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World Health Organization body mass index (BMI) classifications
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The global increase in the prevalence and incidence of obesity has called serious attention to this issue as a major public health concern. Obesity is associated with many chronic diseases, including cardiovascular disease and diabetes, and recently the role of overweight and obesity in lung disease has received new interest. Independently of obesi...
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Background: Vitamin D level can affect pulmonary function in patient who have chronic obstructive pulmonary disease (COPD). Objectives: There are few studies that assess this subject, so we investigate the relation of Vitamin D and COPD. Materials and Methods: A case-control study was conducted among the patients referred to the pulmonology clinic...
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Introduction/Objective. The origin of depressive disorder in Chronic Obstructive Pulmonary Disease (COPD) patients is still not completely known and probably is caused by various factors. Objective. The aim of this study is to establish the most important characteristics of COPD patients who have depressive disorder. Methods. Eighty nine COPD patie...
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Citations
... Most previous studies focused on the prevalence and clinical impact of sarcopenia in chronic obstructive pulmonary disease (COPD) or chronic respiratory disease [6,7], on account of the high prevalence of skeletal muscle dysfunction among corresponding patients, with limited studies that evaluated the relationship between sarcopenia and incident of respiratory disease [8]. Given systemic inflammation, physical inactivity and nutritional deficiencies were considered as part of underlying mechanisms in both sarcopenia and respiratory disease [7,9,10], a causal role for sarcopenia was plausible. Moreover, findings on the association between grip strength and respiratory disease were inconsistent. ...
Background
There is limited evidence about the association of muscle mass, strength and quality with respiratory disease, especially in Chinese populations. We aimed to comprehensively examine such associations and identify better metrics with more clinical and public health relevance.
Methods
We conducted a prospective cohort study based on data from the second resurvey of the China Kadoorie Biobank (CKB) study in participants with no prevalent respiratory disease or cancer. Arm muscle quality was calculated as the ratio of grip strength to arm muscle mass. Low muscle mass, grip strength and arm muscle quality were defined as the sex‐specific lowest quintiles of corresponding variables. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for respiratory disease.
Results
In total, 17 510 participants aged 38–88 (65.4% women; mean age 57.8 ± 9.6) were enrolled in 2013–2014 and followed up until 31 December 2018. During a median follow‐up of 4.82 years, 1346 participants developed respiratory disease. After adjustment for sociodemographic characteristics, lifestyle factors and medical histories, the elevated HR of respiratory disease was 1.31 (1.14–1.51) for low grip strength and 1.25 (1.09–1.44) for low arm muscle quality. Grip strength and arm muscle quality exhibited a linearly inverse association between respiratory disease (p = 0.137 and 0.102), with each standard deviation (SD) decrease in grip strength and arm muscle quality associated with a 22% (95% CI: 11%–34%) and 14% (95% CI: 7%–22%) increased risk of respiratory disease. No association was found for low total muscle mass index and low appendicular muscle mass index.
Conclusion
Low grip strength and arm muscle quality are associated with increased risks of respiratory disease, and they are better muscle‐related metrics for identifying adults at high risk of respiratory disease. Chinese adults may need to maintain normal muscle mass, strength and quality to achieve better respiratory health, but this needs to be validated in appropriately designed clinical trials.
... Previous epidemiologic work has shown that diet can impact pulmonary function in those with COPD (Hanson et al., 2014). A "Western" diet pattern, generally categorized as high in refined grains, cured and red meats, added sugars, and fat, has also been identified as a risk factor for COPD (Young and Hopkins, 2018;Scoditti et al., 2019), impacting both men (Varraso et al., 2007b) and women (Varraso et al., 2007a). ...
Chronic Obstructive Pulmonary Disease (COPD) affects 30 million Americans. Previous epidemiologic work has shown that diet can impact pulmonary function in those with and without COPD. Diet is also a major driver of gut microbiome composition and function. Importantly, the gut microbiome has also been associated with lung health (i.e., the gut-lung axis) in both preclinical and clinical studies. Despite this growing body of evidence, many questions remain regarding the gut-lung axis. Specifically, how the microbiome impacts the relationship between diet factors and spirometry or stage of disease in people with COPD is little understood. We hypothesize that there are taxonomic differences in the gut microbiome among the different stages of COPD and that diet microbiome interactions influence pulmonary function. This study aimed to identify how the GI microbiota correlated with the severity of respiratory disease in COPD patients and how the microbiome may mediate the relationship between diet, including fiber and omega-3 fatty acids, and lung function outcomes.
... Furthermore, comorbidity is associated with increased mortality [88]. Compared to the general population patients with COPD have a higher prevalence of comorbidities, with cardiovascular diseases, osteoporosis, hypertension, and gastroesophageal disease being among the most prevalent [46,[89][90][91][92][93][94][95][96][97]. ...
Background: The management of chronic obstructive pulmonary disease (COPD) lacks standardization due to the diverse clinical presentation, comorbidities, and limited acceptance of recommended approaches by physicians. To address this, a multicenter study was conducted among Italian respiratory physicians to assess consensus on COPD management and pharmacological treatment. Methods: The study employed the Delphi process using the Estimate-Talk-Estimate method, involving a scientific board and expert panel. During a 6-month period, the scientific board conducted the first Delphi round and identified 11 broad areas of COPD management to be evaluated while the second Delphi round translated all 11 items into statements. The statements were subsequently presented to the expert panel for independent rating on a nine-point scale. Consensus was considered achieved if the median score was 7 or higher. Consistently high levels of consensus were observed in the first rating, allowing the scientific board to finalize the statements without requiring further rounds. Results: Topics generating substantial discussion included the pre-COPD phase, patient-reported outcomes, direct escalation from a single bronchodilator to triple therapy, and the role of adverse events, particularly pneumonia, in guiding triple therapy prescriptions. Notably, these topics exhibited higher standard deviations, indicating greater variation in expert opinions. Conclusions: The study emphasized the significance that Italian pulmonologists attribute to managing mortality, tailoring treatments, and addressing cardiovascular comorbidities in COPD patients. While unanimous consensus was not achieved for all statements, the results provide valuable insights to inform clinical decision-making among physicians and contribute to a better understanding of COPD management practices in Italy.
... Three models of adjustment were used: (1) minimally adjusted: gender and region (entered as a strata variable); (2) multivariable-adjusted: gender, region, body mass index, income, education, ethnicity, physical activity, alcohol intake, smoking status, packyears, passive smoking status, deprivation index, prevalent asthma, or prevalent COPD (as relevant, depending on the outcome), and diet stability; (3) multivariable-adjusted including potential dietary confounders: all variables in Model 2 plus intakes (g/d) of wholegrains, refined grains, sugar-sweetened beverages, dairy, eggs, fish, and meat. Confounders were selected based on a priori knowledge [8,[29][30][31]. To examine cross-sectional associations between exposures and spirometry measures we used linear regression models with exposures modeled using restricted cubic splines, as described above. ...
Background
Given their antioxidative stress, anti-allergic, anti-inflammatory, and immune-modulating effects, flavonoids are hypothesized to play a role in preventing chronic obstructive pulmonary disease (COPD) and asthma.
Objectives
This cohort study aimed to examine associations between flavonoid intake and COPD, asthma, and lung function.
Methods
Among 119,466 participants of the UK Biobank, median [interquartile range] age of 60 [53, 65] y, we estimated intakes of flavonoids, flavonoid-rich foods, and a flavodiet score from 24-h diet assessments. Prospective associations with both incident COPD and asthma and cross-sectional associations with measures of lung function [%predicted forced expiratory volume in 1s (FEV1); and FEV1/forced vital capacity (FVC)] were examined using multivariable-adjusted Cox proportional hazards and linear regression models, respectively. We investigated mediation by inflammation––represented by the INFLA score––and stratified analyses by smoking status.
Results
Compared with low intakes, moderate intakes of total flavonoids, flavonols, theaflavins + thearubigins, and flavanones, and moderate-to-high intakes of flavanol monomers, proanthocyanidins, anthocyanins, flavones, and the flavodiet score were associated with up to an 18% lower risk of incident COPD {e.g., [hazard ratio (95% confidence interval) for total flavonoids: 0.83 (0.75, 0.92)]} but not incident asthma. Furthermore, compared with low intakes, higher intakes of all flavonoid subclasses (except theaflavins + thearubigins), and the flavodiet score were associated with better percent predicted FEV1 baseline. Associations were most apparent in ever (current or former) smokers. Flavonoid intakes were inversely associated with the INFLA score, which appeared to mediate 11%–14% of the association between intakes of proanthocyanidins and flavones and incident COPD.
Conclusions
Moderate-to-high flavonoid intakes were associated with a lower risk of COPD and better lung function, particularly among ever smokers. Promoting intakes of healthy flavonoid-rich foods, namely, tea, apples, and berries, may improve respiratory health and lower COPD risk, particularly in individuals with a smoking history.
... The evidence reported previously indicates that clinicians and dietitians must evaluate the nutritional status and body composition of patients when giving nutritional advice or diet recommendations to patients with COPD with obesity to foster an adequate intake of macro-and micronutrients and control obesity as well [15]. ...
Background
Chronic obstructive pulmonary disease (COPD) is a chronic condition among the main causes of morbidity and mortality worldwide, representing a burden on health care systems. Scientific literature highlights that nutrition is pivotal in respiratory inflammatory processes connected to COPD, including exacerbations. Patients with COPD have an increased risk of developing nutrition-related comorbidities, such as diabetes, cardiovascular diseases, and malnutrition. Moreover, these patients often manifest sarcopenia and cachexia. Therefore, an adequate nutritional assessment and therapy are essential to help individuals with COPD in managing the progress of the disease. However, the role of nutrition in pulmonary rehabilitation (PR) programs is often underestimated due to a lack of resources and dedicated services, mostly because pneumologists may lack the specialized training for such a discipline.
Objective
This work proposes a novel knowledge-based decision support system to support pneumologists in considering nutritional aspects in PR. The system provides clinicians with patient-tailored dietary recommendations leveraging expert knowledge.
Methods
The expert knowledge—acquired from experts and clinical literature—was formalized in domain ontologies and rules, which were developed leveraging the support of Italian clinicians with expertise in the rehabilitation of patients with COPD. Thus, by following an agile ontology engineering methodology, the relevant formal ontologies were developed to act as a backbone for an application targeted at pneumologists. The recommendations provided by the decision support system were validated by a group of nutrition experts, whereas the acceptability of such an application in the context of PR was evaluated by pneumologists.
Results
A total of 7 dieticians (mean age 46.60, SD 13.35 years) were interviewed to assess their level of agreement with the decision support system’s recommendations by evaluating 5 patients’ health conditions. The preliminary results indicate that the system performed more than adequately (with an overall average score of 4.23, SD 0.52 out of 5 points), providing meaningful and safe recommendations in compliance with clinical practice. With regard to the acceptability of the system by lung specialists (mean age 44.71, SD 11.94 years), the usefulness and relevance of the proposed solution were extremely positive—the scores on each of the perceived usefulness subscales of the technology acceptance model 3 were 4.86 (SD 0.38) out of 5 points, whereas the score on the intention to use subscale was 4.14 (SD 0.38) out of 5 points.
Conclusions
Although designed for the Italian clinical context, the proposed system can be adapted for any other national clinical context by modifying the domain ontologies, thus providing a multidisciplinary approach to the management of patients with COPD.
... The ineffectiveness of the respiratory muscles reduces strength and increases pulmonary resistance. All these factors lead to inspiratory overload, which increases respiratory effort, oxygen consumption, and respiratory energy expenditure [8,9]. ...
Objective: Obesity, an epidemic metabolic disorder, is associated with various biochemical, inflammatory, oxidative and immunological pathways. We aimed to investigate the biochemical effect correlated with pulmonary dysfunction and complications in overweight and obese patients. Material and Methods: We aimed to evaluate retrospectively the effect of biochemical parameters on pulmonary dysfunction and complications in 79 overweight and obese patients. The correlative effect of biochemical values, including CRP, and spirometric measurements, such as forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), on pulmonary dysfunction and complications in 79 overweight and obese patients seen in the outpatient clinic were evaluated. Body mass index (BMI), FEV1 and FVC, and total biochemistry values, including creatinine, AST, ALT and CRP values were correlated among each other. Results: Low FVC levels, leukocytosis, high AST and ALT levels, and comorbidities of obesity are significantly associated with high BMI values by univariate analysis in these patients. Higher AST levels are significantly correlated with higher leucocyte counts, and both AST and ALT levels are significantly correlated with platelet counts. Conclusion: We investigated the effect of biochemical parameters on pulmonary dysfunction and complications in obese patients. Obesity can be helpful to categorize high-risk patients with low FVC levels in the context of respiratory diseases and high AST and ALT levels for other comorbidities as steatohepatitis, diabetes mellitus and coronary artery disease. This study sheds light on future research on obese patients for prognosis of these diseases, because of their biochemical profile correlation with pulmonary dysfunction and complications.
... Similar to other studies, our study found that obese people with a BMI between 30 and 34.9 had a lower risk of severe exacerbations and mortality than those with a BMI in the normal range. [49][50][51][52] Putcha et al showed that while underweight COPD participants in the UPLIFT and TIOSPIR studies had a significantly higher risk of death and severe exacerbations versus normal weight participants, overweight and obese participants were at lower to no additional risk. 52 In line with this, Spelta et al reported a significant protective effect of obesity in patients with COPD on all-cause mortality, and referred to this as the "obesity paradox." ...
Background:
Chronic Obstructive Pulmonary Disease is a chronic, often progressive disease, which in most patients is caused by tobacco smoking. Our study focuses on differences in COPD-related outcomes between never-smokers, former smokers and current smokers.
Methods:
A nationwide, population-based cohort study utilizing Danish health registries. Clinical and socioeconomical variables including smoking status, comorbidities, and dyspnoea were obtained. Poisson and Cox Regression were used to calculate the impact of these clinical parameters on risk of moderate and severe exacerbations and mortality during 12 months of follow-up.
Results:
49.826 patients ≥40 years of age, with a hospital diagnosis of COPD in 2008-2017, were identified (mean age 69.2 years, 52% females). 2,127 (4%) were never-smokers, 29,854 (60%) former smokers and 17,845 (36%) current smokers. Compared to former and current smokers, never-smokers reported a lower MRC score and had a milder COPD stage according to GOLD classification. During follow-up, never-smokers had a significant lower risk of severe exacerbations (HR 0.87, 95% CI 0.78-0.97) and a lower rate of death (mortality ratio 0.75, 95% CI 0.70-0.81) compared to patients with a smoking history.
Discussion:
Our nationwide study showed that COPD in never-smokers is characterized by a lower level of dyspnoea, milder lung function impairment and a lower risk of exacerbations and death. At the same time, we found active smokers to have the highest risk. These findings highlight the need for campaigns to prevent smoking and may help general practitioners as well as other health care professionals to motivate patients with COPD to stop smoking.
... Increasing evidence is pointing towards a pulmonary-metabolic axis of high importance in both communicable infectious diseases, e. g. COVID19 [1], and non-communicable respiratory diseases, e. g. asthma [2] and chronic obstructive pulmonary disease (COPD) [3]. In both acute and chronic scenarios, obesity and type 2 diabetes are recognized as independent risk factors for disease development and prognosis [4,5] Yet not every person with obesity or type 2 diabetes exhibits pulmonary implications, which indicates an individual complex regulation of this systems interplay. ...
Introduction:
Clara cell 16-kDa protein (CC16) is an anti-inflammatory, immunomodulatory secreted pulmonary protein with reduced serum concentrations in obesity according to recent data.
Objective:
Studies focused solely on bodyweight, which does not properly reflect obesity-associated implications of the metabolic and reno-cardio-vascular system. The purpose of this study was therefore to examine CC16 in a broad physiological context considering cardio-metabolic comorbidities of primary pulmonary diseases.
Methods:
CC16 was quantified in serum samples in a subset of the FoCus (N=497) and two weight loss intervention cohorts (N=99) using ELISA. Correlation and general linear regression analyses were applied to assess CC16 effects of lifestyle, gut microbiota, disease occurrence and treatment strategies. Importance and intercorrelation of determinants were validated using random forest algorithms.
Results:
CC16 A38G gene mutation, smoking and low microbial diversity significantly decreased CC16. Pre-menopausal female displayed lower CC16 compared to post-menopausal female and male participants. Biological age and uricosuric medications increased CC16 (all p < 0.01). Adjusted linear regression revealed CC16 lowering effects of high waist-to-hip ratio (est. -11.19 [-19.4; -2.97], p = 7.99 x 10-3), severe obesity (est. -2.58 [-4.33; -0.82], p = 4.14 x 10-3) and hypertension (est. -4.31 [-7.5; -1.12], p = 8.48 x 10-3). ACEi/ARB medication (p = 2.5 x 10-2) and chronic heart failure (est. 4.69 [1.37; 8.02], p = 5.91 x 10-3) presented increasing effects on CC16. Mild associations of CC16 were observed with blood pressure, HOMA-IR and NT-proBNP, but not manifest hyperlipidemia, type 2 diabetes, diet quality and dietary weight loss intervention.
Conclusion:
A role of metabolic and cardiovascular abnormalities in the regulation of CC16 and its modifiability by behavioral and pharmacological interventions is indicated. Alterations by ACEi/ARB and uricosurics could point towards regulatory axes comprising the renin-angiotensin-aldosterone system and purine metabolism. Findings altogether strengthen the importance of interactions among metabolism, heart and lungs.
... Next, comorbidities of obesity were assessed across chapters A to N of the ICD-10 catalog. Considering that comorbidities are strongly age dependent, we analyzed significant comorbidities in 7 age groups defined by the decade of life (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), and so on). Each age group stratum was further stratified based on 2-year time windows (2003)(2004)(2005)(2006), and so on). ...
... This further underlines the wellestablished role of obesity as a driving factor in metabolic dysregulation, as it constitutes the most important risk factor for diabetes mellitus type 2 and in terms of abdominal obesity places central in the concept of metabolic syndrome [25,26]. Consistently, with increasing age also a variety of known sequelae of the metabolic syndrome such as chronic ischemic heart disease [27], arrhythmia [28] and chronic obstructive pulmonary disorders were identified [29]. The highest risk increase in young patient groups emphasizes the decisive role of obesity for early development of diabetes mellitus and other disorders usually associated with aging [15]. ...
Obesity, a highly prevalent disorder and central diagnosis of the metabolic syndrome, is linked to mental health by clinical observations and biological pathways. Patients with a diagnosis of obesity may show long-lasting increases in risk for receiving psychiatric co-diagnoses. Austrian national registry data of inpatient services from 1997 to 2014 were analyzed to detect associations between a hospital diagnosis of obesity (ICD-10: E66) and disorders grouped by level-3 ICD-10 codes. Data were stratified by age decades and associations between each pair of diagnoses were computed with the Cochran-Mantel-Haenszel method, providing odds ratios (OR) and p values corrected for multiple testing. Further, directions of the associations were assessed by calculating time-order-ratios. Receiving a diagnosis of obesity significantly increased the odds for a large spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating and personality disorders (all pcorr < 0.01, all OR > 1.5). For all co-diagnoses except for psychosis-spectrum, obesity was significantly more often the diagnosis received first. Further, significant sex differences were found for most disorders, with women showing increased risk for all disorders except schizophrenia and nicotine addiction. In addition to the well-recognized role in promoting disorders related to the metabolic syndrome and severe cardiometabolic sequalae, obesity commonly precedes severe mental health disorders. Risk is most pronounced in young age groups and particularly increased in female patients. Consequently, thorough screening for mental health problems in patients with obesity is urgently called for to allow prevention and facilitate adequate treatment.
... A ingestão de nutrientes e padrões alimentares demonstram influência em medidas de função pulmonar e desenvolvimento e progressão da DPOC (Hanson et al., 2014;Hanson et al., 2021). Dados da literatura sugerem que alguns padrões, em que quando ocorre elevado consumo de carne vermelha processada, estão associados a um risco aumentado de DPOC entre fumantes (Kaluza et al., 2016). ...
... Alguns autores referem que o IMC exerce grande influência sobre a qualidade de vida desses pacientes (Fernandes & Research, Society and Development, v. 12, n. 3, e15212340311, 2023(CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v12i3.40311 Bezerra, 2006Hanson et al., 2014). ...
Objetivo: avaliar a antropometria e estilo de vida em portadores de Doença Pulmonar Obstrutiva Crônica (DPOC). Métodos: estudo descritivo, do tipo série de casos, constituído por amostra de 30 pacientes, ≥40 anos, do ambulatório de pneumologia do Hospital das Clínicas de Pernambuco, com diagnóstico de DPOC. Avaliaram-se dados sociodemográficos e comportamentais, peso, altura, índice de massa corporal, alterações ponderais, circunferência do braço, circunferência da panturrilha, circunferência da cintura, circunferência do quadril, relação cintura/estatura, relação cintura/quadril e índice de conicidade. Resultados: Observou-se prevalência de 70% idosos, 70% homens, 63,3% < 8 anos de escolaridade, 76,7% inativos, 66,7% com rendimentos ≤ 1 salário mínimo e residentes na região metropolitana e interior (83,3%). Predominantemente ex-tabagistas que fumaram ≥ 20 anos. 66,7% sedentários e 83,3% não eram etilistas. 50% tinha excesso de peso, enquanto 50% apresentou perda ponderal após doença pulmonar. A gordura abdominal foi elevada (56,7%) segundo circunferência da cintura e, em 83,3% pela relação cintura/estatura; 53,3% apresentaram relação cintura/quadril alterada e circunferência do braço variando de desnutrição (40%) a eutrofia (40%). Na circunferência da panturrilha dos idosos 84% foram classificados como eutróficos, enquanto o índice de conicidade 93% apresentou elevação. Conclusão: Detectou-se elevadas alterações na antropometria, ao mesmo tempo em que foi observado estilo de vida sedentário.
