Can BMI Influence Link Between Adverse Childhood Experiences and COPD?

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

Although prior 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 evaluate the link between ACEs and COPD in a nationally representative sample of US adults regarding BMI and cigarette smoking, but also to examine whether there was any association between ACEs and COPD after adjusting for variables such as socioeconomic status (SES), health risk behaviors, and physical activity.

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

Respondents to the survey were aged 18-79 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 initial 2019 BRFSS sample was 418,268. However, respondents were restricted to only those participants in states that administered the ACEs module, and where data from all the variables was present.

Out 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 link between ACEs and COPD was the strongest for people who were obese (adjusted odds ratio [aOR] ,1.41; 95% CI, 1.04-1.91).

About 18% of participants answered that they currently smoking cigarettes, 25.8% formally smoked cigarettes, and 56.5% had never smoked cigarettes.

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

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

When analyzing date from the COPD Genetic Epidemiology study, researchers found that racial/ethnic differences in symptom perception, access to health care, and attitudes towards health care may be contributors to the high prevalence of pulmonary-related conditions among non-Hispanic Black populations compared with non-Hispanic White populations when adjusting for social-economic status (SES).

The researchers also found that higher education and income were associated with lower odds of having COPD, and that physical activity had a protective effect against COPD. Physicians should prescribe physical activity to patients, which the authors said is “likely to produce many positive effects for patients, including decreased adverse COPD outcomes.”

Additionally, the study found that each additional increase in ACEs score increased the odds 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.

This study was limited by the fact that this was a cross-sectional study, in which only associations could be made, “thus, we are unable to draw any causal inferences between the study variables,” the authors wrote.

Furthermore, the measures evaluated in this study were self-reported, which may have led to bias, particularly in ACEs score and self-reported physician-diagnosed COPD.

Lastly, the use of secondary data limited the researcher’s ability to investigate other theoretically known factors of COPD and ACEs, such as family history of COPD, air quality, pollution, and exposure to second-hand cigarette smoke.

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

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

Reference

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