Fu Chengjie, Yang Hongchang
Department of Physical Education, Hohai University, Nanjing, Jiangsu, China.
Front Nutr. 2023 Jun 29;10:1159949. doi: 10.3389/fnut.2023.1159949. eCollection 2023.
The association of BMI with COPD, and sarcopenia in COPD have been both confirmed by several studies, but research on the relationship and causality of body lean mass and the risk of chronic obstructive pulmonary disease (COPD) remains to be discovered. The purpose of this study was to explore the association between lean mass and COPD risk as well as to further examine the causal relationship in the findings.
Three thousand four hundred fifty-nine participants from NHANES 2013-2018 were included in the epidemiological cross-sectional study to assess the association between relative lean mass and COPD by restricted spline analysis (RCS) and weighted multiple logistic regression. Furthermore, to verify the causality between lean mass and COPD, a two-sample Mendelian randomization (MR) with inverse variance weighting (IVW) method was used to analyze GWAS data from European ancestry. Genetic data from the United Kindom Biobank for appendicular lean mass (450,243 cases) and lung function (FEV/FVC) (400,102 cases) together with the FinnGen platform for COPD (6,915 cases and 186,723 controls) were used for MR.
Weighted multiple logistic regression showed a significant correlation between relative appendicular lean mass and COPD after adjusting for confounders (OR = 0.985, 95% CI: 0.975-0.995). Compared to the lower mass (155.3-254.7) g/kg, the high mass (317.0-408.5) g/kg of appendicular lean apparently decreases the risk of COPD (OR = 0.214, 95% CI: 0.060-0.767). Besides, in the analysis of MR, there was a forward causality between appendicular lean mass and COPD (IVW: OR = 0.803; 95%CI: 0.680-0.949; = 0.01), with a weak trend of causality to lung function.
Our study not only found an inverse association between appendicular lean mass and COPD but also supported a unidirectional causality. This provided possible evidence for further identification of people at risk for COPD and prevention of COPD based on limb muscle exercise and nutritional supplementation to maintain skeletal muscle mass.
多项研究已证实体重指数（BMI）与慢性阻塞性肺疾病（COPD）之间的关联，以及COPD患者存在肌肉减少症，但关于身体瘦体重与慢性阻塞性肺疾病（COPD）风险之间的关系及因果关系的研究仍有待探索。本研究的目的是探讨瘦体重与COPD风险之间的关联，并进一步检验研究结果中的因果关系。
本横断面流行病学研究纳入了2013 - 2018年美国国家健康与营养检查调查（NHANES）的3459名参与者，通过受限样条分析（RCS）和加权多元逻辑回归评估相对瘦体重与COPD之间的关联。此外，为验证瘦体重与COPD之间的因果关系，采用两样本孟德尔随机化（MR）及逆方差加权（IVW）方法分析欧洲血统人群的全基因组关联研究（GWAS）数据。来自英国生物银行的关于四肢瘦体重（450,243例）和肺功能（FEV/FVC）（400,102例）的遗传数据，以及芬兰基因平台的COPD数据（6,915例病例和186,723例对照）用于MR分析。
加权多元逻辑回归显示，在调整混杂因素后，相对四肢瘦体重与COPD之间存在显著相关性（OR = 0.985，95%CI：0.975 - 0.995）。与较低瘦体重（155.3 - 254.7）g/kg相比，较高瘦体重（317.0 - 408.5）g/kg的四肢瘦体重明显降低了COPD风险（OR = 0.214，95%CI：0.060 - 0.767）。此外，在MR分析中，四肢瘦体重与COPD之间存在正向因果关系（IVW：OR = 0.803；95%CI：0.680 - 0.949；P = 0.01），与肺功能之间存在较弱的因果关系趋势。
我们的研究不仅发现四肢瘦体重与COPD之间存在负相关，还支持单向因果关系。这为进一步识别COPD高危人群以及基于肢体肌肉锻炼和营养补充以维持骨骼肌质量来预防COPD提供了可能的证据。
