Association of Metabolic Syndrome with the Severity of Airflow Obstruction in Patients with Chronic Obstructive Pulmonary Disease
Background. Metabolic Syndrome (MetS) is common in Chronic Obstructive Pulmonary Disease (COPD) patients but their association is still an unsettled issue. The aim of this study was to determine the association of MetS with the severity of airflow obstruction.
Methodology. This was a cross-sectional analytic study of 157 patients with COPD. They were classified using the Global Initiative for Chronic Obstructive Lung Diseases (GOLD). MetS was assessed using two well-recognized criteria. Demographics, clinical data, lifestyle-related characteristics, fasting blood sugar (FBS) and lipid profile were obtained. Multiple logistic regression was used to determine the association of MetS with the severity of airflow obstruction.
Results. 40.13% and 17.20% of patients had MetS using the NCEP/ATP III-AHA/NHBLI and IDF criteria, respectively. MetS was not associated with severity of airflow obstruction. Of the MetS components, only elevated blood pressure (BP) was significantly associated with severity of airflow obstruction (GOLD II: OR=3.28, p<0.001; GOLD III: OR=4.04, p=0.2; GOLD IV: OR=6.21, p=0.04). Elevated FBS was also associated with GOLD IV (OR=16.09, p=0.02). Significant factors associated with MetS in COPD patients were body mass index, inhaled steroid, number of pack-years, and GOLD II.
Conclusion. MetS is not associated with severity of airflow obstruction. Only certain components of MetS showed significant associations such as elevated BP with GOLD II-IV and elevated FBS with GOLD IV.
Mirrakhimov AE. Chronic obstructive pulmonary disease and glucose metabolism: A bitter sweet symphony. Cardiovasc Diabetol. 2012;11(1):132. PMID: 23101436. PMCID: PMC3499352. https://doi.org/10.1186/1475-2840-11-132.
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (updated 2015), 2015. http://www.goldcopd.org/.
Mannino DM, Thorn D, Swensen A, Holguin F. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. 2008;32(4):962-9. PMID: 18579551.
Naik D, Joshi A, Paul TV, Thomas N. Chronic obstructive pulmonary disease and the metabolic syndrome: Consequences of a dual threat. Indian J Endocrinol Metab. 2014;18(5):608-16. PMID: 25285275. PMCID: PMC4171881. https://doi.org/10.4103/2230-8210.139212.
Baffi CW, Wood L, Winnica D, et al. Metabolic syndrome and the lung. Chest. 2016;149(6):1525-34. PMID: 26836925. PMCID: PMC4944780. https://doi.org/10.1016/j.chest.2015.12.034.
Clini E, Crisafulli E, Radaeli A, Malerba M. COPD and the metabolic syndrome: An intriguing association. Intern Emerg Med. 2013;8(4):283-9. PMID: 21964838. https://doi.org/10.1007/s11739-011-0700-x.
Park SK, Larson JL. The relationship between physical activity and metabolic syndrome in people with chronic obstructive pulmonary disease. J Cardiovasc Nurs. 2014;29(6):499-507. PMID: 24165700. PMCID: PMC4032377. https://doi.org/10.1097/JCN.0000000000000096.
de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez Moro JM, et al. Chronic Obstructive pulmonary disease as a cardiovascular risk factor. (CONSISTE Study). Int J Chron Obstruct Pulmon Dis. 2012:679-86. PMID: 23055717. PMCID: PMC3468057. https://doi.org/10.2147/COPD.S36222.
Gläser S, Krüger S, Merkel M, Bramlage P, Herth FJ. Chronic obstructive pulmonary disease and diabetes mellitus: A systematic review of the literature. Respiration. 2015;89(3):253-64. PMID: 25677307. https://doi.org/10.1159/000369863.
Lee CT, Mao IC, Lin CH, Lin SH, Hsieh MC. Chronic obstructive pulmonary disease: A risk factor for type 2 diabetes: A nationwide population-based study. Eur J Clin Invest. 2013;43(11):1113-9. PMID: 24028296. https://doi.org/10.1111/eci.12147.
Fumagalli G, Fabiani F, Forte S, et al. INDACO Project : A pilot study on incidence of comorbidities in copd patients referred to pneumology units. 2013:8(1):28. PMID: 23551874.PMCID: PMC3637139.https://doi.org/10.1186/2049-6958-8-28.
Department of Health. The 2013 Philippine Health Statistics. Manila, Philippines, 2013. https://www.doh.gov.ph/sites/default/files/publications/2013PHScompressed_0.pdf.
2009 Philippines’ Global Adult Tobacco Survey Country Report. Manila, Philippines, 2010. http://www.who.int/tobacco/surveillance/2009_gats_report_philippines.pdf.
Idolor LF, De Guia TS, Francisco NA, et al. Burden of obstructive lung disease in a rural setting in the Philippines. 2011;16(7):1111-8. PMID: 2180127. https://doi.org/10.1111/j.1440-1843.2011.02027.x.
Morales DD, Punzalan FE, Paz-Pacheco E, Sy RG, Duante CA, National Nutrition and Health Survey, 2003 Group. Metabolic syndrome in the Philippine general population: Prevalence and risk for atherosclerotic cardiovascular disease and diabetes mellitus. Diab Vasc Dis Res. 2008;5(1):36-43. PMID: 18398811. https://doi.org/10.3132/dvdr.2008.007.
Acharyya A, Shahjahan MD, Mesbah FB, Dey SK, Ali L. Association of Metabolic syndrome with chronic obstructive pulmonary disease in an Indian population. Lung India. 2016;33(4):385-90. http://www.lungindia.com/text.asp?2016/33/4/385/184871.
Díez-Manglano J, Barquero-Romero J, Almagro P, et al. COPD Patients with and without Metabolic Syndrome: Clinical and functional differences. Intern Emerg Med. 2014;9(4):419-25. PMID: 23645508. https://doi.org/10.1007/s11739-013-0945-7.
Tanni SE, Zamuner AT, Coelho LS, Vale SA, Godoy I, Paiva SA. Are metabolic syndrome and its components associated with 5-year mortality in chronic obstructive pulmonary disease patients ? Metab Syndr Relat Disord. 2015;13(1):52-4. PMID: 25353094. https://doi.org/10.1089/met.2014.0100.
Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/National heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112(17):2735-52. PMID: 16157765. https://doi.org/10.1161/CIRCULATIONAHA.105.169404.
Alberti G, Zimmet P, Shaw J, Grundy S. The IDF Consensus Worldwide Definition of the Metabolic Syndrome. Brussels, Belgium, 2006.
Schoenbom CA, Adams PE. Health Behaviors of adults: United States, 2005-2007. Vital Health Stat 10. 2010;(245):132. PMID: 20669609.
World Health Organization. Waist circumference and waist-hip ratio. Report of a WHO expert consultation, Geneva, 8-11 December 2008. http://apps.who.int/iris/bitstream/handle/10665/44583/9789241501491_eng.pdf?ua=1.
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157-63. PMID: 14726171. https://doi.org/10.1016/S0140-6736(03)15268-3.
Fimognari FL, Pasqualetti P, Moro L, et al. The Association between metabolic syndrome and restrictive ventilatory dysfunction in older persons. J Gerontol A Biol Sci . 2007;62(7):760-5. PMID: 17634324.
Lin WY, Yao CA, Wang HC, Huang KC. Impaired lung function is associated with obesity and metabolic syndrome in adults. Obesity (Silver Spring). 2006;14(9):1654-61. PMID: 17030977. https://doi.org/10.1038/oby.2006.190.
Marquis K, Maltais F, Duguay V, et al. The metabolic syndrome in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil. 2005;25(4):226-32. PMID: 16056071.
Watz H, Waschki B, Kirsten A, et al. The metabolic syndrome in patients with chronic bronchitis and COPD: Frequency and associated consequences for systemic inflammation and physical inactivity. Chest. 2009:136(4):1039-46. PMID: 19542257. https://doi.org/10.1378/chest.09-0393.
Cebron Lipovec N, Beijers RJ, can den Borst B, Doehner W, Lainscak M, Schols AM. The prevalence of metabolic syndrome in chronic obstructive pulmonary disease: A systematic review. COPD. 2016;13(3):399-406. PMID: 26914392. https://doi.org/10.3109/15412555.2016.1140732.
Dart RA, Gollub S, Lazar J, Nair C, Schroeder D, Woolf SH. Treatment of systemic hypertension in patients with pulmonary disease: COPD and asthma. Chest. 2003;123(1):222-243. PMID: 12527626.
Lam KB, Jordan RE, Jiang CQ, et al. Airflow obstruction and metabolic syndrome: The Guangzhou biobank cohort study. Eur Respir J. 2010;35(2):317-23. PMID: 19574332. https://doi.org/10.1183/09031936.00024709.
Akpınar EE, Akpınar S, Ertek S, Sayın E, Gülhan M. Systemic inflammation and metabolic syndrome in stable COPD patients. Tuberk Toraks. 2012;60(3):230-7. PMID: 23030748.
Vujic T, L Nagorni O, Maric G, Popovic L, Jankovic J. Metabolic syndrome in patients with chronic obstructive pulmonary disease: Frequency and relationship with systemic inflammation. Hippokratia. 2016:20(2):110-4. PMID: 28416906. PMCID: PMC5388510.
Magnussen H, Watz H. Systemic inflammation in chronic obstructive pulmonary disease and asthma: Relation with comorbidities. Proc Am Thorac Soc. 2009;6(8):648-51. PMID: 20008868. https://doi.org/10.1513/pats.200906-053DP.
Barnes PJ, Celli BR. Systemic manifestations and comorbidities. Eur Respir J. 2009;33(5):1165-85. PMID: 19407051. https://doi.org/10.1183/09031936.00128008.
Sun K, Liu J, Ning G. Active smoking and risk of metabolic syndrome : A meta-analysis of prospective studies. PLoS One. 2012;7(10):e47791. PMID: 23082217. PMCID: PMC3474781. https://doi.org/10.1371/journal.pone.0047791.
Lim S, Lam DC, Muttalif AR, et al. Impact of chronic obstructive pulmonary disease (COPD) in the Asia-Pacific region: The EPIC Asia population-based survey. Asia Pac Fam Med. 2015:14(1):4. PMID: 25937817. PMCID: PMC4416253. https://doi.org/10.1186/s12930-015-0020-9.
COPD prevalence in Phl on ‘ high side.’ Philippine Star Health and Medicine, 2015. http://www.pchrd.dost.gov.ph/index.php/news/library-health-news/4326-copd-prevalence-in-phl-on-high-side. Accessed September 20, 2016.
Steuten LMG, Creutzberg EC, Vrijhoef HJM, Wouters EF. COPD as a multicomponent disease : Inventory of dyspnoea , underweight , obesity and fat free mass depletion in primary care. Prim Care Respir J. 2006:15(2):84-91. PMID: 16701766. https://doi.org/10.1016/j.pcrj.2005.09.001.
Cena H, Tesone A, Niniano R, Cerveri I, Roggi C, Turconi G. Prevalence rate of metabolic syndrome in a group of light and heavy smokers. Diabetol Metab Syndr. 2013:5:28. PMID: 23721527. PMCID: PMC3673853.. https://doi.org/10.1186/1758-5996-5-28.
Balhara YPS. Tobacco and metabolic syndrome. Indian J Endocrinol Metab. 2012;16(1):81-7. PMID: 22276256. PMCID: PMC3263202. https://doi.org/10.4103/2230-8210.91197.
Piazzolla G, Castrovilli A, Liotino V, et al. Metabolic syndrome and chronic obstructive pulmonary disease (COPD): The interplay among smoking , insulin resistance and vitamin D. PloS One. 2017;12(10): e0186708. PMID: 29065130. PMCID: PMC5655494. https://doi.org/10.1371/journal.pone.0186708.
Ghatas T. The relationship between metabolic syndrome and chronic obstructive pulmonary disease. Egypt J Bronchol. 2017;11(1)11-5. https://doi.org/10.4103/1687-8426.198983.
Egbuonu F, Antonio FA, Edavalath M. Effect of inhaled corticosteroids on glycemic status. Open Respir Med J. 2014;8:101-5. PMID: 25674180. PMCID: PMC4319206. https://doi.org/10.2174/1874306401408010101.
Copyright (c) 2018 Journal of the ASEAN Federation of Endocrine Societies
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of the ASEAN Federation of Endocrine Societies is licensed under a Creative Commons Attribution-NonCommercial 4.0 International. (full license at this link: http://creativecommons.org/licenses/by-nc/3.0/legalcode).
To obtain permission to translate/reproduce or download articles or use images FOR COMMERCIAL REUSE/BUSINESS PURPOSES from the Journal of the ASEAN Federation of Endocrine Societies, kindly fill in the Permission Request for Use of Copyrighted Material and return as PDF file to email@example.com or firstname.lastname@example.org.
A written agreement shall be emailed to the requester should permission be granted.