Wang Gang, Hallberg Jenny, Merid Simon Kebede, Kumar Ashish, Klevebro Susanna, Habchi Baninia, Chaleckis Romanas, Wheelock Craig E, Hernandez-Pacheco Natalia, Ekström Sandra, Janson Christer, Kull Inger, Bergström Anna, Melén Erik
Division of Internal Medicine, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China
Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Eur Respir J. 2025 Jan 2;65(1). doi: 10.1183/13993003.00298-2024. Print 2025 Jan.
Few studies have investigated the influence of body mass index (BMI) trajectories on lung function covering the entire growth period.
We conducted a prospective study using data from the Swedish BAMSE birth cohort. Latent class mixture modelling was employed to examine the diversity in BMI z-scores from birth to 24 years of age. Participants with four or more BMI z-scores were included (n=3204, 78.4%). Pre-bronchodilator spirometry was tested at 8, 16 and 24 years, while post-bronchodilator spirometry, multiple-breath nitrogen washout (for lung clearance index) and urinary metabolomics data were assessed at 24 years.
Six distinct BMI development groups were identified. Compared to the stable normal BMI group, the accelerated increasing BMI group exhibited reduced pre- and post-bronchodilator forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) ratio z-scores (pre: β= -0.26, 95% CI -0.44- -0.08; post: β= -0.22, 95% CI -0.39- -0.05), along with elevated lung clearance index (0.30, 95% CI 0.22-0.42) at 24 years. The persistent high BMI group demonstrated lower FEV (-0.24, 95% CI -0.42- -0.05) and FVC (-0.27, 95% CI -0.45- -0.01) z-score growth between 16 and 24 years, and elevated lung clearance index (0.20, 95% CI 0.03-0.39) at 24 years. However, those impairments were not observed in the accelerated resolving BMI group. Conversely, the persistent low BMI group displayed persistently decreased FEV and FVC from 8 to 24 years, as well as decreased lung function growth. Additionally, histidine-related metabolites were associated with pre- and post-bronchodilator FEV (hypergeometric false discovery rate=0.008 and <0.001, respectively).
Early interventions aiming for normal BMI during childhood may contribute to improved lung health later in life.
很少有研究调查体重指数（BMI）轨迹对整个生长发育期肺功能的影响。
我们利用瑞典BAMSE出生队列的数据进行了一项前瞻性研究。采用潜在类别混合模型来研究从出生到24岁BMI z评分的多样性。纳入有四个或更多BMI z评分的参与者（n = 3204，78.4%）。在8岁、16岁和24岁时进行支气管扩张剂使用前肺活量测定，在24岁时评估支气管扩张剂使用后肺活量测定、多次呼吸氮洗脱（用于肺清除指数）和尿液代谢组学数据。
确定了六个不同的BMI发展组。与稳定的正常BMI组相比，BMI加速增加组在支气管扩张剂使用前和使用后1秒用力呼气量（FEV）/用力肺活量（FVC）比值的z评分降低（使用前：β = -0.26，95%CI -0.44 - -0.08；使用后：β = -0.22，95%CI -0.39 - -0.05），并且在24岁时肺清除指数升高（0.30，95%CI 0.22 - 0.42）。持续高BMI组在16至24岁之间FEV（-0.24，95%CI -0.42 - -0.05）和FVC（-0.27，95%CI -0.45 - -0.01）的z评分增长较低，且在24岁时肺清除指数升高（0.20，95%CI 0.03 - 0.39）。然而，在BMI加速恢复组中未观察到这些损害。相反，持续低BMI组在8至24岁期间FEV和FVC持续下降，以及肺功能增长下降。此外，组氨酸相关代谢物与支气管扩张剂使用前和使用后的FEV相关（超几何错误发现率分别为0.008和<0.001）。
在儿童期旨在实现正常BMI的早期干预可能有助于改善成年后的肺健康。
