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已发表论文
哮喘儿童体重指数 Z 评分与肺功能参数之间的非线性关系：一项横断面研究
Authors Wang J, Gao J , Han Y, Cheng L, Ma X
Received 24 June 2025
Accepted for publication 23 September 2025
Published 25 October 2025 Volume 2025:18 Pages 1455—1465
DOI https://doi.org/10.2147/JAA.S549235
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 3
Editor who approved publication: Dr Luis Garcia-Marcos
Jing Wang,1,2,* Jinmao Gao,3,* Yuling Han,1,2 Lu Cheng,1,2 Xiang Ma1,2
1Department of Respiratory, Jinan Children’s Hospital, Jinan, People’s Republic of China; 2Department of Respiratory, Children’s Hospital Affiliated to Shandong University, Jinan, People’s Republic of China; 3Weifang Detachment of Shandong Provincial Corps, PAP, Weifang, Shandong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiang Ma, Children’s Hospital Affiliated to Shandong University, No. 23976, Jingshi Road, Jinan City, Shandong Province, 250022, People’s Republic of China, Email maxiang0176@163.com
Introduction: To assess the relationship between body mass index (BMI) and BMI z-scores with lung function parameters in children with asthma, aiming to provide scientific evidence for individualized treatment and management strategies.
Methods: We enrolled 328 children with asthma during acute exacerbation. The BMI and BMI z-scores were analyzed in relation to lung function parameters, including maximum vital capacity (VCmax), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow rate (MMEF), and instantaneous flows at 25%, 50%, and 75% of maximal expiratory flow (MEF25, MEF50, MEF75). Both linear regression and piecewise regression models were used to identify linear associations and potential threshold effects.
Results: BMI showed significant positive linear correlations with VCmax, FVC, FEV1, MEF50, MEF75, and MMEF, while BMI z-scores demonstrated positive linear associations with VCmax, FVC, FEV1, MEF25, MEF50, and MMEF. After adjusting for age, sex, immunoglobulin E (IgE), eosinophil count (EOS), fractional exhaled nitric oxide (FeNO), and asthma severity, both BMI and BMI z-scores remained positively associated with VCmax, FVC, and FEV1. Piecewise regression analysis revealed significant threshold effects in the relationships between BMI z-scores and VCmax, FVC, FEV1, PEF, MEF25, MEF50, MEF75, and MMEF. Below a z-score of ~2.3– 3.9, BMI z-score was positively associated with pulmonary function. Above this threshold, the association reversed; for instance, FEV1 decreased by 9.7% (β = − 9.69, 95% CI: − 18.93 to − 0.46) and PEF decreased by 12.2% (β = − 12.17, 95% CI: − 21.12 to − 3.22) for every unit increase in BMI z-score beyond 3.945.
Conclusion: A nonlinear relationship exists between BMI z-scores and lung function parameters in children with asthma. Weight-guided interventions may enhance lung function and asthma control.
Keywords: asthma, children, body mass index z-score, lung function, threshold effect
1Department of Respiratory, Jinan Children’s Hospital, Jinan, People’s Republic of China; 2Department of Respiratory, Children’s Hospital Affiliated to Shandong University, Jinan, People’s Republic of China; 3Weifang Detachment of Shandong Provincial Corps, PAP, Weifang, Shandong, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiang Ma, Children’s Hospital Affiliated to Shandong University, No. 23976, Jingshi Road, Jinan City, Shandong Province, 250022, People’s Republic of China, Email maxiang0176@163.com
Introduction: To assess the relationship between body mass index (BMI) and BMI z-scores with lung function parameters in children with asthma, aiming to provide scientific evidence for individualized treatment and management strategies.
Methods: We enrolled 328 children with asthma during acute exacerbation. The BMI and BMI z-scores were analyzed in relation to lung function parameters, including maximum vital capacity (VCmax), forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), maximal mid-expiratory flow rate (MMEF), and instantaneous flows at 25%, 50%, and 75% of maximal expiratory flow (MEF25, MEF50, MEF75). Both linear regression and piecewise regression models were used to identify linear associations and potential threshold effects.
Results: BMI showed significant positive linear correlations with VCmax, FVC, FEV1, MEF50, MEF75, and MMEF, while BMI z-scores demonstrated positive linear associations with VCmax, FVC, FEV1, MEF25, MEF50, and MMEF. After adjusting for age, sex, immunoglobulin E (IgE), eosinophil count (EOS), fractional exhaled nitric oxide (FeNO), and asthma severity, both BMI and BMI z-scores remained positively associated with VCmax, FVC, and FEV1. Piecewise regression analysis revealed significant threshold effects in the relationships between BMI z-scores and VCmax, FVC, FEV1, PEF, MEF25, MEF50, MEF75, and MMEF. Below a z-score of ~2.3– 3.9, BMI z-score was positively associated with pulmonary function. Above this threshold, the association reversed; for instance, FEV1 decreased by 9.7% (β = − 9.69, 95% CI: − 18.93 to − 0.46) and PEF decreased by 12.2% (β = − 12.17, 95% CI: − 21.12 to − 3.22) for every unit increase in BMI z-score beyond 3.945.
Conclusion: A nonlinear relationship exists between BMI z-scores and lung function parameters in children with asthma. Weight-guided interventions may enhance lung function and asthma control.
Keywords: asthma, children, body mass index z-score, lung function, threshold effect