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Determinants of Fractional Exhaled Nitric Oxide in a Population-Based Cohort: The Role of Lung Volumes and Body Composition
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DOI：10.1159/000551192.png)
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Abstract
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Introduction: Fractional exhaled nitric oxide (FeNO) is a clinically utilised marker of type 2 airway inflammation and is used to guide treatment in asthma. We aimed to resolve the ongoing scientific debate, whether FeNO is affected by obesity-related changes in inflammation and airway architecture. Methods: We assessed the association of FeNO levels with obesity markers and lung function parameters in 1,205 respiratory-healthy adult participants (43.1% males) aged 18-82 years from the Austrian LEAD cohort with mean body mass index (BMI) of 26.4 +/- 4.7 kg/m2. Sensitivity analyses were conducted in the respiratory-healthy obese subpopulation (n = 230). Results: Median FeNO levels were 16.0 (interquartile range [IQR]: 12.0-23.0; 95th percentile: 34.0) ppb in the respiratory-healthy any-weight population, with higher levels reported in the respiratory-healthy obese (17.5 [IQR: 12.0-23.0] ppb; 95th percentile: 35.0 ppb) population. Unadjusted multiple regression analyses showed that BMI; fat mass index, visceral adipose tissue index (VATI), and appendicular lean mass index; and residual volume (RV) %predicted were associated with higher FeNO levels in respiratory-healthy any-weight individuals. In obese respiratory-healthy individuals, only VATI showed statistically significant association with FeNO. After adjusting for the confounders such as age, sex, and smoking status, all assessed parameters lost their significance in the assessed populations except for RV- and total lung capacity Z-scores, although at low effect size. Conclusion: Our results demonstrate no independent effect of obesity markers on FeNO levels after adjustments for age, sex, and smoking status. This study investigated whether body weight or fat distribution affects fractional exhaled nitric oxide (FeNO), a breath test used to measure airway inflammation. In 1,205 healthy Austrian adults, including 230 obese individuals, we determined if FeNO levels were influenced by lung size or body weight. While FeNO levels were slightly higher in obese participants, this difference was not retained after accounting for age, sex, and smoking history, indicating that body weight or fat alone does not directly impact FeNO. Instead, lung size (specifically the amount of air remaining in the lungs after exhaling) showed a small but consistent association with FeNO. These findings imply that FeNO tests do not need adjustment for body weight or fat distribution in healthy adults, but subtle lung changes could still influence FeNO, which may be relevant for individuals with lung conditions.
Keywords:
Lung volume measurements
Fractional exhaled nitric oxide
Body mass index
Visceral adipose tissue mass
Residual volume
Total lung capacity
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