD patients. Statistical analysis was performed using multiple linear regression analysis. The curve and the 95% CI area were obtained from the regression equation by fixing each covariate at a certain level. (A and B) BMI used as the quantitative variable to assess the relation of BMI and FEV1% in GOLD 1–2 grade and GOLD 3–4 grade. (C and D) BMI used as the quantitative variable to assess the relation between BMI and FVC in GOLD 1–2 grade and GOLD 3–4 grade.

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Source: PubMed

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