Effects of obesity on lung volume and capacity in children and adolescents: a systematic review

Winck, Aline Dill; Heinzmann-Filho, João Paulo; Soares, Rafaela Borges; Silva, Juliana Severo da; Woszezenki, Cristhiele Taís; Zanatta, Letiane Bueno

doi:10.1016/j.rppede.2016.03.013

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Revista Paulista de Pediatria

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REVIEW ARTICLES • Rev. paul. pediatr. 34 (4) • Oct-Dec 2016 • https://doi.org/10.1016/j.rppede.2016.03.013 copy

Effects of obesity on lung volume and capacity in children and adolescents: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To assess the effects of obesity on lung volume and capacity in children and adolescents.

Data source:

This is a systematic review, carried out in Pubmed, Lilacs, Scielo and PEDro databases, using the following Keywords: Plethysmography; Whole Body OR Lung Volume Measurements OR Total Lung Capacity OR Functional Residual Capacity OR Residual Volume AND Obesity. Observational studies or clinical trials that assessed the effects of obesity on lung volume and capacity in children and adolescents (0-18 years) without any other associated disease; in English; Portuguese and Spanish languages were selected. Methodological quality was assessed by the Agency for Healthcare Research and Quality.

Data synthesis:

Of the 1,030 articles, only four were included in the review. The studies amounted to 548 participants, predominantly males, with sample size ranging from 45 to 327 individuals. 100% of the studies evaluated nutritional status through BMI (z-score) and 50.0% reported the data on abdominal circumference. All demonstrated that obesity causes negative effects on lung volume and capacity, causing a reduction mainly in functional residual capacity in 75.0% of the studies; in the expiratory reserve volume in 50.0% and in the residual volume in 25.0%. The methodological quality ranged from moderate to high, with 75.0% of the studies classified as having high methodological quality.

Conclusions:

Obesity causes deleterious effects on lung volume and capacity in children and adolescents, mainly by reducing functional residual capacity, expiratory reserve volume and residual volume.

KEYWORDS
Lung function tests; Lung volume measurements; Total plethysmography; Obesity; Pediatrics

First author	Year	Country	Age range (years)	Sample size	BMI (z-score)	Waist Circumference
Davidson et al.¹⁷17 Davidson WJ, Mackenzie-Rife KA, Witmans MB, Montgomery MD, Ball GD, Egbogah S, et al. Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol. 2014;49:1003-10.	2014	Canada	6–17	327	2.18±0.41	NA
van de Griendt et al.¹⁸18 Van de Griendt EJ, van der Baan-Slootweg OH, van Essen-Zandvliet EE, van der Palen J, Tamminga-Smeulders CL, Benninga MA, et al. Gain in lung function after weight reduction in severely obese children. Arch Dis Child. 2012;97:1039-42.	2012	The Netherlands	8.5–18.9	112	3.38±0.40 (2.50–4.62)	122.2±15.7
Li et al.¹⁹19 Li AM, Chan D, Wong E, Yin J, Nelson EA, Fok TF. The effects of obesity on pulmonary function. Arch Dis Child. 2003;88:361-3.	2003	China	7–18	64	2.42 (2.13–2.66)	NA
Kongkiattikul et al.²⁰20 Kongkiattikul L, Sritippayawan S, Chomtho S, Deerojanawong J, Prapphal N. Relationship between obesity indices and pulmonary function parameters in obese Thai children and adolescents. Indian J Pediatr. 2015;82:1112-6.	2015	Thailand	8.6–17.3	45	3.2±0.5 (1.9–4.6)	99.1±10.4 (81–134)

Type of equipment	Methodology used	Data presentation	Plethysmographic variables	Additional pulmonary tests	Main plethysmographic results	Additional results
SensorMedics 6200¹⁷17 Davidson WJ, Mackenzie-Rife KA, Witmans MB, Montgomery MD, Ball GD, Egbogah S, et al. Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol. 2014;49:1003-10.	American Thoracic Society (ATS)	% of predicted and in liters*	TLC, VC, FRC, ERV, RV	Spirometry DLCO	Mean reduction of 0.44 of FRC, 0.22 of ERV and 0.20 of RV	Reduction of FEV₁/FVC (p<0.001). Positive linear association between BMI and FVC (p<0.001) and DLCO (p=0.015) Negative linear association between BMI and FRC (p<0.001), ERV (p<0.001), RV (p<0,001) and FEV₁/FVC (p<0.001).
Jaeger Viasys ¹⁸18 Van de Griendt EJ, van der Baan-Slootweg OH, van Essen-Zandvliet EE, van der Palen J, Tamminga-Smeulders CL, Benninga MA, et al. Gain in lung function after weight reduction in severely obese children. Arch Dis Child. 2012;97:1039-42.	NA	% of predicted	TLC, ERV, VC	Spirometry	Mean reduction of 14.3% in ERV	Increase of 2.91% (p=0.002) of FEV₁, 3.08% (p=0.001) of FVC, 2.27% (p=0.001) of TLC, 14.8% (p<0.001) of ERV after reduction in body weight. Negative correlations of the increase in ERV with BMI (r=-0.27; p=0.01) and WC (r=-0.34; p=0.002).
SensorMedics 6200¹⁹19 Li AM, Chan D, Wong E, Yin J, Nelson EA, Fok TF. The effects of obesity on pulmonary function. Arch Dis Child. 2003;88:361-3.	British Thoracic Society	% of predicted	TLC, RV, FRC	Spirometry DLCO	Mean reduction of 7% in FRC	Reduction of 23.5% in DLCO. Negative correlations with subtotal body and trunk fat, respectively, of: FRC (r=–0.367; p<0.01; r=-0.337; p<0.01), RV (r=-0.298; p<0.05; r=-0.290; p<0.05), TLC (r=-0.268; p<0.05; r=-0.264; p<0.05).
SensorMedics 6200²⁰20 Kongkiattikul L, Sritippayawan S, Chomtho S, Deerojanawong J, Prapphal N. Relationship between obesity indices and pulmonary function parameters in obese Thai children and adolescents. Indian J Pediatr. 2015;82:1112-6.	European Respiratory Society (ERS)	% of predicted	TLC, FRC, RV	Spirometry	Mean reduction of 33.1% in FRC	Negative correlations between FRC with BMI (r=-0.32; p=0.03), waist-height ratio (r=-0.32; p=0.02), % body fat (r=-0.32; p=0.03),% fat in trunk (r=-0.32; p=0.04) and FMI (r=-0.36; p=0.02).

Criteria assessed	Reference score	Davidson et al.¹⁷17 Davidson WJ, Mackenzie-Rife KA, Witmans MB, Montgomery MD, Ball GD, Egbogah S, et al. Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol. 2014;49:1003-10.	van de Griendt et al.¹⁸18 Van de Griendt EJ, van der Baan-Slootweg OH, van Essen-Zandvliet EE, van der Palen J, Tamminga-Smeulders CL, Benninga MA, et al. Gain in lung function after weight reduction in severely obese children. Arch Dis Child. 2012;97:1039-42.	Li et al.¹⁹18 Van de Griendt EJ, van der Baan-Slootweg OH, van Essen-Zandvliet EE, van der Palen J, Tamminga-Smeulders CL, Benninga MA, et al. Gain in lung function after weight reduction in severely obese children. Arch Dis Child. 2012;97:1039-42.	Kongkiattikul et al.²⁰20 Kongkiattikul L, Sritippayawan S, Chomtho S, Deerojanawong J, Prapphal N. Relationship between obesity indices and pulmonary function parameters in obese Thai children and adolescents. Indian J Pediatr. 2015;82:1112-6.
Question of the study	2	2	2	2	2
Study population	8	5	5	5	8
Comparability of individuals for the observational studies	22	16	14	11	11
Exposure or intervention	11	11	11	11	11
Outcome Measures	20	20	15	15	15
Statistical Analysis	19	12	9	7	7
Results	8	8	8	8	8
Discussion	5	4	3	4	4
Funding and sponsorship	5	5	0	0	5
Total score	100	83	67	63	71

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[1] * Corresponding author. E-mail:joaopauloheinzmann@hotmail.com (J.P. Heinzmann-Filho).