Ali Gulshan B, Lowe Adrian J, Walters E Haydn, Perret Jennifer L, Erbas Bircan, Lodge Caroline J, Bowatte Gayan, Thomas Paul S, Hamilton Garun S, Thompson Bruce R, Johns David P, Hopper John L, Abramson Michael J, Bui Dinh S, Dharmage Shyamali C
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
Respirology. 2025 Mar;30(3):230-241. doi: 10.1111/resp.14882. Epub 2025 Jan 26.
The impact of lifetime body mass index (BMI) trajectories on adult lung function abnormalities has not been investigated previously. We investigated associations of BMI trajectories from childhood to mid-adulthood with lung function deficits and COPD in mid-adulthood.
Five BMI trajectories (n = 4194) from age 5 to 43 were identified in the Tasmanian Longitudinal Health Study. Lung function outcomes were defined using spirometry at 45 and 53 years. Associations between these BMI trajectories and lung function outcomes were investigated using multivariable regression.
Compared to the average BMI trajectory, the child's average-increasing BMI trajectory was associated with greater FVC decline from 45 to 53 years (β = -178 mL; 95% CI -300.6, -55.4), lower FRC, ERV and higher TLco at 45 years, lower FVC (-227 mL; -345.3, -109.1) and higher TLco at 53 years. The High BMI trajectory was also associated with lower FRC, ERV and higher TLco at 45 years, while spirometric restriction (OR = 6.9; 2.3, 21.1) and higher TLco at 53 years. The low BMI trajectory was associated with an obstructive picture: lower FEV (-124 mL; -196.4, -51.4) and FVC (-91 mL; -173.4, -7.7), and FEV/FVC (-1.2%; -2.2, -0.1) and higher ERV and lower TLco at 45 and 53 years. A similar pattern was found at 53 years. No associations were observed with spirometrically defined COPD.
Our findings revealed contrasting lung function abnormalities were associated with high, subsequently increasing, and low BMI trajectories. These results emphasise the importance of tracking changes in BMI over time and the need to maintain an average BMI trajectory (BMI-Z-score 0 at each time point) throughout life.
终生体重指数（BMI）轨迹对成人肺功能异常的影响此前尚未得到研究。我们调查了从儿童期到中年期的BMI轨迹与中年期肺功能缺陷和慢性阻塞性肺疾病（COPD）之间的关联。
在塔斯马尼亚纵向健康研究中确定了5条从5岁到43岁的BMI轨迹（n = 4194）。肺功能结果通过45岁和53岁时的肺活量测定来定义。使用多变量回归研究这些BMI轨迹与肺功能结果之间的关联。
与平均BMI轨迹相比，儿童期平均上升的BMI轨迹与45岁至53岁时更大的用力肺活量（FVC）下降相关（β = -178 mL；95%置信区间-300.6，-55.4），45岁时功能残气量（FRC）、补呼气量（ERV）较低，肺总量一氧化碳弥散量（TLco）较高，53岁时FVC较低（-227 mL；-345.3，-109.1），TLco较高。高BMI轨迹在45岁时也与较低的FRC、ERV和较高的TLco相关，而在53岁时与肺活量测定受限（比值比[OR] = 6.9；2.3，21.1）和较高的TLco相关。低BMI轨迹与阻塞性表现相关：45岁和53岁时FEV（-124 mL；-196.4，-51.4）和FVC（-91 mL；-173.4，-7.7）较低，FEV/FVC（-1.2%；-2.2，-0.1）较低，ERV较高，TLco较低。在53岁时发现了类似的模式。未观察到与肺活量测定定义的COPD有关联。
我们的研究结果显示，不同的肺功能异常与高、随后上升和低的BMI轨迹相关。这些结果强调了随时间追踪BMI变化的重要性，以及终生维持平均BMI轨迹（各时间点BMI-Z评分0）的必要性。
