Can BMI influence the association between adverse childhood experiences and COPD?

A cross-sectional study found that adverse childhood experiences (ACEs) associated with chronic obstructive pulmonary disease (COPD) could be mitigated by body mass index (BMI) in later adulthood, adding to what is already known about the effects of ACEs on the chronic health outcomes are known in adults.

Although previous studies have examined the association between ACEs and COPD, few have examined cigarette smoking or BMI as moderators of this association. The aim of this study was not only to assess the association between ACEs and COPD in a nationally representative sample of US adults in terms of BMI and cigarette smoking, but also to investigate whether there is an association between ACEs and COPD after variables such as socioeconomic factors were adjusted status (SES), health risk behavior and physical activity.

The data for this study, conducted at the University of Texas at Arlington, came from the 2019 Behavioral Risk Factor Surveillance System (BRFSS), a cross-sectional survey conducted by the CDC.

Survey respondents were 18-79 years old in 17 states (Alabama, Delaware, Florida, Indiana, Iowa, Michigan, Mississippi, Missouri, New Mexico, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia, and Wisconsin).

The first BRFSS sample of 2019 was 418,268. However, respondents were limited to those respondents in countries that administered the ACEs module and where data from all variables were available.

Of a total of 75,700 participants, 8.1% had COPD.

About 1 in 3 (33.6%) had no ACEs and about 1 in 5 (20.2%) had 4 or more ACEs. The association between ACEs and COPD was strongest in obese people (adjusted odds ratio [aOR] .1.41; 95% CI, 1.04-1.91).

About 18% of the participants reported that they currently smoke cigarettes, 25.8% officially smoked cigarettes, and 56.5% had never smoked cigarettes.

About 35.3% of the participants were classified as obese, 34.6% as overweight, 28.3% as normal weight and 1.8% as underweight according to BMI.

The sample was evenly distributed by gender, with most participants self-identifying as non-Hispanic White (74/1%), followed by Non-Hispanic Black (13.0%), other race/ethnicity (3.4%) and mixed race (1.1%).

Analyzing data from the COPD Genetic Epidemiology study, researchers found that racial/ethnic differences in symptom perception, access to health care, and attitudes toward health care were related to the high prevalence of lung disease in the non-Hispanic black population may help with non-Hispanic white populations in adjusting for socioeconomic status (SES).

The researchers also found that higher education and higher income were associated with a lower likelihood of developing COPD and that physical activity had a protective effect against COPD. Physicians should prescribe physical activity to patients, which the authors say is “likely to have many beneficial patient outcomes, including reduced adverse COPD outcomes.”

In addition, the study found that each additional increase in ACE score increased the likelihood of COPD by a factor of 13% (OR 1.13; 95% CI 1.11-1.15). However, the association between ACEs and COPD did not differ by cigarette smoking.

A limitation of this study was that it was a cross-sectional study in which only associations could be established, “hence, we cannot draw causal inferences between the study variables,” the authors write.

In addition, the measures assessed in this study were self-reported, which may have introduced bias, particularly for the ACE score and self-reported physician-diagnosed COPD.

Finally, the use of secondary data limited the investigator’s ability to examine other theoretically known factors of COPD and ACEs, such as: B. Family history of COPD, air quality, pollution, and exposure to second-hand cigarette smoke.

The results of this study add to the number of other studies showing an adverse impact of ACEs on chronic health outcomes in adults, suggesting the importance of multidisciplinary research on prevention strategies that would help reduce the risk of COPD in adults with a history of ACEs reduce .

“Exposure to ACEs leads to emotional and psychological effects such as anxiety, shame and emotional eating, putting individuals at risk of becoming obese and consequently being diagnosed with COPD,” the researchers concluded.

Relation

Westmore MR, Chakraborty P, Thomas LTA, Jenkins L, Ohri F, Baiden P. BMI moderates the association between adverse childhood experiences and COPD. J Psychosome Res. Published online July 16, 2022. doi:10.1016/j.jpsychores.2022.110990