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Original Research: Pulmonary Physiology |

Secular Changes in Relative Leg Length Confound Height-Based Spirometric Reference ValuesSecular Changes in Predicted Lung Function

Philip H. Quanjer, MD, PhD; Masaru Kubota, MD, PhD; Hirosuke Kobayashi, MD, PhD, FCCP; Hisamitsu Omori, MD, PhD; Koichiro Tatsumi, MD, PhD, FCCP; Minoru Kanazawa, MD, PhD; Sanja Stanojevic, PhD; Janet Stocks, PhD; Tim J. Cole, ScD
Author and Funding Information

From the Department of Pulmonary Diseases (Dr Quanjer), and the Department of Paediatrics (Dr Quanjer), Division of Respiratory Medicine, Erasmus University Medical Centre—Sophia Children’s Hospital, Rotterdam, The Netherlands; the Department of Respiratory Medicine, School of Medicine (Dr Kubota), and the Graduate School of Medical Sciences (Dr Kobayashi), Kitasato University, Kanagawa, Japan; the Department of Biomedical Laboratory Sciences (Dr Omori), Faculty of Life Sciences, Kumamoto University, Kuhonji, Chuo-ku, Kumamoto-shi, Kumamoto, Japan; the Department of Respirology (Dr Tatsumi), Graduate School of Medicine, Chiba University, Inohana, Chuo-ku, Chiba-shi, Chiba, Japan; the Department of Respiratory Medicine (Dr Kanazawa), Saitama Medical University, Morohongo, Moroyama, Iruma-gun, Saitama, Japan; the Division of Respiratory Medicine (Dr Stanojevic), The Hospital for Sick Children, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation (Dr Stanojevic), University of Toronto, Toronto, ON, Canada; and the Respiratory, Critical Care, and Anaesthesia Section (Portex Unit) (Dr Stocks), and the Population, Policy and Practice Programme (Dr Cole), UCL Institute of Child Health, London, England.

CORRESPONDENCE TO: Philip H. Quanjer, MD, PhD, Department of Pulmonary Diseases and Department of Paediatrics, Division Respiratory Medicine, Erasmus University Medical Centre—Sophia Children’s Hospital, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands; e-mail: pquanjer@gmail.com


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(3):792-797. doi:10.1378/chest.14-1365
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BACKGROUND:  Most but not all data from different ethnic groups fit the Global Lung Function Initiative (GLI) spirometric reference model. This study investigates to what extent discrepancies are caused by secular changes in body proportions.

METHODS:  FEV1 and FVC from 20,336 healthy Japanese subjects (13,492 women) aged 17 to 95 years were compared with GLI-2012 reference values for Europeans. Data on the sitting height/standing height ratio (Cormic index) in 17-year-old students, collected from 1949 to 2012 in successive birth cohorts, were used to assess secular changes in body frame. The cohort-specific Cormic index was used to assess how variation in body frame affected pulmonary function.

RESULTS:  FEV1 and FVC were lower than GLI-2012 reference values, with values progressively falling until age 35 to 40 years and then rising to European levels in the elderly. The Cormic index rose until 1942, then fell, with a nadir in the 1970s, before rising again until 1995. Nearly one-half of the spirometric variability from predicted values could be explained by differences in the Cormic index between birth cohorts.

CONCLUSIONS:  In low-income countries, improving health conditions are likely to drive increases in height and changes in relative leg length similar to those observed in Japan and, thus, to a change in body frame. This implies that height-based prediction equations for such populations will need to be periodically updated.

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