Abdominal obesity and pulmonary

functions in young Indian adults:

A prospective study.

Dr Yogesh Saxena, Dr Girish Sidhwani, Dr Rashi Upmanyu.

Departments of Physiology & Pulmonary Medicine,
Himalayan Institute of Medical Sciences,
Jolly Grant, Dehradun.

Indian J Physiol Pharmacol 2009; 53 (4)

Introduction
It is globally accepted that obesity is a health hazard
because of its strong association with numerous metabolic
complications like:
Dyslipidemia
Diabetes mellitus
Hypertension
Cardiovascular accidents
Respiratory Complications
OSA (Obstructive Sleep Apnea)
Obesity Hypoventilation Syndrome
Asthma – Children & Adults
Reduced Lung Volumes
Obesity & Respiratory Function
Inverse relation as shown by various studies
Indices of obesity include:
Weight
BMI
Waist Circumference
Percentage of fat mass
Skin fold thickness
Most studies used BMI as measure of overall obesity, But
it does not give any indication of fat distribution
Obesity & Respiratory Function
Abdominal obesity may influence pulmonary function by
restricting diaphragmatic descent vis-a-vis chest wall
compression in overall adiposity
In this study, total body adiposity & abdominal adiposity
were studied hypothesizing that accumulation of
abdominal fat is associated with decrease in FEV1 &
FVC.
 Materials & Methods
80 healthy volunteers, either sex, 20 – 40 years randomly
selected.
Inclusion criteria:
20 – 40 yrs
Physically & mentally fit
Cooperative & understanding procedure
No known respiratory / medical problems
Non-smokers
 Study Protocol
1.Anthropometry Measurements: Included
 Age (yrs)
 Standing height (cms)
 Weight (kgs)
 BMI (kg/m²)
 Waist Circumference (cms): WC ≥ 90 cms in men &
WC ≥ 80 cms in women was taken as a marker of
abdominal obesity.
 Hip Circumference (cms)
 WHR:- WC : HC. Measure of central fat distribution.
Ratio > 0.9 for males & > 0.8 for females taken as a
marker of abdominal obesity.
Study Protocol (contd…)
2. Respiratory Parameters:
PFTs done by computerized spirometer (Spiro lab II)
Procedure explained to each person
Test carried out in private, quiet room, in standing
position with nose clip in place
Spirometric parameters recorded: FVC, FEV1.
Results
Anthropometric measurements:
Variable Males Females
(n=40) (n=40)
Non- Obese P Value Non- Obese P Value
obese obese
Age (yrs) 30.8 ± 6.2 29.4 ± 6.5 NS 28.1 ± 5.6 29.6 ± 6.6 NS
Height 1.66 ± 0.1 1.7 ± 0.1 NS 1.55 ± 0.1 1.54 ± 0.1 NS
(m)
Weight 68.05 ± 96.35 ± < 0.05 54.10 ± 78.65 ± < 0.05
(kg) 10.04 6.97 8.18 7.08
BMI 24.48 ± 33.28 ± < 0.05 22.58 ± 33.15 ± < 0.05
(kg/m²) 1.98 3.39 3.38 2.73
WHR 0.93 ± 0.1 1 ± 0.1 < 0.05 0.81 ± 0.1 0.90 ± 0.1 < 0.05
WC (cms) 96.92 ± 115.93 ± < 0.05 71.16 ± 104.74 ± < 0.05
14.17 11.63 13.41 10.23
Spirometric Values
Males (n=40) Adiposity Non-Obese Obese P-Value
Markers

FVC (L/sec) BMI (kg/m²) 3.75 ± 0.28 3.55 ± 0.36 NS

WC (cms) 3.84 ± 0.11 3.59 ± 0.34 0.022

WHR 3.75 ± 0.30 3.15 ± 0.30 0.009

FEV1 (L/sec) BMI (kg/m²) 3.37 ± 0.25 3.80 ± 0.35 NS

WC (cms) 3.42 ± 0.09 3.23 ± 0.33 0.058

WHR 3.35 ± 0.272 3.17 ± 0.32 0.030

 Spirometric Values (contd…)
Females (n=40) Adiposity
Markers
Non-Obese Obese P-Value

FVC (L/sec) BMI (kg/m²) 3.19 ± 0.26 2.89 ± 0.29 < 0.05

WC (cms) 3.18 ± 0.26 2.93 ± 0.28 0.004

WHR 3.26 ± 0.27 2.97 ± 0.28 0.0048

FEV1 (L/sec) BMI (kg/m²) 2.88 ± 0.25 2.59 ± 0.25 < 0.05

WC (cms) 2.85 ± 0.26 2.64 ± 0.26 0.008

WHR 3.26 ± 0.25 2.67 ± 0.27 0.010

Results
As evident from the tables,
Age & height in the 2 groups were comparable
Weight & adiposity markers like BMI, WC & WHR
showed significant differences (as expected) among the
groups
FVC & FEV1 were significantly lower in obese females
as compared to males
WC showed highly significant decrease in FVC & FEV1
in obese females.
Results (contd…)
In males, WHR showed the highest difference in
pulmonary parameters among obese & non-obese subjects
WHR & BMI showed less than significant correlation
with FEV1
WC & WHR showed significant inverse relationship with
both FVC & FEV1 in both males & females
WC showed the strongest correlation with both FVC &
FEV1
Correlation more significant in males than in females
Discussion
In this population-based, cross-sectional study, a number
of adiposity markers were studied for their effect on
pulmonary function
It was found that dynamic pulmonary parameters were
lower in obese (BMI ≥ 30 kg/m²) in both genders
BMI, WHR & WC were inversely associated with
pulmonary function in both genders
 Discussion (contd…)
Abdominal adiposity markers (WHR & WC) strongly
negatively associated with FEV1 & FVC
WC, specific marker for abdominal adiposity, showed
greatest amount of variance in pulmonary function among all
adiposity markers
Discussion (contd…)
Visceral adipose tissue influences circulating interleukins
& cytokines which may act via systemic inflammation to
negatively affect pulmonary function
WC may negatively affect pulmonary function through
insulin resistance
High levels of serum leptin, CRP, leukocytes &
fibrinogens (markers of systemic inflammation) have
shown inverse relation with FEV1
Discussion (contd…)
Abdominal adiposity may also cause mechanical
limitation of chest expansion leading to a lower FVC
value
WC may be better indicator of overall health than BMI,
especially in males, since persons with low BMI may have
varying levels of abdominal adiposity
Results consistent with Scottish cross-sectional study
(Chen et al 2007)
Discussion (contd…)
British cohort study, 9,674 men & 11,876 women 45 – 79
yrs, (Canoy et al 2004) also found significant inverse
association of WHR with FEV1 & FVC
Various other studies report inverse association of increased
adiposity with pulmonary function
However, Lazarus et al found no inverse association of WC
& WHR with FVC in women, though WHR showed inverse
association with pulmonary function in men
Discussion (contd…)
Collins et al also found decreased pulmonary function in
men with WHR > 0.95
Studies point to the importance of body types: Apple v/s
Pear shaped
Increased abdominal adiposity (apple-shape) may be
important indicator of lung function