Article Text

Original research
Body mass index and weight change are associated with adult lung function trajectories: the prospective ECRHS study
  1. Gabriela P Peralta1,2,3,
  2. Alessandro Marcon4,
  3. Anne-Elie Carsin1,2,3,5,
  4. Michael J Abramson6,
  5. Simone Accordini4,
  6. André FS Amaral7,
  7. Josep M Antó1,2,3,
  8. Gayan Bowatte8,9,
  9. Peter Burney7,
  10. Angelo Corsico10,
  11. Pascal Demoly11,12,
  12. Shyamali Dharmage8,
  13. Bertil Forsberg13,
  14. Elaine Fuertes7,
  15. Vanessa Garcia-Larsen14,
  16. Thorarinn Gíslason15,16,
  17. José-Antonio Gullón17,
  18. Joachim Heinrich8,18,19,
  19. Mathias Holm20,
  20. Deborah L Jarvis7,21,
  21. Christer Janson22,
  22. Rain Jogi23,
  23. Ane Johannessen24,25,
  24. Bénédicte Leynaert26,27,
  25. Jesús Martínez-Moratalla Rovira28,
  26. Dennis Nowak18,19,
  27. Nicole Probst-Hensch29,30,
  28. Chantal Raherison31,
  29. José-Luis Sánchez-Ramos32,
  30. Torben Sigsgaard33,
  31. Valérie Siroux34,
  32. Giulia Squillacioti35,
  33. Isabel Urrutia36,
  34. Joost Weyler37,
  35. Jan-Paul Zock1,2,3,
  36. Judith Garcia-Aymerich1,2,3
  1. 1 ISGlobal, Barcelona, Spain
  2. 2 Universitat Pompeu Fabra (UPF), Barcelona, Spain
  3. 3 CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
  4. 4 Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
  5. 5 IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  6. 6 School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  7. 7 National Heart and Lung Institute, Imperial College London, London, UK
  8. 8 Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population & Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  9. 9 National Institute of Fundamental Studies, Kandy, Sri Lanka
  10. 10 Division of Respiratory Diseases, IRCCS ‘San Matteo’ Hospital Foundation-University of Pavia, Pavia, Italy
  11. 11 Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
  12. 12 UMr-S 1136 inSerM, iPleSP, UPMc, Sorbonne Universités, Paris, France
  13. 13 Section of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
  14. 14 Program in Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  15. 15 Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
  16. 16 Medical Faculty University of Iceland, Reykjavik, Iceland
  17. 17 Department of Pneumology, Hospital San Agustin, Avilés, Spain
  18. 18 Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital Munich (LMU), Munich, Germany
  19. 19 Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
  20. 20 Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
  21. 21 MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
  22. 22 Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
  23. 23 Lung Clinic, Tartu University Hospital, Tartu, Estonia
  24. 24 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  25. 25 Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
  26. 26 INSERM U1168, VIMA (Aging and Chronic Diseases. Epidemiological and Public Health Approaches), Villejuif, France
  27. 27 UMR-S 1168, Univ Versailles St-Quentin-en-Yvelines, St-Quentin-en-Yvelines, France
  28. 28 Facultad de Medicina de Albacete, Universidad de Castilla - La Mancha, Albacete, Spain
  29. 29 Swiss Tropical and Public Health Institute, Basel, Switzerland
  30. 30 Department of Public Health, University of Basel, Basel, Switzerland
  31. 31 INSERM U897, Institute of Public Health and Epidemiology, Bordeaux University, Bordeaux, France
  32. 32 Department of Nursing, University of Huelva, Huelva, Spain
  33. 33 Department of Public Health, Section for Environment Occupation and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark
  34. 34 Institute for Advanced Biosciences, UGA-Inserm U1209-CNRS UMR 5309, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France
  35. 35 Department of Public Health and Pediatrics, University of Turin, Turin, Italy
  36. 36 Department of Respiratory, Galdakao Hospital, Galdakao, Spain
  37. 37 Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
  1. Correspondence to Dr Judith Garcia-Aymerich, ISGlobal, Barcelona 08003, Spain; judith.garcia{at}


Background Previous studies have reported an association between weight increase and excess lung function decline in young adults followed for short periods. We aimed to estimate lung function trajectories during adulthood from 20-year weight change profiles using data from the population-based European Community Respiratory Health Survey (ECRHS).

Methods We included 3673 participants recruited at age 20–44 years with repeated measurements of weight and lung function (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1)) in three study waves (1991–93, 1999–2003, 2010–14) until they were 39–67 years of age. We classified subjects into weight change profiles according to baseline body mass index (BMI) categories and weight change over 20 years. We estimated trajectories of lung function over time as a function of weight change profiles using population-averaged generalised estimating equations.

Results In individuals with normal BMI, overweight and obesity at baseline, moderate (0.25–1 kg/year) and high weight gain (>1 kg/year) during follow-up were associated with accelerated FVC and FEV1 declines. Compared with participants with baseline normal BMI and stable weight (±0.25 kg/year), obese individuals with high weight gain during follow-up had −1011 mL (95% CI −1.259 to −763) lower estimated FVC at 65 years despite similar estimated FVC levels at 25 years. Obese individuals at baseline who lost weight (<−0.25 kg/year) exhibited an attenuation of FVC and FEV1 declines. We found no association between weight change profiles and FEV1/FVC decline.

Conclusion Moderate and high weight gain over 20 years was associated with accelerated lung function decline, while weight loss was related to its attenuation. Control of weight gain is important for maintaining good lung function in adult life.

  • adults
  • BMI
  • lung function
  • obesity
  • weight change
  • epidemiology

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  • Twitter @gabriela___p, @alemagoo, @dietandlungs, @judithgarciaaym

  • Contributors GPP, AM, A-EC and JG-A designed the study. GPP wrote the initial draft and conducted the statistical analyses. JG-A had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors provided substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data for the work, revised the manuscript for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work.

  • Funding The present analyses are part of the Ageing Lungs in European Cohorts (ALEC) Study (, which has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 633212. The local investigators and funding agencies for the European Community Respiratory Health Survey are reported in the online supplement. ISGlobal is a member of the CERCA Programme, Generalitat de Catalunya.

  • Disclaimer The funding sources were not involved in the study design, the collection, analysis and interpretation of data or in the writing of the report and in the decision to submit the article for publication.

  • Competing interests JG-A reports personal fees from Esteve, Chiesi and AstraZeneca, outside the submitted work. MJA reports grants from Pfizer, grants from Boehringer-Ingelheim and personal fees from Sanofi, outside the submitted work. PD reports personal fees from ALK, Stallergenes Greer, IQVIA, Chiesi, AstraZeneca, Thermo Fisher Scientific, Menarini, Bausch & Lomb, Mylan, ASIT Biotech, Novartis, Sanofi and Regeneron, outside the submitted work. RJ reports grants from Estonian Research Council (Personal Research Grant no 562) and personal fees from GSK, Boehringer and Novartis, outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval Each participating centre obtained ethical approval from their local ethics committees and followed the rules for ethics and data protection from their country, which were in accordance with the Declaration of Helsinki.

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

  • Data availability statement No data are available.

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