Appendix (for Online Data Supplement)
Reference values from the subset of healthy adults from two Dutch population-based cohorts
Population
The data were obtained in field surveys conducted at 3-yr intervals between 1965 and 1990 in a rural area (Vlagtwedde) and in an industrial town (Vlaardingen) in the Netherlands. Each survey was completed in 1 week in October. The Vlagtwedde sample was a dynamic cohort. In every field survey all men and women born between 1921 and 1952 and living in a specified area were invited to take part. The Vlaardingen sample was a fixed cohort selected from the municipal register. In 1965 a random sample of men and women born between 1901 and 1925 was selected, and in 1969 an additional sample was selected from those born between 1930 and 1954.
Measurements
Anthropometric and lung function measurements were obtained in a standardized way by trained operators. BTPS measurements of FEV1 and FVC were derived from maximal expiratory flow-volume curves, using pneumotachography. Measurements and procedures complied with recommendations of the European Community for Coal and Steel 1. Calibration was performed approximately every hour.
1Quanjer PhH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volume and forced ventilatory flows. Report Working Party Standardization of lung function tests; Official Statement European Respiratory Society. Eur Respir J 1993; 6 Suppl 16: 15-40
Data selection
For each person up to 5 measurements were available. From amongst persons who had never smoked and had been free of cardio-respiratory symptoms one record per person was selected using an algorithm designed to obtain the most even age distribution attainable. Thus 321 records were obtained for men, and 882 for women.
Data analysis
Statistical analysis of data was performed using R version 2.6.1 for Windows [2], including models for nonlinear regression. The 5th percentile was computed by quantile regression with bootstrapping to estimate standard errors and confidence intervals (package quantreg in R [3]).
[2] R Development Core Team (2008). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0, URL
[3] Roger Koenker (2008). quantreg: Quantile Regression. R package version 4.17. URL
Various models are used in the literature to describe the relationship of ventilatory indices with standing height (H) and age (A). We tested the following models:
Index =a + b·H + c·A(1)
a + b·H + c·A + d·A²(2)
(a + b·A)·Hk(3)
a + b·H² + c·A + d·A²(4)
ln(Index) =a + b·ln(H) + c·A(5)
(a + b·A)·H + c(6)
a + b·ln(H) + c·A + d·A²(7)
where ln is the natural logarithm, and height and age are in centimetres and years, respectively.
Results
Standing height in women varied between 144-190 cm (mean 163.5, SD 5.90), age between 17-74 yr (mean 44.74, SD 13.26). Corresponding data for men were height 150-205 cm (mean 178.53, SD 7.51), age 17-79 yr (mean 36.10, SD 12.46).
Differences in explained variance for FEV1%FVC were small; they varied between 0.187 and 0.196 in men, and between 0.188 and 0.197 in women. There was a slightly greater range in explained variance for FEV1: between 0.604 and 0.634 in men, and between 0.554 and 0.588 in women. Given the very small differences in the performance of the various models we selected the model which combined a high explained variance with a distribution of residuals that came closest to a Gaussian distribution as indicated by Shapiro-Wilk index and inspection of Q-Q plots. Predicted values were as follows:
Gender / Index / EquationMale / FEV1%FVC / 111.23 - 0.1246·H - 0.3040·A + 0.00064·A2
LLN FEV1%FVC / 144.33 - 0.3754·H - 0.2259·A - 0.00094·A2
Female / FEV1%FVC / 130.69 - 0.2112·H - 0.5068·A + 0.00283·A2
LLN FEV1%FVC / 123.72 - 0.2501·H - 0.2621·A - 0.00138·A2
Male / FEV1 / 0.0504·H - 0.0121·A - 0.000254·A2 - 3.797
LLN FEV1 / 0.0438·H + 0.0297·A - 0.00080·A2 - 4.142
Female / FEV1 / 0.0372·H - 0.0174·A - 0.00012 ·A2 - 2.135
LLN FEV1 / 0.0298·H - 0.0448·A + 0.00019·A2 - 1.002
LLN = 5th percentile
List of publications on predicted values for adult men and women. Some publications provided prediction equations for more than one ethnic group.
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