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Only severe COPD is associated with being underweight: results from a population survey

Berne Eriksson, Helena Backman, Apostolos Bossios, Anders Bjerg, Linnea Hedman, Anne Lindberg, Eva Rönmark, Bo Lundbäck
ERJ Open Research 2016 2: 00051-2015; DOI: 10.1183/23120541.00051-2015
Berne Eriksson
1Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
2Dept of Internal Medicine, The Central County Hospital of Halmstad, Halmstad, Sweden
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  • ORCID record for Berne Eriksson
  • For correspondence: berne.eriksson@telia.com
Helena Backman
3Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, University of Umeå, Umeå, Sweden
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Apostolos Bossios
1Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Anders Bjerg
1Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Linnea Hedman
3Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, University of Umeå, Umeå, Sweden
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Anne Lindberg
4Division of Medicine/Respiratory Medicine and Allergy, University of Umeå, Umeå, Sweden
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Eva Rönmark
3Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, University of Umeå, Umeå, Sweden
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Bo Lundbäck
1Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
3Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, University of Umeå, Umeå, Sweden
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Figures

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  • FIGURE 1
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    FIGURE 1

    Graphic presentation of the study population drawn from three OLIN (Obstructive Lung Disease in Northern Sweden) cohorts.

  • FIGURE 2
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    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
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    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
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    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
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    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

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  • TABLE 1

    Basic characteristics of the study population

    Subjects3942
    Normal spirometry2843 (72.1%)
    COPD grade 1319 (8.1%)
    COPD grade 2305 (7.7%)
    COPD grade 343 (1.1%)
    COPD grade 412 (0.3%)
    All COPD679 (17.2%)
    Restrictive spirometric pattern420 (10.7%)
    Never-smokers1595 (40.5%)
    Former smokers1481 (37.6%)
    Smokers819 (20.8%)
    Underweight#102 (2.6%)
    Normal weight¶1402 (35.6%)
    Pre-obesity+1721 (43.7%)
    Obesity§719 (18.2%)
    Coronary artery disease521 (13.2%)
    Heart failure51 (1.3%)
    Arrhythmia238 (6.0%)
    Hypertension1369 (34.7%)
    Claudication151 (3.8%)
    Diabetes357 (9.1%)
    Wheeze most days a week424 (10.8%)
    mMRC dyspnoea score ≥2668 (16.9%)
    Chronic productive cough1072 (27.2%)
    Any inhaled steroids897 (22.8%)
    Any oral steroids301 (7.6%)
    Professionals or executives1003 (25.4%)
    Assistant nonmanual employees645 (16.4%)
    Manual workers in industry768 (19.5%)
    Manual workers in services1144 (29.0%)
    Self-employed nonprofessionals236 (6.0%)
    Other occupations146 (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 BMIp-value
    All26.67
    Men26.830.019
    Women26.52
    Never-smokers26.780.647+
    Former smokers26.85
    Current smokers26.11<0.001§
    Chronic productive cough#26.69ns
    Wheeze most days a week#27.97<0.001
    mMRC dyspnoea score 2–4#28.21<0.001
    Urban living26.43<0.001ƒ
    Rural living27.49
    Asthma¶27.29<0.001
    COPD¶25.83<0.001
    Coronary artery disease#27.210.002
    Heart failure#27.950.029
    Arrhythmia#26.72ns
    Hypertension#27.83<0.001
    Claudication#27.00ns
    Diabetes#28.74<0.001
    Any inhalation steroids#27.29<0.001
    Any oral steroids#26.90ns
    Professionals and executives26.15<0.001ƒ
    Assistant nonmanual employees26.63
    Manual workers in industry26.83
    Manual workers in service27.02
    Self-employed nonprofessionals26.68
    Other26.91
    • 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 weightUnderweightp-valuePre-obesityp-valueObesityp-value
    Subjects1296861544596
    Mean age years59.060.10.44658.90.71958.80.779
    Men/women44.7%/55.3%25.6%/74.4%0.00155.4%/44.6%<0.00145.1%/54.9%0.902
    Mean FEV1 % predicted9587<0.001960.511930.001
    Mean FVC % predicted98940.00297<0.00193<0.001
    Normal spirometry77.8%67.4%0.06082.4%0.00384.6%<0.001
    COPD grade 111.7%14.0%8.0%5.2%
    COPD grade 28.7%14.0%8.4%8.4%
    COPD grades 3 and 41.8%4.7%1.1%1.8%
    Never-smokers39.2%32.6%0.00441.6%0.00142.6%0.072
    Former smokers36.2%26.7%0.00439.5%0.00137.4%0.072
    Smokers24.2%40.7%18.9%20.0%
    Coronary artery disease10.8%8.1%0.43212.4%0.21815.8%0.003
    Heart failure0.8%1.2%0.7581.0%0.7322.3%0.008
    Hypertension24.4%22.1%0.63134.9%<0.00150.8%<0.001
    Diabetes4.5%4.7%0.9348.2%<0.00116.5%<0.001
    Wheeze most days a week7.2%15.1%0.0079.9%0.01016.4%<0.001
    mMRC dyspnoea score ≥210.5%23.2%<0.00115.1%<0.00127.3%<0.001
    Chronic productive cough25.0%31.4%0.18626.6%0.34627.2%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

    SubjectsUnderweightObesity
    Female10173.02 (1.65–5.53)0.92 (0.72–1.17)
    Age1.01 (0.99–1.03)0.99 (0.98–1.00¶)
    Never-smoker7271.01.0
    Ex-smoker6630.96 (0.54–1.72)0.90 (0.69–1.16)
    Smoker4451.86 (1.07–3.26)0.84 (0.62–1.15)
    Normal spirometry14621.01.0
    COPD grade 11891.27 (0.64–2.53)0.43 (0.27–0.68)
    COPD grade 21691.43 (0.70–2.94)0.83 (0.55–1.26)
    COPD grade 3–4353.24 (1.00#–10.5)0.62 (0.26–1.48)
    Professional or executive4961.01.0
    Assistant nonmanual employee3041.39 (0.70–2.74)1.38 (0.96–2.00)
    Manual worker in industry3441.90 (0.86–4.18)1.59 (1.11–2.28)
    Manual worker in service5311.02 (0.55–1.90)1.83 (1.33–2.51)
    Self-employed nonprofessional1121.60 (0.56–4.55)1.53 (0.92–2.56)
    Other501.55 (0.48–5.00)1.49 (0.71–3.13)
    Coronary artery disease2290.81 (0.35–1.90)1.18 (0.83–1.67)
    Heart failure241.40 (0.16–12.0)1.95 (0.79–4.82)
    Hypertension5710.80 (0.46–1.39)2.97 (2.34–3.78)
    Diabetes1381.14 (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

    SubjectsUnderweightObesity
    OLIN reference values using LLN for COPD and restrictive spirometry
     Non-COPD146211
     COPD grade 1561.23 (0.35–4.25)0.58 (0.26–1.26)
     COPD grade 21141.69 (0.78–3.66)0.53 (0.30–0.94)
     COPD grades 3 and 4353.38 (1.16–9.82)0.52 (0.20–1.36)
    Berglund reference values, fixed ratio
     Non-COPD234211
     COPD grade 1751.35 (0.67–2.71)0.41 (0.26–0.66)
     COPD grade 21831.49 (0.71–3.14)0.92 (0.60–1.40)
     COPD grades 3 and 4523.66 (1.24–10.84)0.52 (0.22–1.25)
    ECSC reference values, fixed ratio
     Non-COPD159011
     COPD grade 11991.14 (0.58–2.25)0.40 (0.26–0.63)
     COPD grade 21571.46 (0.70–3.0)0.86 (0.56–1.30)
     COPD grades 3 and 4373.47 (1.20–10.06)0.48 (0.20–1.17)
    GLI reference values using LLN
     Non-COPD261411
     COPD grade 1630.91 (0.27–3.10)0.34 (0.19–0.61)
     COPD grade 21421.30 (0.55–3.06)0.87 (0.61–1.26)
     COPD grades 3 and 4422.85 (0.90–9.03)0.54 (0.28–1.05)
    Analyses on random sample with fixed ratio and GLI reference values
     Non-COPD57311
     COPD grade 1751.77 (0.65–4.87)0.46 (0.22–0.98)
     COPD grade 2531.42 (0.41–4.95)0.70 (0.31–1.58)
     COPD grades 3 and 492.91 (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.

Additional Files

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Only severe COPD is associated with being underweight: results from a population survey
Berne Eriksson, Helena Backman, Apostolos Bossios, Anders Bjerg, Linnea Hedman, Anne Lindberg, Eva Rönmark, Bo Lundbäck
ERJ Open Research Jul 2016, 2 (3) 00051-2015; DOI: 10.1183/23120541.00051-2015

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Only severe COPD is associated with being underweight: results from a population survey
Berne Eriksson, Helena Backman, Apostolos Bossios, Anders Bjerg, Linnea Hedman, Anne Lindberg, Eva Rönmark, Bo Lundbäck
ERJ Open Research Jul 2016, 2 (3) 00051-2015; DOI: 10.1183/23120541.00051-2015
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