High BMI and COPD Outcomes in Alpha-1 Antitrypsin Deficiency

CHEST pulmonary Pub Date : 2025-03-01 DOI:10.1016/j.chpulm.2024.100113

Michael A. Campos MD , Leonard Riley MD , Jorge Lascano MD , Brian Garnet MD , Robert Sandhaus MD, PhD

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Abstract

Background

Elevations in BMI impact morbidity in patients with COPD in general, but little is known about its impact in patients with COPD due to alpha-1 antitrypsin deficiency (AATD-COPD).

Research Question

What is the prevalence and clinical impact of high BMI in AATD-COPD?

Study Design and Methods

A total of 646 patients completed clinical and health-related quality of life (HRQoL) questionnaires for 2 years. Patients were grouped by baseline BMI categories (underweight, normal, overweight, obese, and morbidly obese) to compare symptoms, exacerbations, HRQoL, and 5- and 10-year survival. Relation between changes in BMI over time on HRQoL was assessed.

Results

The cohort’s mean age ± SD (55 ± 9.2 years), sex distribution (50.1% male), and mean % FEV₁ ± SD (36.6% ± 17.0%) was similar across all BMI categories. One-third (31.6%) had normal BMI, 5.6% were underweight, and 62% had a high BMI (37.3% overweight, 16.1% obese, and 9.4% morbidly obese). Patients with a high BMI had significantly worse St. George’s Respiratory questionnaire (SGRQ) and 36-Item Short Form Survey (SF-36) physical composite scores than patients with normal weight. Patients with morbid obesity had the highest odds of being in the worst SGRQ (OR, 3.8; 95% CI, 1.9-7.8) and SF-36 physical composite (OR, 4.2; 95% CI, 2.1-8.1) quartiles and experienced more emergency department visits and hospitalizations than patients with normal weight (P < .05). Patients who transitioned to a higher BMI category over time reported worsening of SGRQ and SF-36 physical composite scores (P < .05) and vice versa. Despite their higher morbidity, no difference in survival was observed between patients with high BMI and normal BMI after a mean follow-up of 9 years.

Interpretation

BMI above normal is prevalent in patients with AATD-COPD and is associated with greater comorbidity and poor HRQoL but does not impact survival. HRQoL is inversely affected by BMI changes over time.

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研究背景体重指数的升高对一般慢性阻塞性肺病患者的发病率有影响，但对于其对α-1抗胰蛋白酶缺乏所致慢性阻塞性肺病（AATD-COPD）患者的影响却知之甚少。研究问题高体重指数在 AATD-COPD 中的患病率和临床影响如何？按照基线体重指数类别（体重不足、正常、超重、肥胖和病态肥胖）对患者进行分组，以比较症状、病情加重、HRQoL以及5年和10年生存率。结果在所有 BMI 类别中，队列的平均年龄（55 ± 9.2 岁）、性别分布（50.1% 为男性）和平均 FEV1% ± SD（36.6% ± 17.0%）相似。三分之一（31.6%）的患者体重指数正常，5.6%体重不足，62%体重指数较高（37.3%超重，16.1%肥胖，9.4%病态肥胖）。体重指数高的患者的圣乔治呼吸问卷（SGRQ）和 36 项简表调查（SF-36）身体综合评分明显低于体重正常的患者。与体重正常的患者相比，病态肥胖患者处于最差 SGRQ（OR，3.8；95% CI，1.9-7.8）和 SF-36 体力综合评分（OR，4.2；95% CI，2.1-8.1）四分位数的几率最高，急诊就诊和住院治疗的次数也更多（P <.05）。随着时间的推移，体重指数升至较高类别的患者的 SGRQ 和 SF-36 体能综合评分有所下降（P < .05），反之亦然。尽管高 BMI 患者的发病率较高，但在平均 9 年的随访后，未观察到高 BMI 患者与正常 BMI 患者的生存率有任何差异。随着时间的推移，HRQoL 与 BMI 的变化成反比。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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CHEST pulmonary

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