Tuesday, December 5, 2023
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
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This activity is intended for primary care physicians, pulmonary medicine specialists, nurses, physician assistants, and other members of the healthcare team who care for adults at risk for chronic respiratory illness.
The goal of this activity is for learners to be better able to evaluate the relationship between body mass index (BMI), waist circumference (WC), and chronic respiratory illness.
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CME / ABIM MOC / CE Released: 5/26/2023
Valid for credit through: 5/26/2024, 11:59 PM EST
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Approximately 42% of US adults have obesity as defined by a body mass index (BMI) of ≥ 30 kg/m2; yet a minority of these individuals actually do not have increased adiposity but instead have larger muscle mass. Waist circumference (WC) is a simple office-based tool that can more accurately distinguish abdominal obesity, but a study of more than 700,000 electronic health records among adults aged at least 40 years in Canada found that just 11.5% of patients had a WC recorded. This percentage increased to 23.7% among individuals who qualified for overweight or obesity by BMI.
A review by the International Atherosclerosis Society (IAS) and International Chair on Cardiometabolic Risk (ICCR) Working Group on Visceral Obesity recommends that waist circumference is important enough to become part of routine vital signs gathered on adult patients. Their statement, which was published in the February 4, 2020 issue of Nature Reviews Endocrinology[1]noted that mortality is increased with higher degrees of WC, regardless of BMI. In fact, when WC and BMI are considered as continuous variables in the same risk prediction model, WC become more predictive of adverse health events, whereas BMI weakens as a risk predictor. Waist circumference is most potent as a predictor of adverse outcomes after correction for BMI.
One of the negative health outcomes associated with elevated BMI is asthma and chronic respiratory symptoms. The current study by Kisiel and colleagues assessed the relationship between both BMI and WC and chronic respiratory illness among adults.
A recent Swedish study found that both abdominal and general obesity were independently associated with respiratory illnesses, including asthma and self-reported chronic obstructive pulmonary disease (COPD).
Researchers assessed relationships between respiratory conditions with characterized obesity types in adults using self-report surveys from participants originally enrolled in the European Community Respiratory Health Survey (ECRHS) investigating asthma, allergy, and risk factors. The Respiratory Health in Northern Europe (RHINE) III provides a second follow-up substudy of ECRHS focused on 2 forms of obesity associated with respiratory illnesses.
Obesity is a characteristic risk factor linked to respiratory ailments such as asthma and COPD. High BMI and WC provide quantitative measurements for defining conditions of comprehensive general and abdominal obesity, respectively.
Although both types of obesity have been associated with asthma incidence, studies on their independent impact on this disease have been limited. Previous reports on abdominal obesity associated with asthma have been inconsistent when considering sexes in the analysis. In addition, COPD and related outcomes differed between abdominal and general obesity, indicating a need to discover whether self-reported WC abdominal obesity and BMI-based general obesity are independently associated with respiratory symptoms, early and late-onset asthma, COPD, chronic bronchitis, rhinitis, and sex, Marta A. Kisiel, MD, PhD, of the department of environmental and occupational medicine, Uppsala, Sweden, and colleagues wrote.
In a prospective study published in the journal Respiratory Medicine,[2] the researchers reported on a cross-sectional investigation of responses to a questionnaire similar to one used 10 years earlier in the RHINE II study. Questions required simple yes/no responses that covered asthma, respiratory symptoms, allergic rhinitis, chronic bronchitis, and COPD. Additional requested information included age of asthma onset, potential confounding variables of age, smoking, physical activity, and highest education level, weight and height for BMI calculation, and WC measurement with instructions and a provided tape measure.
The population of the RHINE III study conducted from 2010 to 2012 comprised 12,290 participants (53% response frequency) obtained from a total of 7 research centers located in 5 northern European countries. Obesity categorization classified 1837 (6.7%) participants as generally obese based on a high BMI ≥ 30 kg/m2 and 4261 (34.7%) as abdominally obese by WC measurements ≥ 102 cm for men and ≥ 88 cm for women. Of the 4261 total participants, 1669 met both general and abdominal obesity criteria. Mean age was in the low 50s range, and the obese population consisted of more women than men.
Simple linear regression revealed that BMI and WC were highly correlated, and both were associated with tested respiratory conditions when adjusted for confounding variables. Differences with respect to WC and BMI were independently associated with most of the examined respiratory conditions when WC was adjusted for BMI and vice versa. Neither early onset asthma nor allergic rhinitis were associated with WC, BMI, or abdominal or general obesity.
A significantly high proportion of individuals with general and abdominal obesity experienced a variety of defined respiratory symptoms, had asthma, chronic bronchitis, or COPD. An independent association of abdominal obesity (with or without general obesity) was found to occur with respiratory symptoms, asthma, late-onset asthma, and chronic bronchitis.
Adjusting for abdominal obesity, general obesity showed an independent and significant association with respiratory symptoms, asthma, adult-onset asthma, and COPD. An analysis stratified by sex indicated a significant association of abdominal and general obesity with asthma in women presented as an odds ratio (OR) of 1.56 (95% CI: 1.3, 1.87) and 1.95 (95% CI: 1.56, 2.43), respectively, compared with men, with an OR of 1.22 (95% CI: 0.97, 3.17) and 1.28 (95% CI: 0.97, 1.68), respectively. The association of abdominal and general obesity with COPD was also stronger in women compared with men.
The researchers concluded that "both general and abdominal obesity [were] independent of each other associated with respiratory symptoms in adults."
There is also a distinct difference between women and men for the association of self-reported asthma and COPD with abdominal and general obesity.
The large randomly selected sample size of participants from research centers located in 5 northern European countries was considered a major strength of this study, as it permitted simultaneous adjustment for multiple potential confounders. Several limitations were acknowledged, including absence of data on obstructive respiratory disease severity, WC measurements not being performed by trained staff, and self-reported height and weight measurements.
The authors have disclosed no relevant financial relationships.
