A population-based cohort study in Korea has suggested that obesity may put women at a higher risk for airway obstructive diseases like chronic obstructive pulmonary disease (COPD) and asthma.
In an adjusted model, premenopausal women with severe obesity had a 67% higher risk for chronic obstructive pulmonary disease, while postmenopausal women had a 57% elevated risk, compared with women of normal weight, reported Dr Do-Hoon Kim of Korea University Ansan Hospital and colleagues in Menopause, the journal of the North American Menopause Society (NAMS).
Although not to the same extent, non-severe obesity and overweight also increased women’s risk of developing COPD, regardless of menopausal status.
Kim’s group found the same positive correlation between waist circumference and risk for COPD. Premenopausal women with a waist circumference of 95cm or higher saw the biggest increased risk for COPD, compared with a reference waist circumference of 65cm to 75cm.
These patterns were similar when the researchers looked at the risk for asthma.
Likewise, both pre- and postmenopausal women with higher BMI and waist circumference had significantly higher risks for developing asthma.
Looking at the other end of the spectrum, pre- and postmenopausal women who were underweight did not have a higher risk for these airway obstructive diseases, with the exception of postmenopausal women with a BMI under 18.5 or waist circumference under 65cm who showed a modestly higher risk for COPD, but not asthma.
However, Kim's group pointed out that several prior studies have suggested a relationship between underweight and incidence of COPD.
“This study highlights yet another detrimental effect of obesity and abdominal adiposity in women, and specifically identified that women with a high BMI and/or waist circumference had a greater risk of developing COPD and asthma,” said Dr Stephanie Faubion, medical director of NAMS. “In addition to avoiding tobacco use, maintaining a healthy body weight and composition may help reduce the incidence of COPD and asthma in women.”
Inflammation is one likely culprit behind this association, Kim and colleagues suggested. “Increased adiposity associated with obesity acts by increasing the levels of pro-inflammatory cytokines, such as tumour necrosis factor-alpha and interleukin-6, and decreasing the levels of adiponectin, thereby increasing systemic inflammation,” they wrote.
For the analysis, the researchers used national health insurance claims data for 1,644,635 women ages 30 and older enrolled in the Korean National Health Insurance Service, who had no prior diagnosis of COPD or asthma. Women who previously underwent a hysterectomy were excluded.
They categorised BMI according to the WHO Western Pacific Region’s categories: underweight (under 18.5), normal weight (18.5-23), overweight (23-25), obesity (25-30), and severe obesity (30+).
They adjusted their model for age, smoking status, alcohol intake, income level, exercise, hypertension, dyslipidemia, and hormone therapy usage.
The study was exclusive to South Korean women, which was a limitation, the researchers acknowledged. In addition, menopausal status was sometimes incorrectly self-reported.
Obesity and abdominal obesity are risk factors for airway obstructive diseases in Korean women
Lee, Chung-Woo; Kim, HyunJin; Nam, Myung Ji; Choi, Yeon Joo; Han, Kyungdo P; Jung, Jin-Hyung; Kim, Do-Hoon; Park, Joo-Hyun
Published in Menopause on 21 February 2022
Existing studies show that women are more susceptible to chronic obstructive pulmonary disease (COPD) and asthma, and that obesity affects the risk of these airway obstructive diseases. We aimed to determine the effect of body mass index (BMI) and waist circumference (WC) on COPD and asthma development in premenopausal and postmenopausal women.
This nationwide population-based cohort study included 1,644,635 women ages ≥30 years without diagnosis of COPD or asthma, who underwent national cancer screening in 2009. We classified them as premenopausal and postmenopausal women based on their menopause status at the time of cancer screening. Baseline BMI and WC were measured, and they were classified into five BMI groups (<18.5 kg/m2, 18.5-23 kg/m2, 23-25 kg/m2, 25-30 kg/m2, and ≥30 kg/m2) and WC groups (<60 cm, 65-75 cm, 75-85 cm, 85-95 cm, and ≥95 cm). The hazard ratios (HRs) for COPD and asthma were measured for each group.
Regardless of the menopausal status, the high BMI and WC groups had a significantly higher COPD and asthma incidence than that of the normal group, and the HRs increased further with increases in BMI and WC. However, the HR in the underweight group was significantly higher among the postmenopausal women. The HR for asthma in the obese group was significantly higher for both premenopausal and postmenopausal women. The HR for COPD was significantly higher in the group with a WC of ≥95 cm for both premenopausal and postmenopausal women, respectively; the HR for asthma was also significantly higher in this group.
Obesity and abdominal obesity are risk factors for COPD and asthma in premenopausal and postmenopausal Korean women. Controlling weight and maintaining a healthy body shape can help prevent COPD and asthma in women.
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