Low Body Mass Index Is Associated with Higher Odds of COPD and Lower Lung Function in Low- and Middle-Income Countries

Matthew R Grigsby, Trishul Siddharthan, Suzanne L Pollard, Muhammad Chowdhury, Adolfo Rubinstein, J. Jaime Miranda, Antonio Bernabe-Ortiz, Dewan Alam, Bruce Kirenga, Rupert Jones, Frederick van Gemert, William Checkley*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    2 Citations (Scopus)


    The relationship of body mass index (BMI) with lung function and COPD has been previously described in several high-income settings. However, few studies have examined this relationship in resource-limited settings where being underweight is more common. We evaluated the association between BMI and lung function outcomes across 14 diverse low- and middle-income countries. We included data from 12,396 participants aged 35-95 years and used multivariable regressions to assess the relationship between BMI with either COPD and lung function while adjusting for known risk factors. An inflection point was observed at a BMI of 19.8kg/m(2). Participants with BMI <19.8kg/m(2) had a 2.28 greater odds (95% CI 1.83-2.86) of having COPD and had a 0.21 (0.13-0.30) lower FEV1 and 0.34 (0.27-0.41) lower FEV1/FVC z-score compared to those with BMI 19.8kg/m(2). The association with lung function remained even after excluding participants with COPD. Individuals with lower BMI were more likely to have COPD and had lower lung function compared to those in higher BMI. The association with lung function remained positive even after excluding participants with COPD, suggesting that being underweight may also play a role in having worse lung function.

    Original languageEnglish
    Pages (from-to)58-65
    Number of pages8
    JournalCOPD: Journal of Chronic Obstructive Pulmonary Disease
    Issue number1
    Publication statusPublished - 2-Jan-2019


    • COPD
    • low and middle income countries
    • body mass index
    • lung function
    • RISK

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