Figures
- FIGURE 1
Graphic presentation of the study population drawn from three OLIN (Obstructive Lung Disease in Northern Sweden) cohorts.
- FIGURE 2
Body mass index (BMI) among subjects with normal spirometry, chronic obstructive pulmonary disease (COPD) and restrictive spirometry. Horizontal lines represent medians, boxes represent interquartile range and error bars represent 5–95th percentiles. The circles represent outliers lying outside 1.5 times the interquartile range and the asterisks represent extreme outliers >3 times the interquartile range.
- FIGURE 3
Scatter plot of body mass index (BMI) versus forced expiratory volume in the first second (FEV1), and linear correlation lines for normal spirometry and chronic obstructive pulmonary disease (COPD) with COPD grades.
- FIGURE 4
Mean forced expiratory volume in the first second (FEV1)/vital capacity (VC) ratio versus four body mass index (BMI) grades. Circles represent means and error bars represent 95% confidence intervals. ns: nonsignificant.
- FIGURE 5
Risk ratio of body mass index (BMI) categories versus normal spirometry. p-values are versus normal spirometry and normal weight. Inset: distribution of BMI grades among subjects with normal spirometry. COPD: chronic obstructive pulmonary disease; ns: nonsignificant.
Tables
- TABLE 1
Basic characteristics of the study population
Subjects 3942 Normal spirometry 2843 (72.1%) COPD grade 1 319 (8.1%) COPD grade 2 305 (7.7%) COPD grade 3 43 (1.1%) COPD grade 4 12 (0.3%) All COPD 679 (17.2%) Restrictive spirometric pattern 420 (10.7%) Never-smokers 1595 (40.5%) Former smokers 1481 (37.6%) Smokers 819 (20.8%) Underweight# 102 (2.6%) Normal weight¶ 1402 (35.6%) Pre-obesity+ 1721 (43.7%) Obesity§ 719 (18.2%) Coronary artery disease 521 (13.2%) Heart failure 51 (1.3%) Arrhythmia 238 (6.0%) Hypertension 1369 (34.7%) Claudication 151 (3.8%) Diabetes 357 (9.1%) Wheeze most days a week 424 (10.8%) mMRC dyspnoea score ≥2 668 (16.9%) Chronic productive cough 1072 (27.2%) Any inhaled steroids 897 (22.8%) Any oral steroids 301 (7.6%) Professionals or executives 1003 (25.4%) Assistant nonmanual employees 645 (16.4%) Manual workers in industry 768 (19.5%) Manual workers in services 1144 (29.0%) Self-employed nonprofessionals 236 (6.0%) Other occupations 146 (3.7%) COPD: chronic obstructive pulmonary disease; mMRC: modified Medical Research Council. #: body mass index (BMI) <20; ¶: 20≤BMI<25; +: 25≤BMI<30; §: BMI≥30.
- TABLE 2
Mean body mass index (BMI) in various subgroups
Mean BMI p-value All 26.67 Men 26.83 0.019 Women 26.52 Never-smokers 26.78 0.647+ Former smokers 26.85 Current smokers 26.11 <0.001§ Chronic productive cough# 26.69 ns Wheeze most days a week# 27.97 <0.001 mMRC dyspnoea score 2–4# 28.21 <0.001 Urban living 26.43 <0.001ƒ Rural living 27.49 Asthma¶ 27.29 <0.001 COPD¶ 25.83 <0.001 Coronary artery disease# 27.21 0.002 Heart failure# 27.95 0.029 Arrhythmia# 26.72 ns Hypertension# 27.83 <0.001 Claudication# 27.00 ns Diabetes# 28.74 <0.001 Any inhalation steroids# 27.29 <0.001 Any oral steroids# 26.90 ns Professionals and executives 26.15 <0.001ƒ Assistant nonmanual employees 26.63 Manual workers in industry 26.83 Manual workers in service 27.02 Self-employed nonprofessionals 26.68 Other 26.91 mMRC: modified Medical Research Council; COPD: chronic obstructive pulmonary disease; ns: nonsignificant. #: versus subjects not having the condition/treatment; ¶: physician's diagnosis and/or own esteem; +: versus former smokers; §: versus never-smokers and former smokers; ƒ: between groups.
- TABLE 3
Characteristics and prevalence of conditions and determinants among normal-weight, underweight, pre-obese and obese subjects
Normal weight Underweight p-value Pre-obesity p-value Obesity p-value Subjects 1296 86 1544 596 Mean age years 59.0 60.1 0.446 58.9 0.719 58.8 0.779 Men/women 44.7%/55.3% 25.6%/74.4% 0.001 55.4%/44.6% <0.001 45.1%/54.9% 0.902 Mean FEV1 % predicted 95 87 <0.001 96 0.511 93 0.001 Mean FVC % predicted 98 94 0.002 97 <0.001 93 <0.001 Normal spirometry 77.8% 67.4% 0.060 82.4% 0.003 84.6% <0.001 COPD grade 1 11.7% 14.0% 8.0% 5.2% COPD grade 2 8.7% 14.0% 8.4% 8.4% COPD grades 3 and 4 1.8% 4.7% 1.1% 1.8% Never-smokers 39.2% 32.6% 0.004 41.6% 0.001 42.6% 0.072 Former smokers 36.2% 26.7% 0.004 39.5% 0.001 37.4% 0.072 Smokers 24.2% 40.7% 18.9% 20.0% Coronary artery disease 10.8% 8.1% 0.432 12.4% 0.218 15.8% 0.003 Heart failure 0.8% 1.2% 0.758 1.0% 0.732 2.3% 0.008 Hypertension 24.4% 22.1% 0.631 34.9% <0.001 50.8% <0.001 Diabetes 4.5% 4.7% 0.934 8.2% <0.001 16.5% <0.001 Wheeze most days a week 7.2% 15.1% 0.007 9.9% 0.010 16.4% <0.001 mMRC dyspnoea score ≥2 10.5% 23.2% <0.001 15.1% <0.001 27.3% <0.001 Chronic productive cough 25.0% 31.4% 0.186 26.6% 0.346 27.2% 0.215 p-values are versus normal weigh. Subjects with a restrictive spirometric pattern were excluded. FEV1: forced expiratory volume in the first second; FVC: forced vital capacity; COPD: chronic obstructive pulmonary disease; mMRC: modified Medical Research Council.
- TABLE 4
Adjusted analyses of determinants of underweight and obesity versus normal weight
Subjects Underweight Obesity Female 1017 3.02 (1.65–5.53) 0.92 (0.72–1.17) Age 1.01 (0.99–1.03) 0.99 (0.98–1.00¶) Never-smoker 727 1.0 1.0 Ex-smoker 663 0.96 (0.54–1.72) 0.90 (0.69–1.16) Smoker 445 1.86 (1.07–3.26) 0.84 (0.62–1.15) Normal spirometry 1462 1.0 1.0 COPD grade 1 189 1.27 (0.64–2.53) 0.43 (0.27–0.68) COPD grade 2 169 1.43 (0.70–2.94) 0.83 (0.55–1.26) COPD grade 3–4 35 3.24 (1.00#–10.5) 0.62 (0.26–1.48) Professional or executive 496 1.0 1.0 Assistant nonmanual employee 304 1.39 (0.70–2.74) 1.38 (0.96–2.00) Manual worker in industry 344 1.90 (0.86–4.18) 1.59 (1.11–2.28) Manual worker in service 531 1.02 (0.55–1.90) 1.83 (1.33–2.51) Self-employed nonprofessional 112 1.60 (0.56–4.55) 1.53 (0.92–2.56) Other 50 1.55 (0.48–5.00) 1.49 (0.71–3.13) Coronary artery disease 229 0.81 (0.35–1.90) 1.18 (0.83–1.67) Heart failure 24 1.40 (0.16–12.0) 1.95 (0.79–4.82) Hypertension 571 0.80 (0.46–1.39) 2.97 (2.34–3.78) Diabetes 138 1.14 (0.40–3.34) 3.10 (2.10–5.58) Data are presented as odds ratios (95% CI) unless otherwise stated. COPD: chronic obstructive pulmonary disease. #: 1.0004, p=0.0499; ¶: 0.9983, p=0.0050.
- TABLE 5
Sensitivity analysis of the association between chronic obstructive pulmonary disease (COPD) severity grades and underweight and obesity using different reference values in a multinomial regression analysis with normal weight as the reference
Subjects Underweight Obesity OLIN reference values using LLN for COPD and restrictive spirometry Non-COPD 1462 1 1 COPD grade 1 56 1.23 (0.35–4.25) 0.58 (0.26–1.26) COPD grade 2 114 1.69 (0.78–3.66) 0.53 (0.30–0.94) COPD grades 3 and 4 35 3.38 (1.16–9.82) 0.52 (0.20–1.36) Berglund reference values, fixed ratio Non-COPD 2342 1 1 COPD grade 1 75 1.35 (0.67–2.71) 0.41 (0.26–0.66) COPD grade 2 183 1.49 (0.71–3.14) 0.92 (0.60–1.40) COPD grades 3 and 4 52 3.66 (1.24–10.84) 0.52 (0.22–1.25) ECSC reference values, fixed ratio Non-COPD 1590 1 1 COPD grade 1 199 1.14 (0.58–2.25) 0.40 (0.26–0.63) COPD grade 2 157 1.46 (0.70–3.0) 0.86 (0.56–1.30) COPD grades 3 and 4 37 3.47 (1.20–10.06) 0.48 (0.20–1.17) GLI reference values using LLN Non-COPD 2614 1 1 COPD grade 1 63 0.91 (0.27–3.10) 0.34 (0.19–0.61) COPD grade 2 142 1.30 (0.55–3.06) 0.87 (0.61–1.26) COPD grades 3 and 4 42 2.85 (0.90–9.03) 0.54 (0.28–1.05) Analyses on random sample with fixed ratio and GLI reference values Non-COPD 573 1 1 COPD grade 1 75 1.77 (0.65–4.87) 0.46 (0.22–0.98) COPD grade 2 53 1.42 (0.41–4.95) 0.70 (0.31–1.58) COPD grades 3 and 4 9 2.91 (0.31–27.76) 0.80 (0.13–4.80) Data are presented as odds ratios (95% CI) unless otherwise stated. All analyses were adjusted for sex, age, smoking habits, socioeconomic status, coronary artery disease, heart failure, hypertension and diabetes with the same model as in table 4. OLIN: Obstructive Lung Disease in Northern Sweden; LLN: lower limit of normal; ECSC: European Community for Steel and Coal; GLI: Global Lung Initiative.
Disclosures
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