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Yamazaki A, Kinose D, Kawashima S, Tsunoda Y, Matsuo Y, Uchida Y, Nakagawa H, Yamaguchi M, Ogawa E, Nakano Y. Predictors of longitudinal changes in body weight, muscle and fat in patients with and ever-smokers at risk of COPD. Respirology 2023; 28:851-859. [PMID: 37364930 DOI: 10.1111/resp.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Weight and muscle loss are predictors of poor outcomes in chronic obstructive pulmonary disease. However, to our knowledge, no study has investigated the predictors of longitudinal weight loss or its composition from functional and morphological perspectives. METHODS This longitudinal observational study with a median follow-up period of 5 years (range: 3.0-5.8 years) included patients with COPD and ever-smokers at risk of COPD. Using chest computed tomography (CT) images, airway and emphysematous lesions were assessed as the square root of the wall area of a hypothetical airway with an internal perimeter of 10 mm (√Aaw at Pi10) and the percentage of low attenuation volume (LAV%). Muscle mass was estimated using cross-sectional areas (CSAs) of the pectoralis and erector spinae muscles, and fat mass was estimated using the subcutaneous fat thickness at the level of the 8th rib measured using chest CT images. Statistical analyses were performed using the linear mixed-effects models. RESULTS In total, 114 patients were enrolled. Their body mass index remained stable during the study period while body weight and muscle CSA decreased over time and the subcutaneous fat thickness increased. Reduced forced expiratory volume in 1 s and peak expiratory flow (PEF) at baseline predicted the future decline in muscle CSA. CONCLUSION Severe airflow limitation predicted future muscle wasting in patients with COPD and ever-smokers at risk of COPD. Airflow limitation with a PEF slightly below 90% of the predicted value may require intervention to prevent future muscle loss.
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Affiliation(s)
- Akio Yamazaki
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Daisuke Kinose
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Satoru Kawashima
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoko Tsunoda
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yumiko Matsuo
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- Health Administration Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuki Uchida
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroaki Nakagawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masafumi Yamaguchi
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Emiko Ogawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
- Health Administration Center, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
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Sokar SS, Afify EH, Osman EY. Dexamethasone and losartan combination treatment protected cigarette smoke-induced COPD in rats. Hum Exp Toxicol 2021; 40:284-296. [PMID: 32812458 DOI: 10.1177/0960327120950012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a dangerous prevalent smoking-related disease characterized by abnormal inflammation and oxidative stress and expected to be the third cause of death in the world next decade. Corticosteroids have low effects in decreasing numbers of inflammatory mediators specifically in long-term use. Our study designed to investigate the possible protective effects of combined dexamethasone (Dex) (2mg/kg) and losartan (Los) (30mg/kg angiotensin receptor blocker, it possesses antioxidant and anti-inflammatory properties in lung injury in mice) against cigarette -smoke (CS) induced COPD in rats compared with dexamethasone and losartan. Male Sprague Dawley rats (N = 40) divided into five groups (n = 8): control group, CS group, Dex group, Los group, and Dex +Los group. COPD induced in rats by CS exposure twice daily for 10 weeks. After the specified treatment period, bronchoalveolar lavage fluid (BALF) and lung tissue were collected for measurement of SOD, NO, MDA, ICAM-, MMP-9, CRP, NF-κB and histopathology scoring. Our results indicated that Los+Dex significantly prevent CS-induced COPD emphysema, congested alveoli, and elevation of lung injury parameters in BALF. They also showed a significant decrease in MDA, ICAM-1, MMP-9, CRP, and NF-κB and a significant increase in SOD and NO. In conclusion, adding Los to Dex potentiating their activity in inhibition the progression of COPD based on its activity on oxidative stress, inflammation, and NF-κB protein expression.
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Affiliation(s)
- Samia S Sokar
- Professor of Pharmacology and Toxicology, 68904Faculty of Pharmacy, Tanta University, Egypt
| | | | - Enass Y Osman
- Department of Pharmacology and Toxicology, 68904Faculty of Pharmacy, Tanta University, Egypt
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Kim EK, Singh D, Park JH, Park YB, Kim SI, Park B, Park J, Kim JH, Kim MA, Lee JH, Kim TH, Yoon HK, Oh YM. Impact of Body Mass Index Change on the Prognosis of Chronic Obstructive Pulmonary Disease. Respiration 2020; 99:943-953. [PMID: 33264797 DOI: 10.1159/000511022] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low body mass index (BMI) is an important prognostic factor in chronic obstructive pulmonary disease (COPD). However, the prognostic value of longitudinal BMI change in COPD has not been well studied. OBJECTIVE We aimed to evaluate the association between longitudinal change of BMI and prognosis of COPD in Korean COPD cohort. METHODS This study was conducted in a prospective Korean Obstructive Lung Disease (KOLD) cohort where COPD patients were recruited on an outpatient basis at 17 hospitals in South Korea. Annual BMI was measured over a period of 3 years or more. All patients were categorized into underweight (UW), normal weight (NW), and overweight (OW) groups by BMI. Clinical characteristics and outcomes including exacerbation and mortality were compared based on initial BMI grade and longitudinal change of BMI. RESULTS This analysis included 537 COPD patients (mean age = 67.4 ± 7.9 years, male = 97.0%, mean BMI = 23.0 ± 3.1) of KOLD cohort. The proportions of UW, NW, and OW groups were 6.9% (n = 37), 68.9% (n = 370), and 24.2% (n = 130) respectively. The UW group showed lower forced expiratory volume in 1 s (FEV1) (p < 0.001), shorter 6-minute walk distance (p < 0.001), higher modified Medical Research Council score (p = 0.002), higher St. George Respiratory Questionnaire score (p < 0.001), higher emphysema index (p < 0.001) and air-trapping index (p < 0.001), and more frequent (p < 0.001) and severe exacerbations (p = 0.003). Multivariable analyses demonstrated that decrease of BMI (hazard ratio [HR] = 0.786, p = 0.038) and the descent of BMI group (HR = 3.167, p = 0.016) at 3-year follow-up along with age, initial BMI, post-bronchodilator FEV1, and severe exacerbations were significantly associated with mortality. CONCLUSIONS This study demonstrated that BMI decrease during follow-up was independently associated with exacerbation and higher mortality of COPD, suggesting BMI reduction in COPD should be carefully managed.
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Affiliation(s)
- Eun Kyung Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Dave Singh
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, Republic of Korea,
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seung-Il Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jisoo Park
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jung-Hyun Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Mi-Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Ji-Hyun Lee
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Tae-Hyung Kim
- Division of Pulmonology, Department of Internal Medicine, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary, allergy and Critical Care Medicine, Department of Internal Medicine, Seoul Saint Mary's hospital, Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Pitkäniemi J, Heikkinen S, Seppä K, Ryynänen H, Ylöstalo T, Eriksson JG, Härkänen T, Jousilahti P, Knekt P, Koskinen S, Männistö S, Albanes D, Rissanen H, Malila N, Laaksonen MA. Pooling of Finnish population-based health studies: lifestyle risk factors of colorectal and lung cancer. Acta Oncol 2020; 59:1338-1342. [PMID: 32657191 DOI: 10.1080/0284186x.2020.1789214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Sanna Heikkinen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Karri Seppä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Heidi Ryynänen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Tiina Ylöstalo
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Johan G. Eriksson
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Singapore
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tommi Härkänen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pekka Jousilahti
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Paul Knekt
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Demetrius Albanes
- Department of Health and Human Services, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Harri Rissanen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Maarit A. Laaksonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- School of Mathematics and Statistics, Faculty of Science, University of New South Wales, Sydney, Australia
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Marchioro J, Gazzotti MR, Moreira GL, Manzano BM, Menezes AMB, Perez-Padilla R, Jardim JR, Nascimento OA. Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study. J Bras Pneumol 2019; 45:e20170157. [PMID: 31365731 PMCID: PMC6715159 DOI: 10.1590/1806-3713/e20170157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 01/18/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012). METHODS This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase. RESULTS Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = -1.7 ± 8.1 and ΔBMI = -0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = -0.5 ± 5.4 and ΔBMI = -0.8 ± 3.3). CONCLUSIONS Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.
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Affiliation(s)
- Josiane Marchioro
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Mariana Rodrigues Gazzotti
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Graciane Laender Moreira
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Beatriz Martins Manzano
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | | | | | - José Roberto Jardim
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
| | - Oliver Augusto Nascimento
- . Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil
- . Faculdade de Medicina São Leopoldo Mandic, Campinas (SP) Brasil
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Abstract
OBJECTIVE Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized idiopathic systemic disorder associated with elevated serum IgG4 level and tissue infiltration by IgG4-positive plasma cells. Multiple neurological manifestations, including peripheral neuropathy, have been described in IgG4-RD. Our objective is to discuss a case report and review of the literature, which would expand the spectrum of IgG4-RD. METHODS We describe the clinical features and biopsy findings in a patient with IgG4-RD who presented with features suggestive of neuromyopathy in the setting of recurrent pleural effusion and weight loss. RESULTS Electrodiagnostic findings were suggestive of an irritable myopathy and polyradiculoneuropathy with primary demyelination and secondary axonal degeneration. Pleural biopsy and laboratory studies confirmed the diagnosis. Improvement was sustained with steroid therapy. CONCLUSIONS We describe the first case, to our knowledge, of IgG4-related neuromyopathy associated with recurrent pleural effusion. Our case expands the clinical spectrum of IgG4-RD. Neurologists should be aware of this treatable disorder and in the appropriate clinical context consider it in the differential diagnosis of neuromyopathy.
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Dale C, Nüesch E, Prieto-Merino D, Choi M, Amuzu A, Ebrahim S, Casas JP, Davey-Smith G. Why do thin people have elevated all-cause mortality? Evidence on confounding and reverse causality in the association of adiposity and COPD from the British Women's Heart and Health Study. PLoS One 2015; 10:e0115446. [PMID: 25884834 PMCID: PMC4401726 DOI: 10.1371/journal.pone.0115446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022] Open
Abstract
Low adiposity has been linked to elevated mortality from several causes including respiratory disease. However, this could arise from confounding or reverse causality. We explore the association between two measures of adiposity (BMI and WHR) with COPD in the British Women's Heart and Health Study including a detailed assessment of the potential for confounding and reverse causality for each adiposity measure. Low BMI was found to be associated with increased COPD risk while low WHR was not (OR = 2.2; 95% CI 1.3-3.1 versus OR = 1.2; 95% CI 0.7-1.6). Potential confounding variables (e.g. smoking) and markers of ill-health (e.g. unintentional weight loss) were found to be higher in low BMI but not in low WHR. Women with low BMI have a detrimental profile across a broad range of health markers compared to women with low WHR, and women with low WHR do not appear to have an elevated COPD risk, lending support to the hypothesis that WHR is a less confounded measure of adiposity than BMI. Low adiposity does not in itself appear to increase the risk of respiratory disease, and the apparent adverse consequences of low BMI may be due to reverse causation and confounding.
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Affiliation(s)
- Caroline Dale
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Eveline Nüesch
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Prieto-Merino
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Minkyoung Choi
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Antoinette Amuzu
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Juan P. Casas
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - George Davey-Smith
- CAiTE centre, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
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Angelidis G, Valotassiou V, Georgoulias P. Current and potential roles of ghrelin in clinical practice. J Endocrinol Invest 2010; 33:823-38. [PMID: 21293171 DOI: 10.1007/bf03350350] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Ghrelin is a novel GH-releasing peptide, which has been identified as an endogenous ligand for GH-secretagogue receptor. Ghrelin is mainly secreted by the stomach and plays a critical role in a variety of physiological processes including endocrine, metabolic, cardiovascular, immunological, and other actions. Ghrelin stimulates food intake via hypothalamic neurons and causes a positive energy balance and body weight gain by decreasing fat utilization and promoting adiposity. Given the multiple effects of ghrelin, its potential clinical applications have been evaluated in various conditions. Preliminary trials have shown that it may prove valuable in the management of disease-induced cachexia. Ghrelin may improve the wasting syndrome through GH-dependent or GH-independent effects. Moreover, ghrelin may play a role in the management of disorders of gut motility and obesity. Finally, other potential clinical applications of ghrelin include the treatment of patients with diabetes mellitus, infections, rheumatological diseases or GH deficiency and the diagnosis of this hormonal disorder.
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Affiliation(s)
- G Angelidis
- Department of Nuclear Medicine, University Hospital of Larissa, Mezourlo, Larissa, Hellas
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Abstract
Obesity is a worldwide epidemic and is known to increase the risk of cardiovascular disease, type 2 diabetes, and certain forms of cancer. In addition, obesity is now recognized as an important risk factor in the development of several respiratory diseases. Of these respiratory diseases, it has already been well established that obesity can lead to obstructive sleep apnea (OSA) and obesity-hypoventilation syndrome (OHS). More recent data suggest that the prevalence of wheezing and bronchial hyper-responsiveness, two symptoms often associated with asthma, are increased in overweight and obese individual. Indeed, epidemiological studies have reported that obesity is a risk factor for the development of asthma. Furthermore, a number of studies indicate that obesity is also associated with a higher risk of developing deep vein thrombi, pulmonary emboli, pulmonary hypertension, and pneumonia. Finally, weight reduction has been shown to be effective in improving the symptoms and severity of several respiratory diseases, including OSA and asthma. Thus, overweight and obese patients should be encouraged to lose weight to reduce their risk of developing respiratory diseases or improve the course of pre-existing conditions.
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Affiliation(s)
- A T Murugan
- Division of Allergy, Pulmonary, Immunology, Critical Care, and Sleep, Department of Internal Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
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Jung EJ, Kim YK, Lee YM, Kim KU, Uh ST, Kim YH, Kim DJ, Park CS, Hwang JH. The Correlation of Dyspnea and Radiologic Quantity in Patients with COPD. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.4.288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eun Jung Jung
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Seoul, Korea
| | - Yang Ki Kim
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Seoul, Korea
| | - Young Mok Lee
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Seoul, Korea
| | - Ki-Up Kim
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Seoul, Korea
| | - Soo-Taek Uh
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Seoul, Korea
| | - Yong Hoon Kim
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Cheonan, Korea
| | - Do Jin Kim
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Bucheon, Korea
| | - Choon Sik Park
- Division of Respiratory and Allergy Medicine, Soonchunhyang University Hospital, College of Medicine, Bucheon, Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Seoul, Korea
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Celik T, Iyisoy A, Gundogdu F, Isik E. Chronic pulmonary cachexia syndrome: the role of anorexia. Int J Cardiol 2007; 132:432-3; author reply 434. [PMID: 17651825 DOI: 10.1016/j.ijcard.2007.04.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2007] [Accepted: 04/25/2007] [Indexed: 10/23/2022]
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12
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Koehler F, Doehner W, Hoernig S, Witt C, Anker SD, John M. Anorexia in chronic obstructive pulmonary disease--association to cachexia and hormonal derangement. Int J Cardiol 2006; 119:83-9. [PMID: 17064790 DOI: 10.1016/j.ijcard.2006.07.088] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 07/15/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND In patients with chronic obstructive pulmonary disease (COPD) weight loss frequently occurs that may ultimately lead to cachexia as a serious co-morbidity, indicating severely impaired functional capacity, health status and increased mortality. Increased energy expenditure due to mechanic and metabolic inefficiency and systemic inflammation are determinants of a hypermetabolic state that is not balanced by dietary intake. Anorexia may importantly contribute to weight loss in COPD, however, the association between immune and hormonal derangement and altered appetite has not been studied in detail. AIM The aim of the present study was to investigate whether anorexia in COPD is related to inflammation and hormonal derangement in association to weight loss. METHODS We prospectively enrolled 103 consecutive patients with COPD (age 59.8+/-1.3 years, 35% female, mean FEV1 38.3+/-1.7%) in comparison to healthy controls of similar age (n=15). RESULTS In 34 patients (33%) cachexia was diagnosed (weight loss >7.5%, BMI < or = 24 kg/m2). Cachectic COPD patients had lower BMI (19.0+/-0.5 vs 25.6+/-0.7 kg/m2) and impaired lung function (FEV1 31+/-2% vs 42+/-2%, FVC 51+/-3 vs 59+/-3%, both p<0.001). Inflammatory immune activation (IL-6 and IL-6/IL-10 ratio) was significantly higher in cachectic COPD patients. Analysis of the extent of anorexia (visual analogue scale) revealed that cachectic COPD patients had significantly decreased subjective desire to eat compared to non-cachectic patients (3.5+/-0.3 vs 6.3+/-0.2, p<0.001). Patients with COPD and cachexia showed evidence of acquired GH resistance (decreased IGF-1/GH ratio) and insulin resistance (HOMA). Anorexia showed a direct correlation with the IGF-1/GH ratio (r=0.34, p<0.05) and was further related to BMI and % weight loss (both p<0.001). CONCLUSION In COPD anorexia relates to hormonal derangement and inflammatory immune activation. Anorexia contributes to development of cachexia. The concept of appetite stimulating therapy emerges as a novel therapeutic option in cachectic COPD patients.
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Affiliation(s)
- Friedrich Koehler
- Department of Cardiology, Charité University Hospital, Campus Mitte, Berlin, Germany
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13
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Ham HS, Lee HY, Lee SJ, Cho YJ, Jung YY, Kim HC, Hahm JR, Park CH, Lee JD, Sohn HJ, Youn HS, Hwang YS. Relationship between Systemic Inflammatory Marker, Oxidative Stress and Body Mass Index in Stable COPD Patient. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.61.4.330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Hyun Seok Ham
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
| | - Hae Young Lee
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
| | - Yu Ji Cho
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
| | - Yi Young Jung
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jong Ryeal Hahm
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Chan Hoo Park
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Jong Deok Lee
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Hyun Joon Sohn
- Department of Anatomy, Medical School of Chungbuk National University, Chungju, Korea
| | - Hee Shang Youn
- Department of Pediatrics, College of Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
| | - Young Sil Hwang
- Department of Internal Medicine, Gyeongsang National University, Jinju, Korea
- Gyeongsang Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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14
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Luo FM, Liu XJ, Li SQ, Wang ZL, Liu CT, Yuan YM. Circulating ghrelin in patients with chronic obstructive pulmonary disease. Nutrition 2005; 21:793-8. [PMID: 15975486 DOI: 10.1016/j.nut.2004.11.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2004] [Accepted: 11/22/2004] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Unexplained weight loss is common in patients with chronic obstructive pulmonary disease (COPD). Because ghrelin plays an important role in energy homeostasis, this study investigated the plasma level of ghrelin in COPD. METHODS Plasma ghrelin levels and levels of leptin, tumor necrosis factor-alpha, and C-reactive protein were measured in 29 patients with COPD and 17 healthy controls. Body composition was assessed with bioelectrical impedance analysis. RESULTS Body mass index and percentage of body fat were lower in patients who had COPD than in healthy controls. Plasma ghrelin and leptin concentrations were significantly lower in patients who had COPD than in healthy controls (ghrelin: 0.25+/-0.22 ng/mL versus 0.43+/-0.24 ng/mL, P=0.013; leptin: 1.77+/-0.70 ng/mL versus 2.85+/-0.96 ng/mL, P=0.000). In contrast, tumor necrosis factor-alpha and C-reactive protein were significantly higher in those with COPD than in controls. Plasma ghrelin (log transformed) was positively correlated with body mass index and percentage of body fat in patients with COPD but negatively correlated in control subjects. Plasma ghrelin was negatively correlated with tumor necrosis factor-alpha and C-reactive protein in COPD. CONCLUSION Plasma ghrelin level was decreased in COPD and this is different from other weight-loss diseases. These data suggest that decreased ghrelin and other factors may contribute to alterations in metabolic status during inflammatory stress in this disease.
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Affiliation(s)
- Feng-Ming Luo
- West China Hospital of Sichuan University, Chengdu, China
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15
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Borghi e Silva A, Costa D, Baldissera V, Cardello L, Demonte A. Correlações entre os níveis de L-carnitina plasmática, o estado nutricional e a função ventilatória de portadores de doença pulmonar obstrutiva crônica. REV NUTR 2005. [DOI: 10.1590/s1415-52732005000300007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Avaliar os níveis de L-carnitina livre no plasma, o estado nutricional, a função pulmonar e a tolerância ao exercício em pacientes com doença pulmonar obstrutiva crônica e verificar as correlações entre a composição corporal e as frações de L-carnitina no plasma. MÉTODOS: Quarenta pacientes entre 66,2±9 anos, com diagnóstico clínico de doença pulmonar obstrutiva crônica, foram divididos em dois grupos: G1, com índice de massa corporal menor que 20kg/m², e G2, com índice de massa corporal maior que 20kg/m². Foram mensurados os parâmetros espirométricos, a tolerância ao exercício no teste de caminhada, a força muscular respiratória, a composição corporal por meio da impedância bioelétrica e as dosagens da L-carnitina plasmática, através de amostras de sangue. RESULTADOS: Foram observados menores valores das variáveis espirométricas (p<0,01), da força muscular respiratória e dos níveis de L-carnitina nos pacientes do G1; porém, não houve diferença entre os grupos quanto à capacidade de realizar exercício físico dinâmico de baixa intensidade. Correlações significativas entre o percentual de gordura e os níveis de L-carnitina plasmática foram observadas nos pacientes (r=0,53 com p<0,002); sendo que, nos pacientes com índice de massa corporal menor que 18kg/m², essa relação aumentou (r<0,73 com p<0,01). CONCLUSÃO: Na doença pulmonar obstrutiva crônica, a desnutrição está associada tanto aos prejuízos da função pulmonar e da força muscular respiratória, quanto aos baixos níveis de L-Carnitina plasmática.
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