Obesity in COPD: Comorbidities with Practical Consequences?

Figures & data

Figure 1. Cohort formation.

Table 1. Patient’s characteristics categorized by GOLD stage (I–IV).

GOLD	I	II	III	IV	Total
N (%)	122 (7.4)	723 (43.7)	610 (36.9)	199 (12.0)	1654 (100)
Male/Female (%)	46.7/53.3	51.3/48.7	50.8/49.3	59.3/40.7	51.7/48.3
Age, years	69.1 ± 12.2	69.8 ± 10.8* (III–IV)	68.2 ± 9.9	64.5 ± 8.8*(I–III)	68.5 ± 10.5
Height, m	168.7 ± 10.3	168.7 ± 9.2	168.3 ± 8.9	170.5 ± 9.6*(III)	168.8 ± 9.2
Weight, kg	75.6 ± 16.2	77.9 ± 18.9* (III–IV)	73.2 ± 17.6	69.0 ± 16.7*(I–III)	74.9 ± 18.2
BMI, kg/m^2	26.5 ± 4.6	27.3 ± 5.9* (III–IV)	25.8 ± 5.6	23.7 ± 5.5*(I–III)	26.3 ± 5.8
FEV1, L	2.3 ± 0.7^a	1.6 ± 0.5^a	1.0 ± 0.3^a	0.7 ± 0.2^a	1.3 ± 0.6
FEV1, % predicted	90.0 ± 7.9^a	62.2 ± 8.2^a	40.3 ± 5.7^a	24.7 ± 3.5^a	51.7 ± 18.4
VC, L	4.0 ± 1.2^a	3.4 ± 1.0^a	3.0 ± 0.9^s	2.8 ± 0.9^a	3.2 ± 1.0
VC, % predicted	122.0 ± 15.7^a	101.9 ± 17.3^a	89.0 ± 17.3^a	75.2 ± 15.4^a	95.4 ± 20.5
FEV1 /VC MAX, %	56.6 ± 6.2^a	47.6 ± 8.5^a	35.9 ± 8.2^a	26.3 ± 6.0^a	41.4 ± 11.6
FEV1/FVC, %	59.4 ± 7.6^a	51.2 ± 9.4^a	39.6 ± 9.6^a	30.1 ± 7.6^a	45.0 ± 12.4
DLCO(mmol/min/Kpa) predicted (n = 658)®	63.0 ± 20.0	57.9 ± 17.2	48.1 ± 15.1*(I-II, IV)	38.7 ± 11.8*(I–III)	53.1 ± 17.8
DLCO/VA predicted (n = 658)®	66.5 ± 20.7	69.3 ± 21.9	62.8 ± 21.3*(II)	54.8 ± 19.6*(I–III)	65.3 ± 21.8
Smoking status, %
Current smoker	47.1	36.7	32.8	36.2	35.9
Ex-smoker	47.9	60.7	64.2	62.3	61.3
Never smoked	5.0	2.3	2.0	1.5	2.3
Unknown	0.0	0.3	1.0	0.0	0.5

Data presented as mean ± SD unless otherwise stated.

* p < 0.05 compared with the GOLD classes mentioned within brackets.

^a p < 0.05 compared with all other groups.

^® From 1654 patients the DL_CO and DL_CO/VA of 658 patients were available in our database.

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; GOLD, the global initiative for chronic obstructive lung disease; L, liter; Max, maximal; FEV₁, forced expiratory volume in 1 second; FEV₁% predicted, % of predicted value of forced expiratory volume in 1 second; VC, vital capacity; VC % predicted, % of predicted value of vital capacity; DL_CO, diffusing capacity of the Lungs for carbon monoxide; VA, alveolar volume; SD, standard deviation.

Figure 2. Distribution of weight classes in the COPD population. The prevalence (in percentages) of each weight class is provided in the pie-chart. Abbreviations: UW, under-weight; NW, normal weight; OW, overweight; OB, obese.

Figure 3. Prevalence (%) of obese (OB) and under-weight (UW) patients in different GOLD stages (I–IV). *p < 0.05 compared to GOLD class IV of the same weight class, # p < 0.05 compared to GOLD class III of the same weight class.

Figure 4. Number of comorbidities (%) in the obese and non-obese individuals.

Table 2. Prevalence of comorbidities (%) in the COPD population.

Cardiovascular
Hypertension	45.5
Coronary artery disease	18.5
Congestive heart failure	15.2
Atrial fibrillation or flutter	15.9
Peripheral vascular disease	12.7
Myocardial infarction	8.4
Metabolic syndrome
Diabetes mellitus	17.5
Diabetes mellitus uncomplicated	15.5
Diabetes with end organ damage	2.1
Gastrointestinal and liver disease
Peptic ulcer disease	3.1
Chronic liver disease	1.9
Moderate or severe liver disease	0.7
Malignancy
All types of cancer	23.4
Lung carcinoma	4.8
Breast carcinoma	2.3
Carcinoma with metastasis	1.4
Lymphoma	0.6
Esophageal carcinoma	0.3
Leukemia	0.3
Pancreatic carcinoma	0.1
All other cancer types	13.6
Psychological status
Depression	13.2
Anxiety	7.5
Dementia	1.6
Skeletal disease
Osteoporosis	12.8
Neurological disorder
Cerebrovascular disease	5.7
Hemiplegia	1.0
Others
Moderate to severe chronic kidney disease	10.2
Pulmonary fibrosis	1.7
Connective tissue disease	0.2
AIDS	0.2

Figure 5. Prevalence of comorbidities (%) in obese and non-obese COPD patients. Abbreviations: HT, hypertension; CA, carcinoma; CAD, coronary artery disease; DM, diabetes mellitus; AF, atrial fibrillation or flutter; CHF, congestive heart failure; DP, depression; PVD, peripheral vascular disease; OS, osteoporosis; CKD, moderate to severe chronic kidney disease; MI, myocardial infarction; AN, anxiety; CVD, cerebrovascular disease; LUC, lung cancer. * Comorbidity is significantly more prevalent comparing to the other group (p < 0.05).

Table 3. Comorbidities which are significantly more prevalent in obese or non-obese COPD patients.

	Prevalence (%)	OR	95% CI	p value
Obese
DM	34	3.74	2.81–4.99	<0.01
HT	63	2.68	2.08–3.47	<0.01
CHF	19	1.74	1.25–2.42	<0.01
AF	20	1.53	1.11–2.12	0.01
Non obese
LUC	5	2.01	1.04–4.01	0.04
OS	14	1.73	1.15–2.61	<0.01

The odds are adjusted for age, sex, smoking status and FEV₁% predicted.

Abbreviations: DM, diabetes mellitus; HT, hypertension; CHF, congestive heart failure; AF, atrial fibrillation or flutter; LUC, lung cancer; OS, osteoporosis.