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The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study
  1. Magnus Pär Ekström1,
  2. Anders Blomberg2,
  3. Göran Bergström3,
  4. John Brandberg4,
  5. Kenneth Caidahl5,
  6. Gunnar Engström6,
  7. Jan Engvall7,
  8. Maria Eriksson8,
  9. Klas Gränsbo9,
  10. Tomas Hansen10,
  11. Tomas Jernberg11,
  12. Lars Nilsson12,
  13. Ulf Nilsson12,
  14. Anna-Carin Olin13,
  15. Lennart Persson14,
  16. Annika Rosengren3,
  17. Martin Sandelin15,
  18. Magnus Sköld16,17,
  19. Johan Sundström18,
  20. Eva Swahn14,
  21. Stefan Söderberg12,
  22. Hanan A Tanash19,
  23. Kjell Torén20,
  24. Carl Johan Östgren14,
  25. Eva Lindberg21
  1. 1 Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Faculty of Medicine, Lund, Sweden
  2. 2 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  3. 3 The Wallenberg Laboratory, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
  4. 4 Department of Radiology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
  5. 5 Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  6. 6 Department of Clinical Science, Lund University, Malm, Sweden
  7. 7 Department of Clinical Physiology, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  8. 8 Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
  9. 9 Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden
  10. 10 Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
  11. 11 Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institute, Stockholm, Sweden
  12. 12 Department of Public Health and Clinical Medicine, Unit of Medicine, Umeå University, Umeå, Sweden
  13. 13 Section of Occupational and environmental medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  14. 14 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  15. 15 Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
  16. 16 Department of Medicine, Respiratory Medicine Unit, Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
  17. 17 Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
  18. 18 Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
  19. 19 Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund Univ, Malmö, Sweden
  20. 20 Department of Occupational and Environmental, Sahlgrenska University Hospital, Gothenburg, Sweden
  21. 21 Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Magnus Pär Ekström, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Faculty of Medicine, Lund, Sweden; pmekstrom{at}gmail.com

Abstract

Introduction Breathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.

Methods This population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.

Results We included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness.

Conclusion Breathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.

  • dyspnoea
  • sex
  • weight
  • lung function
  • lung volume
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Footnotes

  • MPE and AB are first authors.

  • Contributors Members of SCAPIS National Steering committee and therefore responsible for funding and the planning and execution of the SCAPIS study: AB, GB, JB, GE, JEE, TJ, AR, MS, JS, SS, KT, CJÖ and EL. Responsible for the conception and design of the analyses included in the specific manuscript and first draft: ME, AB and EL. Data collection: JB, JEE, KG, TH, LTN, HLP, MS, ES and HT. Statistical analysis: ME; All authors were involved in the planning and data interpretation and revision of manuscript drafts for important intellectual content, and approval of the version to be published.

  • Funding The main funding body of The Swedish CArdioPulmonary bioImage Study (SCAPIS) is the Swedish Heart and Lung Foundation. The study is also funded by the Knut and Alice Wallenberg Foundation, the Swedish Research Council and VINNOVA (Sweden’s Innovation agency) the University of Gothenburg and Sahlgrenska University Hospital, Karolinska Institutet and Karolinska University Hospital, Linköping University and University Hospital, Lund University and Skåne University Hospital, Umeå University and University Hospital, Uppsala University and University Hospital. Individual research support: AR from AFA Insurance [160334]; from the Swedish state under the agreement between Swedish government and the county councils, the ALF-agreement [ALG-GBG-74300 to K.T., G.B., J.B. A.C.O., A.R.], [ALF-VLL-548791 for S.S.] and [ALFLIO-700841 for J.E.E.]. ME was supported by unrestricted grants from The Swedish Society of Medicine, the Swedish Heart-Lung Foundation, and the Swedish Society for Medical Research.

  • Competing interests SS reports being an advisory board member and receiving speakers honoraria from Actelion, Bayer, MSD, outside the submitted work. Dr Olin reports having a patent WO2009045163 (Collection and measurement of exhaled particles) and being a chairholder and board member of PExA AB, outside the submitted work. JS reports advisory board work for Itrim, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional Ethical Review Board at Umeå University (Nr: 2010- 228–31 M).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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