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      Only severe COPD is associated with being underweight : results from a population survey

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          Abstract

          Low body mass index (BMI) and malnutrition in chronic obstructive pulmonary disease (COPD) are associated with a poor prognosis. The prevalence of underweight, as well as overweight, in severity grades of COPD is sparsely investigated in studies of the general population and the associated patterns of risk factors are not well established. The aim of the present study was to determine the association between severity grades of airflow limitation in COPD, and both underweight and obesity when corrected for possible confounding factors.

          The study is based on pooled data from the OLIN (Obstructive Lung Disease in Northern Sweden) studies. Complete records with lung function, BMI and structured interview data were available from 3942 subjects (50.7% women and 49.3% men). COPD and severity grading were defined using the Global Initiative for Chronic Obstructive Lung Disease criteria. In sensitivity analyses, the lower limit of normal was used.

          The prevalence of underweight was 7.3% in severe COPD (grades 3 and 4) versus 2.0% in those with normal spirometry. The prevalence of obesity increased from 9.7% in grade 1, to 16.3% in grade 2 and 20.0% in severe COPD, versus 17.7% in those with normal spirometry.

          In adjusted analysis, of the COPD severity grades, only severe COPD was associated with underweight (OR 3.24, 95% CI 1.0004–10.5), while the COPD severity grades tended to be inversely associated with overweight.

          Abstract

          COPD grades 3 and 4 are associated with underweight http://ow.ly/GGRP300QYlN

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          Most cited references28

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          Excess deaths associated with underweight, overweight, and obesity.

          As the prevalence of obesity increases in the United States, concern over the association of body weight with excess mortality has also increased. To estimate deaths associated with underweight (body mass index [BMI] or =30) in the United States in 2000. We estimated relative risks of mortality associated with different levels of BMI (calculated as weight in kilograms divided by the square of height in meters) from the nationally representative National Health and Nutrition Examination Survey (NHANES) I (1971-1975) and NHANES II (1976-1980), with follow-up through 1992, and from NHANES III (1988-1994), with follow-up through 2000. These relative risks were applied to the distribution of BMI and other covariates from NHANES 1999-2002 to estimate attributable fractions and number of excess deaths, adjusted for confounding factors and for effect modification by age. Number of excess deaths in 2000 associated with given BMI levels. Relative to the normal weight category (BMI 18.5 to or =30) was associated with 111,909 excess deaths (95% confidence interval [CI], 53,754-170,064) and underweight with 33,746 excess deaths (95% CI, 15,726-51,766). Overweight was not associated with excess mortality (-86,094 deaths; 95% CI, -161,223 to -10,966). The relative risks of mortality associated with obesity were lower in NHANES II and NHANES III than in NHANES I. Underweight and obesity, particularly higher levels of obesity, were associated with increased mortality relative to the normal weight category. The impact of obesity on mortality may have decreased over time, perhaps because of improvements in public health and medical care. These findings are consistent with the increases in life expectancy in the United States and the declining mortality rates from ischemic heart disease.
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            Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.

            W MacNee, , B Celli (2004)
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              Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis.

              Individuals with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular diseases, osteoporosis, and muscle wasting. Systemic inflammation may be involved in the pathogenesis of these disorders. A study was undertaken to determine whether systemic inflammation is present in stable COPD. A systematic review was conducted of studies which reported on the relationship between COPD, forced expiratory volume in 1 second (FEV(1)) or forced vital capacity (FVC), and levels of various systemic inflammatory markers: C-reactive protein (CRP), fibrinogen, leucocytes, tumour necrosis factor-alpha (TNF-alpha), and interleukins 6 and 8. Where possible the results were pooled together to produce a summary estimate using a random or fixed effects model. Fourteen original studies were identified. Overall, the standardised mean difference in the CRP level between COPD and control subjects was 0.53 units (95% confidence interval (CI) 0.34 to 0.72). The standardised mean difference in the fibrinogen level was 0.47 units (95% CI 0.29 to 0.65). Circulating leucocytes were also higher in COPD than in control subjects (standardised mean difference 0.44 units (95% CI 0.20 to 0.67)), as were serum TNF-alpha levels (standardised mean difference 0.59 units (95% CI 0.29 to 0.89)). Reduced lung function is associated with increased levels of systemic inflammatory markers which may have important pathophysiological and therapeutic implications for subjects with stable COPD.
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                Author and article information

                Journal
                ERJ Open Res
                ERJ Open Res
                ERJOR
                erjor
                ERJ Open Research
                European Respiratory Society
                2312-0541
                July 2016
                07 July 2016
                : 2
                : 3
                : 00051-2015
                Affiliations
                [1 ]Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
                [2 ]Dept of Internal Medicine, The Central County Hospital of Halmstad, Halmstad, Sweden
                [3 ]Dept of Public Health and Clinical Medicine, Division of Occupational and Environmental Medicine/the OLIN Unit, University of Umeå, Umeå, Sweden
                [4 ]Division of Medicine/Respiratory Medicine and Allergy, University of Umeå, Umeå, Sweden
                Author notes
                Berne Eriksson, Dept of Internal Medicine, The Central County Hospital of Halmstad, Halmstad 301 85, Sweden. E-mail: berne.eriksson@ 123456telia.com
                Author information
                http://orcid.org/0000-0003-3341-3234
                Article
                00051-2015
                10.1183/23120541.00051-2015
                5034593
                27730201
                60d770ce-62f2-4448-8434-326d8b1e241f
                Copyright ©ERS 2016

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 05 August 2015
                : 22 May 2016
                Funding
                Funded by: the Swedish Heart-Lung Foundation http://doi.org/
                Funded by: The County Council of Norrbotten http://doi.org/
                Funded by: The Health Authorities of the Northern Sweden University Region http://doi.org/
                Categories
                Original Articles
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