title: Body mass index and chronic airflow limitation in a worldwide population-based study.
abstract: Nutritional status has been associated with clinical outcome in chronic airflow limitation (CAL), but epidemiological studies are scarce. We aimed to assess the relationship between body mass index (BMI) and CAL, taking into account confounding factors. 18,606 participants (49% male, 21% smokers, mean age: 55.8 ± 11.2 years, mean BMI: 26.7 ± 5.5 kg/m(2)) of the BOLD initiative from 26 sites in 23 countries were included. CAL was defined as post-bronchodilator forced expiratory volume in the first second/forced vital capacity < lower limit of normal. Low and obese BMI were defined as <21 kg/m(2) and ≥30 kg/m(2), respectively. Multivariate logistic regression analysis controlled for confounders age, sex and smoking, and meta-analysis of between-site heterogeneity and clustering. Prevalence of low and obese BMI, smoking history and prevalence of CAL were highly variable between sites. After adjustment for confounders, the meta-analysis of all sites showed that compared to subjects without CAL, low BMI was more frequent, (adjusted odds ratio (OR): 2.23 (95% confidence interval: 1.75, 2.85)) and conversely, obesity was less frequent in subjects with CAL (adjusted OR: 0.78 (0.65, 0.94)). In a worldwide population sample, CAL was associated with lower BMI, even after adjusting for confounding factors age, gender, smoking and between-site heterogeneity. These results indicate a CAL-specific association with body composition.
authors.affiliation: Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands lowievanfleteren@ciro-horn.nl.
authors.forename: Lowie Egw
authors.initials: LE
authors.lastname: Vanfleteren
authors.affiliation: Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria Faculty of Medicine, Johannes Kepler University, Linz, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Lamprecht
authors.affiliation: Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Studnicka
authors.affiliation: Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kaiser
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Louisa
authors.initials: L
authors.lastname: Gnatiuc
authors.affiliation: National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Burney
authors.affiliation: Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
authors.forename: Emiel Fm
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands.
authors.forename: Frits Me
authors.initials: FM
authors.lastname: Franssen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D001993:Bronchodilator Agents; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology*; D016017:Odds Ratio; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000503:physiopathology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D013147:Spirometry; D013851:Thinness / Q000453:epidemiology*
chemical_list: D001993:Bronchodilator Agents
keywords: Chronic airflow limitation; body mass index; burden of obstructive lung disease (BOLD); chronic obstructive pulmonary disease