Highlights
- •Increasing BMI is associated with worse pulmonary function, functional capacity, dyspnea, and quality of life in ILD.
- •Mass loading of the thorax in higher BMI categories could exacerbate the restrictive pulmonary defect characteristic of ILD.
- •Intentional weight-loss in overweight and obese patients may improve pulmonary function in addition to functional capacity.
Abstract
Obesity is a health epidemic associated with greater morbidity and mortality in the
general population. Mass loading of the thorax from obesity leads to a restrictive
pulmonary defect that reduces lung capacity in obese individuals without pulmonary
disease, and may exacerbate the restrictive pulmonary physiology that is characteristic
of interstitial lung disease (ILD). The purpose of this study was to test the association
of body mass index (BMI) with pulmonary function, functional capacity, and patient-reported
outcomes (dyspnea and quality of life) in patients with ILD. We analyzed 3169 patients
with fibrotic ILD from the Canadian Registry for Pulmonary Fibrosis. Patients were
subcategorized as underweight (BMI<18.5 kg/m2), normal weight (18.5≤BMI<25), overweight (25≤BMI<30), obese I (30≤BMI<35), obese
II (35≤BMI<40), and obese III (BMI>40). Analysis was performed using a linear regression
with adjustment for common prognostic variables. Overweight and obese BMI categories
were associated with worse pulmonary function, functional capacity, dyspnea, and quality
of life compared to normal weight. This is likely a result of mass loading on the
thorax, and we speculate that intentional weight-loss may improve lung function and
functional capacity in obese patients with fibrotic ILD. The underweight BMI category
was also associated with worse functional capacity compared to normal weight, which
may reflect greater disease severity or the presence of other comorbidities. Future
work should explore the clinical utility of BMI to improve patient outcomes.
Keywords
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References
- The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis.BMC Publ. Health. 2009; 9: 88
- Body mass index and mortality in chronic obstructive pulmonary disease: a dose-response meta-analysis.Medicine (Baltim.). 2016; 95: e4225
- Decrements of body mass index are associated with poor outcomes of idiopathic pulmonary fibrosis patients.PLoS One. 2019; 14e0221905
- Body mass index and mortality in patients with idiopathic pulmonary fibrosis.Chest. 2007; 131: 1448-1453
- Association of body mass index and change in weight with mortality in patients with fibrotic interstitial lung disease.Chest. 2021;
- The CAnadian REgistry for Pulmonary Fibrosis (CARE-PF): design and rationale of a national pulmonary fibrosis registry.Cancer Res. J. 2015;
- Trends and projections of obesity among Canadians.Health Promot Chronic. Dis. Prev. Can: Res, Policy, Pract. 2015; 35: 109-112
- The effects of body mass index on lung volumes.Chest. 2006; 130: 827-833
- Combined effects of obesity and chronic obstructive pulmonary disease on dyspnea and exercise tolerance.Am. J. Respir. Crit. Care Med. 2009; 180: 964-971
- The impact of bariatric surgery on pulmonary function: a meta-analysis.Surg. Obes. Relat. Dis. 2018; 14: 225-236
Article info
Publication history
Published online: March 05, 2022
Accepted:
February 22,
2022
Received in revised form:
February 21,
2022
Received:
January 11,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
