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COPD and the metabolic syndrome: an intriguing association

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Abstract

Chronic Obstructive Pulmonary Disease (COPD) has been recently recognized as a condition involving more than the lungs. The presence of common factors in COPD and in other chronic extra-pulmonary diseases, as well as the co-existence of these conditions in the same adult individual, supports the hypothesis of a shared pathogenetic pathway. We will here review the interplay between coexisting COPD and the metabolic syndrome (MS), based on the most updated knowledge. We will discuss this clinical condition from the definition, to the pathophysiology and to the clinical implications. Basically, MS is more likely to be present in a COPD patients, and increased levels of circulatory pro-inflammatory proteins from both the lung and adipose tissue coincide in these patients. The relative impact of the coexisting COPD and MS may depend on several factors: the presence of physical inactivity and of systemic inflammation related to a smoking habit, sedentary lifestyle, airway inflammation and obstruction, adipose tissue and inflammatory marker activation. More studies will be required to elucidate the association between COPD and MS and to formulate individualized management approaches for this specific disease phenotype.

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Abbreviations

BMI:

Body mass index

COPD:

Chronic obstructive pulmonary disease

CRP:

C-reactive protein

FEV1:

Forced expiratory volume in the 1st second

FFA:

Free fatty acids

FVC:

Forced vital capacity

ICS:

Inhaled corticosteroids

IL6:

Interleukine 6

IL8:

Interleukine 8

MS:

Metabolic syndrome

PAI-1:

Plasminogen activator inhibitor-1

PaO2:

Arterial oxygen pressure

TNFα:

Tumour necrosis factor alpha

References

  1. From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007. Available from: http://www.goldcopd.org/

  2. Fabbri LM, Luppi F, Beghé B, Rabe KF (2008) Complex chronic comorbidities of COPD. Eur Respir J 31:204–212

    Article  PubMed  CAS  Google Scholar 

  3. International Diabetes Federation. Metabolic syndrome. The IDF consensus worldwide definition of the metabolic syndrome. http://www.idf.org Accessed February 2011

  4. Crisafulli E, Gorgone P, Vagaggini B et al (2010) Efficacy of standard rehabilitation in COPD outpatients with comorbidities. Eur Respir J 36:1042–1048

    Article  PubMed  CAS  Google Scholar 

  5. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K; DECODE Study Group (2004) Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med. 164(10):1066–1076

    Google Scholar 

  6. Marquis K, Maltais F, Duguay V et al (2005) The metabolic syndrome in patients with chronic obstructive pulmonary disease. J Cardiopulm Rehabil 25:226–232

    Article  PubMed  Google Scholar 

  7. Watz H, Waschki B, Kirsten A et al (2009) The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic inflammation and physical inactivity. Chest 136:1039–1046

    Article  PubMed  CAS  Google Scholar 

  8. Lam KB, Jordan RE, Jiang CQ et al (2010) Airflow obstruction and metabolic syndrome: the Guangzhou Biobank Cohort Study. Eur Respir J 35:317–323

    Article  PubMed  Google Scholar 

  9. Lakka HM, Laaksonen DE, Lakka TA et al (2002) The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 288:2709–2716

    Article  PubMed  Google Scholar 

  10. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB (2003) The metabolic syndrome: prevalence and associated risk factor findings in the US population from the Third National Health and Nutrition Examination Survey, 1988–1994. Arch Intern Med 163:427–436

    Article  PubMed  Google Scholar 

  11. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006) Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367:1747–1757

    Article  PubMed  Google Scholar 

  12. Leone N, Courbon D, Thomas F et al (2009) Lung function impairment and metabolic syndrome the critical role of abdominal obesity. Am J Respir Crit Care Med 179:509–516

    Article  PubMed  Google Scholar 

  13. Chinn DJ, Cotes JE, Reed JW (1996) Longitudinal effects of change in body mass on measurements of ventilatory capacity. Thorax 51:699–704

    Article  PubMed  CAS  Google Scholar 

  14. Guerra S, Sherrill DL, Bobadilla A, Martinez FD, Barbee RA (2002) The relation of body mass index to asthma, chronic bronchitis, and emphysema. Chest 122:1256–1263

    Article  PubMed  Google Scholar 

  15. Paek YJ, Jung KS, Hwang YI, Lee KS, Lee DR, Lee JU (2010) Association between low pulmonary function and metabolic risk factors in Korean adults: the Korean National Health and Nutrition Survey. Metabolism 59(9):1300–1306

    Article  PubMed  CAS  Google Scholar 

  16. Franssen FME, O’Donnell DE, Goossens GH, Blaak EE, Schols AWJ (2008) Obesity and the lung: 5. Obesity and COPD. Thorax 63:1110–1117

    Article  PubMed  CAS  Google Scholar 

  17. Carr DB, Utzschneider KM, Hull RL et al (2004) Intra-abdominal fat is a major determinant of the National Cholesterol Education Program Adult Treatment Panel III criteria for the metabolic syndrome. Diabetes 53:2087–2094

    Article  PubMed  CAS  Google Scholar 

  18. Nyholm B, Nielsen MF, Kristensen K et al (2004) Evidence of increased visceral obesity and reduced physical fitness in healthy insulin-resistant first-degree relatives of type 2 diabetic patients. Eur J Endocrinol 150:207–214

    Article  PubMed  CAS  Google Scholar 

  19. Bergman RN, Van Citters GW, Mittelman SD et al (2001) Central role of the adipocyte in the metabolic syndrome. J Investig Med 49:119–126

    Article  PubMed  CAS  Google Scholar 

  20. Koehler F, Doehner W, Hoernig S, Witt C, Anker SD, John M (2007) Anorexia in chronic obstructive pulmonary disease: association to cachexia and hormonal derangement. Int J Cardiol 119:83–89

    Article  PubMed  Google Scholar 

  21. Vestbo J, Prescott E, Almdal T et al (2006) Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 173:79–83

    PubMed  Google Scholar 

  22. Curtis JP, Selter JG, Wang Y et al. (2005) The obesity paradox: body mass index and outcomes in patients with heart failure. Arch Intern Med 165:55–61.47

    Google Scholar 

  23. Ulubay G, Ulasli SS, Sahin T, Erayman Z, Gùrsoy A (2010) Metabolic syndrome is associated with increased risk of acute exacerbation of COPD: a preliminary study. Endocrine 38:76–82

    Article  PubMed  Google Scholar 

  24. Poulain M, Doucet M, Major GC et al (2006) The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. Can Med Ass J 174:1293–1299

    Article  Google Scholar 

  25. Banerji MA, Faridi N, Atluri R, Chaiken RL, Lebovitz HE (1999) Body composition, visceral fat, leptin, and insulin resistance in Asian Indian men. J Clin Endocrinol Metab 84:137–144

    Article  PubMed  CAS  Google Scholar 

  26. Mannino DM, Thorn D, Swensen A et al (2008) Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 32:962–969

    Article  PubMed  CAS  Google Scholar 

  27. Pitta F, Troosters T, Spruit MA, Probst VS, Decramer M, Gosselink R (2005) Characteristics of physical activities in daily life in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 171:972–977

    Article  PubMed  Google Scholar 

  28. Watz H, Waschki B, Boehme C et al (2008) Extrapulmonary effects of chronic obstructive pulmonary disease on physical activity: a cross-sectional study. Am J Respir Crit Care Med 177:743–751

    Article  PubMed  Google Scholar 

  29. Calverley PM, Anderson JA, Celli B et al (2007) Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. N Engl J Med 356:775–789

    Article  PubMed  CAS  Google Scholar 

  30. Wedzicha JA, Calverley PM, Seemungal TA, Hagan G, Ansari Z, Stockley RA (2008) The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide. Am J Respir Crit Care Med 177:19–26

    Article  PubMed  CAS  Google Scholar 

  31. Suissa S, Kezouh A, Ernst P (2010) Inhaled corticosteroids and the risk of diabetes onset and progression. Am J Med 123(11):1001–1006

    Article  PubMed  CAS  Google Scholar 

  32. Fabbri LM, Rabe KF (2007) From COPD to chronic systemic inflammatory syndrome? Lancet 370:797–799

    Article  PubMed  Google Scholar 

  33. Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF (2007) Systemic effects of smoking. Chest 131:1557–1566

    Article  PubMed  CAS  Google Scholar 

  34. Agusti A, Thomas A (2006) Neff lecture: chronic obstructive pulmonary disease—a systemic disease. Proc Am Thorac Soc 3:478–481

    Article  PubMed  CAS  Google Scholar 

  35. Barnes PJ, Celli B (2009) Systemic manifestations and comorbidities of COPD. Eur Respir J 33:1165–1185

    Article  PubMed  CAS  Google Scholar 

  36. Wouters EFM (2005) Local and systemic inflammation in chronic obstructive pulmonary disease. Proc Am Thor Soc 2:26–33

    Article  CAS  Google Scholar 

  37. Kessler R, Faller M, Fourgaut G, Mennecier M, Weitzenblum E (1999) Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159:158–164

    Article  PubMed  CAS  Google Scholar 

  38. Ttkacova R (2010) Systemic inflammation in chronic obstructive pulmonary disease: may adipose tissue play a role? Rev Lit Future Perspect Mediat Inflamm 2010:585989

    Google Scholar 

  39. Trayhurn P, Beattie JH (2001) Physiological role of adipose tissue: white adipose tissue as an endocrine and secretory organ. Proc Nutr Soc 60:329–339

    Article  PubMed  CAS  Google Scholar 

  40. Trayhurn P, Wood IS (2004) Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 92:347–355

    Article  PubMed  CAS  Google Scholar 

  41. Kershaw EE, Flier JS (2004) Adipose tissue as an endocrine organ. J Clin Endocrinol Metab 89:2548–2556

    Article  PubMed  CAS  Google Scholar 

  42. Hotamisligil GS, Arner P, Caro JF, Atkinson RL, Spiegelman BM (1995) Increased adipose tissue expression of tumor necrosis factor-alpha in human obesity and insulin resistance. J Clin Invest 95:2409–2415

    Article  PubMed  CAS  Google Scholar 

  43. Mohamed-Ali V, Flower L, Sethi J et al (2001) Beta-adrenergic regulation of IL-6 release from adipose tissue: in vivo and in vitro studies. J Clin Endocrinol Metabol 86:5864–5869

    Article  CAS  Google Scholar 

  44. Bruun JM, Pedersen SB, Kristensen K, Richelsen B (2002) Opposite regulation of interleukin-8 and tumor necrosis factor-alpha by weight loss. Obesity Res 10:499–506

    Article  CAS  Google Scholar 

  45. Hosogai H, Fukuhara A, Oshima K et al (2007) Adipose tissue hypoxia in obesity and its impact on adipocytokine dysregulation. Diabetes 56:901–911

    Article  PubMed  CAS  Google Scholar 

  46. Wenger RH (2002) Cellular adaptation to hypoxia: O2-sensing protein hydroxylases, hypoxia-inducible transcription factors, and O2-regulated gene expression. FASEB J 16:1151–1162

    Article  PubMed  CAS  Google Scholar 

  47. Bolton CE, Evans M, Ionescu AA et al (2007) Insulin resistance and inflammation: a further systemic complication of COPD. J COPD 4:121–126

    Article  CAS  Google Scholar 

  48. Sava F, Laviolette L, Breton MJ, Bourbeau J, Maltais JF (2010) The impact of obesity on walking and cycling performance and response to pulmonary rehabilitation. BMC Pulm Med 10:55

    Article  PubMed  Google Scholar 

  49. Donini ML, Savina C, Castellaneta E, Coletti C, Paolini M, Scavone L, Civale C, Ceccarelli P, Zaninotto S, Tineri M, Grossi G, De Felice MR, Cannella C (2009) Multidisciplinary approach to obesità. Eat Weight Disor 14:23–31

    CAS  Google Scholar 

  50. Han MK, Agusti A, Calverley PM et al (2010) Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med 182(5):598–604

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Oncology, Haematology and Pneumology, University of Modena, Modena, Italy

    Enrico Clini

  2. Department of Pulmonary Rehabilitation, Ospedale Villa Pineta, Pavullo (MO), Italy

    Enrico Clini & Ernesto Crisafulli

  3. Department of Emergency, Spedali Civili, Brescia, Italy

    Alessandro Radaeli

  4. Department of Internal Medicine, University of Brescia, Brescia, Italy

    Mario Malerba

Authors
  1. Enrico Clini
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  2. Ernesto Crisafulli
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  3. Alessandro Radaeli
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  4. Mario Malerba
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Correspondence to Mario Malerba.

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Clini, E., Crisafulli, E., Radaeli, A. et al. COPD and the metabolic syndrome: an intriguing association. Intern Emerg Med 8, 283–289 (2013). https://doi.org/10.1007/s11739-011-0700-x

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