1110
Brief report
Association between body mass index and pulmonary function of
patients with chronic obstructive pulmonary disease
QIU Ting, TANG Yong-jiang, XU Zhi-bo, XU Dan, XIAO Jun, ZHANG Ming-ke, FENG Yu-lin and WANG Ke
Keywords: chronic obstructive pulmonary disease; body mass index; pulmonary function test
C hronic obstructive pulmonary disease (COPD) is a
major cause of chronic morbidity and mortality
throughout the world. It is a preventable and treatable
disease with significant extra pulmonary effects that may
contribute to the severity in individual patients. It is
characterized by airflow limitation that is not fully
reversible.1 The diagnosis of COPD should be confirmed
by spirometry. Body mass index (BMI) is an important
indicator that can well reflect nutritional status of patients,
and low BMI is an independent risk factor for mortality in
patients with COPD.2
Hallin et al3 have shown that COPD patients who are
underweight at admission to hospital for an exacerbation
have a higher risk of dying within the next 2 years and
those with overweight have the significantly lowest
mortality risk. Schols et al4 have argued that weight gain
can reverse the increased mortality risk. The decline in
BMI in patients with COPD is a marker of advanced
disease, corresponding to a currently unknown factor or
factors that are also responsible for the decline in
pulmonary function and progression of the disease. This
prospective study is undertaken to investigate the
relationship between BMI and pulmonary function of
COPD patients.
METHODS
Subjects
Between March 2001 and June 2007, a total of 180
outpatients diagnosed with COPD, basing on the
diagnostic criteria developed by Respiratory Division of
Chinese Medical Association in 2002,5 were recruited
from clinics in West China Hospital and the Third
Peoples Hospital in Chengdu. All subjects were
nonsmokers or ex-smokers for at least 2 years with a
smoking history of less than 15 pack-years. The average
age of these patients was (59.310.3) years.
Methods
All the patients were required to take pulmonary function
test twice every year. The key variables were forced
expiratory volumn in 1 second (FEV1)/forced vital
capacity (FVC) and FEV1% Pred. Decline of FEV1/FVC
and FEV1% Pred per year was calculated. Pulmonary
function test machine used in this study was Vmax229D
(Sensor Medics Yorba Linda, CA, USA). BMI was
Chin Med J 2009;122(9):1110-1111
calculated as weight (kg)/length2 (cm)100. Based on
their BMI, patients were assigned to three groups: the
overweight group (BMI 24), the normal weight group
(18.5 BMI <24), the underweight group (BMI <18.5).6
The follow-up duration was five years.
Statistical analysis
Analysis was carried out using statistical package for
social sciences (SPSS12.0 for windows). Continuous
variables were presented as mean standard deviation
(SD). Multiple comparisons among groups were analyzed
by analysis of variance followed by Student-Newman-
Keuls test to isolate significant difference. Categorical
data were analysed using chi-square test. Pearson
correlation analysis was used to determine the
relationship between BMI and pulmonary function. A P
value of <0.05 was considered statistically significant.
RESULTS
Of the 180 patients (86 women and 94 men), 59 were
overweight, 56 were of normal weight, and 65 were
underweight, 5 patients had lost follow-up. No significant
differences were found between the groups concerning
gender or age. FEV1/FVC and FEV1% Pred were lowest in
the underweight group and highest among the overweight
patients. A positive correlation between BMI and FEV1/FVC,
FEV1% Pred was observed (correlation coefficient (r) was
0.812, 0.876 respectively, both P values were <0.05).
Change rates of three groups were (0.520.16)%,
(1.130.27)%, (1.470.37)% respectively. This
demonstrated that there was a negative correlation between
BMI and the degree of decreased FEV1/FVC, FEV1% Pred
(r was 0.533, 0.752 respectively (both P <0.05) (Table).
DISCUSSION
The result of our study showed that BMI positively
DOI: 10.3760/cma.j.issn.0366-6999.2009.09.019
Department of Respiratory Medicine, West China Hospital of
Sichuan University, Chengdu, Sichuan 610041, China (Qiu T, Tang
YJ, Xu D, Xiao J, Zhang MK, Feng YL and Wang K)
Department of Respiratory Medicine, Third Peoples Hospital of
Chengdu, Sichuan 610031, China (Xu ZB)
Correspondence to: Dr. WANG Ke, Department of Respiratory
Medicine, West China Hospital of Sichuan University, Chengdu,
Sichuan 610041, China (Tel: 86-28-13980978170. Email:
wang2ke@yahoo.com.cn)
Chinese Medical Journal 2009;122(9):1110-1111
Table. BMI and characteristics of the subjects
Overweight Normal weight Underweight
Variables
(n=59) (n=56)
Age (years) 57.68.5 61.112.0
Gender (n, men/ women) 29/30 29/27
FEV1/FVC (%) 64.24.8 59.65.9
FEV1% Pred 68.58.9 61.67.2
BMI 29.23.6 23.94.1
FEV1/FVC per year (%) 0.520.16 1.130.27
FEV1% Pred per year (%) 0.610.19 1.230.28
P value of comparison of gender or age among groups was >0.05.
related to FEV1/FVC and FEV1% Pred, which was in line
with previous studies.7 Other factors such as cigarette
smoking, gender and age might affect pulmonary function,
so all the subjects in this study were nonsmokers or
ex-smokers for at least 2 years with a smoking history of
less than 15 pack-years and no significant differences
were found between the groups concerning gender or age.
The consequence of our follow-up demonstrated that
there was negative correlation between BMI and degree
of decreased FEV1/FVC and FEV1% Pred. Research
showed that patients with COPD are more likely to be
underweight.8 Loss of body weight in COPD is of
multifactorial origins. First, substantial proportion of
patients with moderate to severe COPD exhibit an
elevated resting metabolic rate.9 Second, systemic
inflammation can induce excessive apoptosis of skeletal
muscle.10 Third, the presence of hypoxia and the more
frequent use of systemic corticosteroids can cause
skeletal muscle diminishing.11 Vandenbergh et al12 had
already highlighted a relation between weight loss and
mortality in patients with end stage COPD. The
association between BMI and mortality was very clear, as
risk of death from COPD was dramatically increased in
underweight patients.
However, there were very few studies investigating the
relationship between BMI and pulmonary function. The
effect of BMI on pulmonary function is mediated in part
by its effect on respiratory muscles. Arora and
Rochester13 showed that nutritional depletion reduced
respiratory muscle strength in patients without lung
disease, and can also cause respiratory muscle wasting, as
demonstrated by diaphragm weight in emphysematous
patients being lower than expected for body weight.14
Limitation of the current study that must be
acknowledged was that the participants were out-patients
of two hospitals; therefore selection bias could not be
avoided.
In summary, we have found that BMI is positively related
to pulmonary function of COPD patients.
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(Received September 11, 2008)
Edited by WANG Mou-yue and LIU Huan