普通人群中肥胖者患慢性咳嗽的风险和影响
2021/07/28
摘要
背景：肥胖者患慢性咳嗽的风险可能更高。我们调查了普通人群中肥胖者慢性咳嗽的风险和影响。
方法：我们记录了来自哥本哈根普通人群研究的44554名成年人的慢性咳嗽、体重指数(BMI)和其他相关的临床情况。排除哮喘和/或慢性阻塞性肺疾病患者(n=10977)。体重指数分为：低体重指数<18.5 kg/m2、正常体重(18.5～24.9 kg/m2)、超重(25.0～29.9 kg/m2)、肥胖(30.0～34.9 kg/m2)和重度肥胖(≥35.0 kg/m2)。
结果：在来自普通人群的33577名成年人中，非肥胖者27829人(83%)，肥胖者5748人(17%)。与正常体重者相比，超重者、肥胖者和重度肥胖者的慢性咳嗽风险的多变量调整OR值分别为1.4 (95%CI 1.2-1.6)、1.9 (95%CI 1.7-2.2)和2.6 (95%CI 2.1-3.2)。调节因素分析表明，肥胖引起的慢性咳嗽高达23%是由胃食管反流病(GERD)介导的。其他调节因素包括低蔬菜摄入量(10%)和职业暴露(8%)。在肥胖者中，伴有与不伴有慢性咳嗽的人相比，伴随更严重的呼吸道症状，更常见合并症包括GERD和糖尿病，更多的医疗保健利用，更低的肺功能和更高的血液炎症(均p<0.05)。
结论：BMI与慢性咳嗽之间存在剂量-反应关系，普通人群中肥胖者的慢性咳嗽风险是正常人群的2-3倍。风险增加的部分原因是GERD、低蔬菜摄入量和职业暴露，改善患有慢性咳嗽的肥胖者的这些因素可能会带来获益。
Risk and impact of chronic cough in obese individuals from the general population
Eskild Morten Landt, Yunus Çolak, Børge G Nordestgaard, Peter Lange, Morten Dahl
Abstract
BACKGROUND:Obese individuals may be at higher risk of chronic cough. We investigated the risk and impact of chronic cough in obese individuals from the general population.
METHODS:We recorded chronic cough, body mass index (BMI) and other related clinical conditions in 44 554 adults from the Copenhagen General Population Study. Individuals with asthma and/or chronic obstructive pulmonary disease were excluded (n=10 977). BMI was divided into: underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2) and severely obese (≥35.0 kg/m2).
RESULTS: Among 33 577 adults from the general population, 27 829 (83%) were non-obese and 5748 (17%) were obese. Compared with individuals with normal weight, multivariable adjusted ORs for chronic cough risk were 1.4 (95% CI 1.2 to 1.6) in overweight, 1.9 (95% CI 1.7 to 2.2) in obese and 2.6 (95% CI 2.1 to 3.2) in severely obese individuals. Mediation analyses showed that chronic cough due to obesity was up to 23% mediated by gastro-oesophageal reflux disease (GERD). Other mediators included low vegetable intake with 10% and occupational exposure with 8%. Among obese individuals, those with versus without chronic cough had worse accompanying respiratory symptoms, more often comorbidities including GERD and diabetes, greater healthcare utilisations, lower lung function and higher blood inflammation (all p<0.05).
CONCLUSION: There is dose-response relationship between BMI and chronic cough, and chronic cough risk is twofold to threefold higher in obese individuals from the general population. This increased risk was partly mediated by GERD, low vegetable intake and occupational exposure, supporting that there may be benefit to gain by ameliorating some of these factors in obese individuals with chronic cough.
背景：肥胖者患慢性咳嗽的风险可能更高。我们调查了普通人群中肥胖者慢性咳嗽的风险和影响。
方法：我们记录了来自哥本哈根普通人群研究的44554名成年人的慢性咳嗽、体重指数(BMI)和其他相关的临床情况。排除哮喘和/或慢性阻塞性肺疾病患者(n=10977)。体重指数分为：低体重指数<18.5 kg/m2、正常体重(18.5～24.9 kg/m2)、超重(25.0～29.9 kg/m2)、肥胖(30.0～34.9 kg/m2)和重度肥胖(≥35.0 kg/m2)。
结果：在来自普通人群的33577名成年人中，非肥胖者27829人(83%)，肥胖者5748人(17%)。与正常体重者相比，超重者、肥胖者和重度肥胖者的慢性咳嗽风险的多变量调整OR值分别为1.4 (95%CI 1.2-1.6)、1.9 (95%CI 1.7-2.2)和2.6 (95%CI 2.1-3.2)。调节因素分析表明，肥胖引起的慢性咳嗽高达23%是由胃食管反流病(GERD)介导的。其他调节因素包括低蔬菜摄入量(10%)和职业暴露(8%)。在肥胖者中，伴有与不伴有慢性咳嗽的人相比，伴随更严重的呼吸道症状，更常见合并症包括GERD和糖尿病，更多的医疗保健利用，更低的肺功能和更高的血液炎症(均p<0.05)。
结论：BMI与慢性咳嗽之间存在剂量-反应关系，普通人群中肥胖者的慢性咳嗽风险是正常人群的2-3倍。风险增加的部分原因是GERD、低蔬菜摄入量和职业暴露，改善患有慢性咳嗽的肥胖者的这些因素可能会带来获益。
(中日友好医院呼吸与危重症医学科 王静茹 摘译 林江涛 审校)
(Thorax. 2021 Jul 6; thoraxjnl-2020-216351. doi: 10.1136/thoraxjnl-2020-216351.)
(Thorax. 2021 Jul 6; thoraxjnl-2020-216351. doi: 10.1136/thoraxjnl-2020-216351.)
Risk and impact of chronic cough in obese individuals from the general population
Eskild Morten Landt, Yunus Çolak, Børge G Nordestgaard, Peter Lange, Morten Dahl
Abstract
BACKGROUND:Obese individuals may be at higher risk of chronic cough. We investigated the risk and impact of chronic cough in obese individuals from the general population.
METHODS:We recorded chronic cough, body mass index (BMI) and other related clinical conditions in 44 554 adults from the Copenhagen General Population Study. Individuals with asthma and/or chronic obstructive pulmonary disease were excluded (n=10 977). BMI was divided into: underweight (BMI <18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obese (30.0-34.9 kg/m2) and severely obese (≥35.0 kg/m2).
RESULTS: Among 33 577 adults from the general population, 27 829 (83%) were non-obese and 5748 (17%) were obese. Compared with individuals with normal weight, multivariable adjusted ORs for chronic cough risk were 1.4 (95% CI 1.2 to 1.6) in overweight, 1.9 (95% CI 1.7 to 2.2) in obese and 2.6 (95% CI 2.1 to 3.2) in severely obese individuals. Mediation analyses showed that chronic cough due to obesity was up to 23% mediated by gastro-oesophageal reflux disease (GERD). Other mediators included low vegetable intake with 10% and occupational exposure with 8%. Among obese individuals, those with versus without chronic cough had worse accompanying respiratory symptoms, more often comorbidities including GERD and diabetes, greater healthcare utilisations, lower lung function and higher blood inflammation (all p<0.05).
CONCLUSION: There is dose-response relationship between BMI and chronic cough, and chronic cough risk is twofold to threefold higher in obese individuals from the general population. This increased risk was partly mediated by GERD, low vegetable intake and occupational exposure, supporting that there may be benefit to gain by ameliorating some of these factors in obese individuals with chronic cough.
