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Esposito P, Picciotto D, Battaglia Y, Costigliolo F, Viazzi F, Verzola D. Myostatin: Basic biology to clinical application. Adv Clin Chem 2022; 106:181-234. [PMID: 35152972 DOI: 10.1016/bs.acc.2021.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Myostatin is a member of the transforming growth factor (TGF)-β superfamily. It is expressed by animal and human skeletal muscle cells where it limits muscle growth and promotes protein breakdown. Its effects are influenced by complex mechanisms including transcriptional and epigenetic regulation and modulation by extracellular binding proteins. Due to its actions in promoting muscle atrophy and cachexia, myostatin has been investigated as a promising therapeutic target to counteract muscle mass loss in experimental models and patients affected by different muscle-wasting conditions. Moreover, growing evidence indicates that myostatin, beyond to regulate skeletal muscle growth, may have a role in many physiologic and pathologic processes, such as obesity, insulin resistance, cardiovascular and chronic kidney disease. In this chapter, we review myostatin biology, including intracellular and extracellular regulatory pathways, and the role of myostatin in modulating physiologic processes, such as muscle growth and aging. Moreover, we discuss the most relevant experimental and clinical evidence supporting the extra-muscle effects of myostatin. Finally, we consider the main strategies developed and tested to inhibit myostatin in clinical trials and discuss the limits and future perspectives of the research on myostatin.
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Affiliation(s)
- Pasquale Esposito
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Daniela Picciotto
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Yuri Battaglia
- Nephrology and Dialysis Unit, St. Anna University Hospital, Ferrara, Italy
| | - Francesca Costigliolo
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Viazzi
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Daniela Verzola
- Clinica Nefrologica, Dialisi, Trapianto, Department of Internal Medicine, University of Genoa and IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Wilson AC, Kumar PL, Lee S, Parker MM, Arora I, Morrow JD, Wouters EFM, Casaburi R, Rennard SI, Lomas DA, Agusti A, Tal-Singer R, Dransfield MT, Wells JM, Bhatt SP, Washko G, Thannickal VJ, Tiwari HK, Hersh CP, Castaldi PJ, Silverman EK, McDonald MLN. Heme metabolism genes Downregulated in COPD Cachexia. Respir Res 2020; 21:100. [PMID: 32354332 PMCID: PMC7193359 DOI: 10.1186/s12931-020-01336-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/11/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Cachexia contributes to increased mortality and reduced quality of life in Chronic Obstructive Pulmonary Disease (COPD) and may be associated with underlying gene expression changes. Our goal was to identify differential gene expression signatures associated with COPD cachexia in current and former smokers. METHODS We analyzed whole-blood gene expression data from participants with COPD in a discovery cohort (COPDGene, N = 400) and assessed replication (ECLIPSE, N = 114). To approximate the consensus definition using available criteria, cachexia was defined as weight-loss > 5% in the past 12 months or low body mass index (BMI) (< 20 kg/m2) and 1/3 criteria: decreased muscle strength (six-minute walk distance < 350 m), anemia (hemoglobin < 12 g/dl), and low fat-free mass index (FFMI) (< 15 kg/m2 among women and < 17 kg/m2 among men) in COPDGene. In ECLIPSE, cachexia was defined as weight-loss > 5% in the past 12 months or low BMI and 3/5 criteria: decreased muscle strength, anorexia, abnormal biochemistry (anemia or high c-reactive protein (> 5 mg/l)), fatigue, and low FFMI. Differential gene expression was assessed between cachectic and non-cachectic subjects, adjusting for age, sex, white blood cell counts, and technical covariates. Gene set enrichment analysis was performed using MSigDB. RESULTS The prevalence of COPD cachexia was 13.7% in COPDGene and 7.9% in ECLIPSE. Fourteen genes were differentially downregulated in cachectic versus non-cachectic COPD patients in COPDGene (FDR < 0.05) and ECLIPSE (FDR < 0.05). DISCUSSION Several replicated genes regulating heme metabolism were downregulated among participants with COPD cachexia. Impaired heme biosynthesis may contribute to cachexia development through free-iron buildup and oxidative tissue damage.
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Affiliation(s)
- Ava C Wilson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Preeti L Kumar
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sool Lee
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Margaret M Parker
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Itika Arora
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jarrett D Morrow
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Emiel F M Wouters
- Centre of expertise for chronic organ failure, Horn, the Netherlands
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Stephen I Rennard
- Department of Medicine, Nebraska Medical Center, Omaha, NE, USA
- BioPharmaceuticals R&D, AstraZeneca, Cambridge, UK
| | - David A Lomas
- UCL Respiratory, Division of Medicine, University College London, London, UK
| | - Alvar Agusti
- Fundació Investigació Sanitària Illes Balears (FISIB), Ciber Enfermedades Respiratorias (CIBERES), Barcelona, Catalunya, Spain
- Thorax Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Michael Wells
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - George Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Victor J Thannickal
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hemant K Tiwari
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Craig P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Merry-Lynn N McDonald
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL, USA.
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Optimization of nutritional management of patients awaiting lung transplant at the Strasbourg University Hospitals. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Holst M, Beck A, Rasmussen H, Lange P. Insufficient intake of energy and protein is related to physical functional capacity among COPD patients referred to municipality based pulmonary rehabilitation. Clin Nutr ESPEN 2019; 30:35-41. [DOI: 10.1016/j.clnesp.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
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Kochetkova EA, Nevzorova VA, Ugai LG, Maistrovskaia YV, Massard G. The Role of Tumor Necrosis Factor Alpha and TNF Superfamily Members in Bone Damage in Patients with End-Stage Chronic Obstructive Lung Disease Prior to Lung Transplantation. Calcif Tissue Int 2016; 99:578-587. [PMID: 27501819 DOI: 10.1007/s00223-016-0185-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 08/01/2016] [Indexed: 11/25/2022]
Abstract
A disequilibrium of tumor necrosis superfamily (TNF) members, including the serum osteoprotegerin, soluble receptor activator of nuclear factor-κB ligand, soluble TNF-related apoptosis-inducing ligand and TNF-α, was associated with the occurrence of a reduced skeletal mass and osteoporosis in male patients with end-stage chronic obstructive pulmonary disease (COPD). The purpose of this study was to explore the associations between serum biomarkers of tumor necrosis factor (TNF) superfamily and body and bone compositions in end-stage COPD males. Pulmonary function, T-score at the lumbar spine and femoral neck, lean mass, serum osteoprotegerin (OPG), soluble receptor activator of nuclear factor-κB ligand (sRANKL), TNF-α and its receptors (sTNFR-I, sTNFR-II) and soluble TNF-related apoptosis-inducing ligand (sTRAIL) levels were evaluated in 48 male patients with end-stage COPD and 36 healthy male volunteers. OPG was lower in male COPD patients than in control subjects, whereas sRANKL, TNF-α and its receptors were higher. The serum sTRAIL level showed a tendency to increase compared with that of healthy subjects (P = 0.062). Serum OPG showed a positive correlation with bone density. In contrast, serum TNF-α, sRANKL and sTRAIL were inversely associated with pretransplant bone density. We have noted the appearance of statistically significant inverse relationships between lean mass values and TNF-α, sTNFR-I and II and sRANKL levels in male COPD patients. Moreover, there was a negative correlation between sTRAIL levels with airway obstruction (P = 0.005) and hypercapnia (P = 0.042) in advanced COPD patients. Through a multiple linear regression analysis, our study revealed that a disequilibrium of TNF family members was strongly associated with the occurrence of a reduced skeletal mass and osteoporosis. These results provide further evidence that abnormal levels of TNF superfamily molecules may cause not only a decrease in BMD, but also lower muscle mass in end-stage COPD.
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Affiliation(s)
- Evgenia A Kochetkova
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950.
| | - Vera A Nevzorova
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950
| | - Ludmila G Ugai
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950
| | - Yulia V Maistrovskaia
- Central Scientific Research Laboratory, Pacific State Medical University, 2 Ostryakova Av., Vladivostok, Russian Federation, 690950
| | - Gilbert Massard
- Department of Pulmonology, Allergy and Thoracic Surgery, Faculty of Medicine, University of Strasbourg, Strasbourg, France
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Varian BJ, Goureshetti S, Poutahidis T, Lakritz JR, Levkovich T, Kwok C, Teliousis K, Ibrahim YM, Mirabal S, Erdman SE. Beneficial bacteria inhibit cachexia. Oncotarget 2016; 7:11803-16. [PMID: 26933816 PMCID: PMC4914249 DOI: 10.18632/oncotarget.7730] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/05/2016] [Indexed: 12/18/2022] Open
Abstract
Muscle wasting, known as cachexia, is a debilitating condition associated with chronic inflammation such as during cancer. Beneficial microbes have been shown to optimize systemic inflammatory tone during good health; however, interactions between microbes and host immunity in the context of cachexia are incompletely understood. Here we use mouse models to test roles for bacteria in muscle wasting syndromes. We find that feeding of a human commensal microbe, Lactobacillus reuteri, to mice is sufficient to lower systemic indices of inflammation and inhibit cachexia. Further, the microbial muscle-building phenomenon extends to normal aging as wild type animals exhibited increased growth hormone levels and up-regulation of transcription factor Forkhead Box N1 [FoxN1] associated with thymus gland retention and longevity. Interestingly, mice with a defective FoxN1 gene (athymic nude) fail to inhibit sarcopenia after L. reuteri therapy, indicating a FoxN1-mediated mechanism. In conclusion, symbiotic bacteria may serve to stimulate FoxN1 and thymic functions that regulate inflammation, offering possible alternatives for cachexia prevention and novel insights into roles for microbiota in mammalian ontogeny and phylogeny.
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Affiliation(s)
- Bernard J. Varian
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sravya Goureshetti
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Theofilos Poutahidis
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
- Laboratory of Pathology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jessica R. Lakritz
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tatiana Levkovich
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Caitlin Kwok
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Konstantinos Teliousis
- Laboratory of Pathology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Yassin M. Ibrahim
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sheyla Mirabal
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Susan E. Erdman
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA, USA
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van Dijk DP, van de Poll MC, Moses AG, Preston T, Olde Damink SW, Rensen SS, Deutz NE, Soeters PB, Ross JA, Fearon KC, Dejong CH. Effects of oral meal feeding on whole body protein breakdown and protein synthesis in cachectic pancreatic cancer patients. J Cachexia Sarcopenia Muscle 2015; 6:212-21. [PMID: 26401467 PMCID: PMC4575552 DOI: 10.1002/jcsm.12029] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/12/2015] [Accepted: 02/23/2015] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pancreatic cancer is often accompanied by cachexia, a syndrome of severe weight loss and muscle wasting. A suboptimal response to nutritional support may further aggravate cachexia, yet the influence of nutrition on protein kinetics in cachectic patients is poorly understood. METHODS Eight cachectic pancreatic cancer patients and seven control patients received a primed continuous intravenous infusion of l-[ring-(2)H5]phenylalanine and l-[3,3-(2)H2]tyrosine for 8 h and ingested sips of water with l-[1-(13)C]phenylalanine every 30 min. After 4 h, oral feeding was started. Whole body protein breakdown, protein synthesis, and net protein balance were calculated. Results are given as median with interquartile range. RESULTS Baseline protein breakdown and protein synthesis were higher in cachectic patients compared with the controls (breakdown: 67.1 (48.1-79.6) vs. 45.8 (42.6-46.3) µmol/kg lean body mass/h, P = 0.049; and synthesis: 63.0 (44.3-75.6) vs. 41.8 (37.6-42.5) µmol/kg lean body mass/h, P = 0.021). During feeding, protein breakdown decreased significantly to 45.5 (26.9-51.1) µmol/kg lean body mass/h (P = 0.012) in the cachexia group and to 33.7 (17.4-37.1) µmol/kg lean body mass/h (P = 0.018) in the control group. Protein synthesis was not affected by feeding in cachectic patients: 58.4 (46.5-76.1) µmol/kg lean body mass/h, but was stimulated in controls: 47.9 (41.8-56.7) µmol/kg lean body mass/h (P = 0.018). Both groups showed a comparable positive net protein balance during feeding: cachexia: 19.7 (13.1-23.7) and control: 16.3 (13.6-25.4) µmol/kg lean body mass/h (P = 0.908). CONCLUSION Cachectic pancreatic cancer patients have a higher basal protein turnover. Both cachectic patients and controls show a comparable protein anabolism during feeding, albeit through a different pattern of protein kinetics. In cachectic patients, this is primarily related to reduced protein breakdown, whereas in controls, both protein breakdown and protein synthesis alterations are involved.
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Affiliation(s)
- David Pj van Dijk
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands
| | - Marcel Cg van de Poll
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands ; Department of Intensive Care Medicine, Maastricht University Medical Centre Maastricht, The Netherlands
| | | | - Thomas Preston
- Stable Isotope Biochemistry Laboratory, Scottish Universities Environmental Research Centre East Kilbride, Glasgow, UK
| | - Steven Wm Olde Damink
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands
| | - Sander S Rensen
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands
| | - Nicolaas Ep Deutz
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands
| | - Peter B Soeters
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands
| | - James A Ross
- Department of Surgery, Royal Infirmary of Edinburgh Edinburgh, UK
| | | | - Cornelis Hc Dejong
- Department of Surgery, Maastricht University Medical Centre Maastricht, The Netherlands ; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Maastricht, The Netherlands ; Department of Surgery, Royal Infirmary of Edinburgh Edinburgh, UK
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Sharma M, McFarlane C, Kambadur R, Kukreti H, Bonala S, Srinivasan S. Myostatin: expanding horizons. IUBMB Life 2015; 67:589-600. [PMID: 26305594 DOI: 10.1002/iub.1392] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/29/2015] [Indexed: 12/13/2022]
Abstract
Myostatin is a secreted growth and differentiation factor that belongs to the TGF-β superfamily. Myostatin is predominantly synthesized and expressed in skeletal muscle and thus exerts a huge impact on muscle growth and function. In keeping with its negative role in myogenesis, myostatin expression is tightly regulated at several levels including epigenetic, transcriptional, post-transcriptional, and post-translational. New revelations regarding myostatin regulation also offer mechanisms that could be exploited for developing myostatin antagonists. Increasingly, it is becoming clearer that besides its conventional role in muscle, myostatin plays a critical role in metabolism. Hence, molecular mechanisms by which myostatin regulates several key metabolic processes need to be further explored.
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Affiliation(s)
- Mridula Sharma
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
- Department of Cell & Molecular Biology, Brenner Centre for Molecular Medicine, Singapore Institute of Clinical Sciences (SICS), Singapore
| | - Craig McFarlane
- Department of Cell & Molecular Biology, Brenner Centre for Molecular Medicine, Singapore Institute of Clinical Sciences (SICS), Singapore
| | - Ravi Kambadur
- Department of Cell & Molecular Biology, Brenner Centre for Molecular Medicine, Singapore Institute of Clinical Sciences (SICS), Singapore
- School of Biological Sciences, Nanyang Technological University, Singapore
| | - Himani Kukreti
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | - Sabeera Bonala
- Department of Cell & Molecular Biology, Brenner Centre for Molecular Medicine, Singapore Institute of Clinical Sciences (SICS), Singapore
| | - Shruti Srinivasan
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí A, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EFM, ZuWallack RL. An Official American Thoracic Society/European Respiratory Society Statement: Research questions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015; 191:e4-e27. [PMID: 25830527 DOI: 10.1164/rccm.201501-0044st] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this Official American Thoracic Society (ATS)/European Respiratory Society (ERS) Research Statement is to describe evidence related to diagnosis, assessment, and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management. METHODS Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarized, and then salient knowledge gaps were identified. RESULTS Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulated via discussion and consensus. CONCLUSIONS Great strides have been made in the diagnosis, assessment, and management of COPD as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS Research Statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centered outcomes.
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Celli BR, Decramer M, Wedzicha JA, Wilson KC, Agustí A, Criner GJ, MacNee W, Make BJ, Rennard SI, Stockley RA, Vogelmeier C, Anzueto A, Au DH, Barnes PJ, Burgel PR, Calverley PM, Casanova C, Clini EM, Cooper CB, Coxson HO, Dusser DJ, Fabbri LM, Fahy B, Ferguson GT, Fisher A, Fletcher MJ, Hayot M, Hurst JR, Jones PW, Mahler DA, Maltais F, Mannino DM, Martinez FJ, Miravitlles M, Meek PM, Papi A, Rabe KF, Roche N, Sciurba FC, Sethi S, Siafakas N, Sin DD, Soriano JB, Stoller JK, Tashkin DP, Troosters T, Verleden GM, Verschakelen J, Vestbo J, Walsh JW, Washko GR, Wise RA, Wouters EF, ZuWallack RL. An official American Thoracic Society/European Respiratory Society statement: research questions in COPD. Eur Respir J 2015; 45:879-905. [DOI: 10.1183/09031936.00009015] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity, mortality, and resource use worldwide. The goal of this official American Thoracic Society (ATS)/European Respiratory Society (ERS) research statement is to describe evidence related to diagnosis, assessment and management; identify gaps in knowledge; and make recommendations for future research. It is not intended to provide clinical practice recommendations on COPD diagnosis and management.Clinicians, researchers, and patient advocates with expertise in COPD were invited to participate. A literature search of Medline was performed, and studies deemed relevant were selected. The search was not a systematic review of the evidence. Existing evidence was appraised and summarised, and then salient knowledge gaps were identified.Recommendations for research that addresses important gaps in the evidence in all areas of COPD were formulatedviadiscussion and consensus.Great strides have been made in the diagnosis, assessment and management of COPD, as well as understanding its pathogenesis. Despite this, many important questions remain unanswered. This ATS/ERS research statement highlights the types of research that leading clinicians, researchers, and patient advocates believe will have the greatest impact on patient-centred outcomes.
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11
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Choudhury G, Rabinovich R, MacNee W. Comorbidities and Systemic Effects of Chronic Obstructive Pulmonary Disease. Clin Chest Med 2014; 35:101-30. [DOI: 10.1016/j.ccm.2013.10.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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von Haehling S, Steinbeck L, Doehner W, Springer J, Anker SD. Muscle wasting in heart failure: An overview. Int J Biochem Cell Biol 2013; 45:2257-65. [DOI: 10.1016/j.biocel.2013.04.025] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/28/2013] [Indexed: 01/10/2023]
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13
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Op den Kamp CM, Langen RC, Snepvangers FJ, de Theije CC, Schellekens JM, Laugs F, Dingemans AMC, Schols AM. Nuclear transcription factor κ B activation and protein turnover adaptations in skeletal muscle of patients with progressive stages of lung cancer cachexia. Am J Clin Nutr 2013; 98:738-48. [PMID: 23902785 DOI: 10.3945/ajcn.113.058388] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Experimental models of cancer cachexia have indicated that systemic inflammation induces muscle-protein breakdown and wasting via muscular nuclear transcription factor κB (NF-κB) activation. This process may limit the efficacy of nutritional intervention. OBJECTIVES We assessed muscle NF-κB activity and protein turnover signaling in progressive stages of clinical lung cancer cachexia and assessed whether circulating factors can induce muscular NF-κB activity. DESIGN Patients with lung cancer precachexia (n = 10) and cachexia (n = 16) were cross-sectionally compared with 22 healthy control subjects. mRNA transcripts of muscle proteolytic (ubiquitin proteasome system and autophagy lysosomal pathway) and myogenic markers and protein expression of PI3K/Akt, myostatin, and autophagy signaling were measured. A multiplex analysis showed the systemic inflammatory status, whereas plasma exposure to stable NF-κB-luciferase-reporter muscle cells revealed NF-κB inducibility. RESULTS Compared with healthy control subjects, cachectic patients had reduced (appendicular) muscle mass (-10%), muscle fiber atrophy (-27%), and decreased quadriceps strength (-31%). Subtle alterations in the muscle morphology were also detectable in precachectic patients, without changes in body composition. Despite increased Akt phosphorylation, downstream phosphosubstrates glycogen synthase kinase 3β, mammalian target of rapamycin, and Forkhead box protein were unaltered. The expression of autophagy effectors B cell lymphoma 2/adenovirus E1B 19-kDa protein-interacting protein 3 and microtubule-associated proteins 1A/1B light chain 3B gradually increased from precachectic to cachectic patients, without differences in E3 ubiquitin ligases. Systemic and local inflammation was evident in cachexia and intermediate in precachexia, but the plasma of both patients groups caused ex vivo muscle NF-κB activation. CONCLUSIONS In lung cancer, muscular NF-κB activity is induced by factors contained within the circulation. Autophagy may contribute to increased muscle proteolysis in lung cancer cachexia, whereas the absence of downstream changes in phosphosubstrates despite increased Akt phosphorylation suggests impaired anabolic signaling that may require targeted nutritional intervention.
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Affiliation(s)
- Céline M Op den Kamp
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Centre, Maastricht, Netherlands.
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Lainscak M, Gosker HR, Schols AMWJ. Chronic obstructive pulmonary disease patient journey: hospitalizations as window of opportunity for extra-pulmonary intervention. Curr Opin Clin Nutr Metab Care 2013; 16:278-83. [PMID: 23507875 DOI: 10.1097/mco.0b013e328360285d] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Hospitalizations due to exacerbation of chronic obstructive pulmonary disease (COPD) are a major burden for patient and healthcare system. Extra-pulmonary needs and resulting interventions are poorly investigated. RECENT FINDINGS COPD induces nutritional issues, body composition changes and limits patient exercise capacity. The COPD patient journey can be accelerated through exacerbations during which disease-related detrimental factors such as systemic inflammation, hypoxia, inactivity, and glucocorticosteroid treatment converge and intensify, which acutely and often irreversibly worsens patient condition. Specific needs during exacerbations reach beyond the respiratory system, thus clinicians should comprehensively evaluate patients and identify potent and feasible metabolic and anabolic intervention targets. General and specific nutritional support appear feasible and with potential to cover for the changed bodily requirements during exacerbation. Adjunctive physical exercise or neuromuscular electrical stimulation may prevent the muscle loss. SUMMARY Hospitalizations should be considered as a window of opportunity for detailed patient assessment and implementation of tailored extra-pulmonary adjunctive strategies with long-term implications. Nutritional assessment and support as well as physical exercise appear promising but should be investigated in adequately designed and conducted trials.
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Affiliation(s)
- Mitja Lainscak
- Division of Cardiology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia.
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van den Borst B, Slot IGM, Hellwig VACV, Vosse BAH, Kelders MCJM, Barreiro E, Schols AMWJ, Gosker HR. Loss of quadriceps muscle oxidative phenotype and decreased endurance in patients with mild-to-moderate COPD. J Appl Physiol (1985) 2013; 114:1319-28. [DOI: 10.1152/japplphysiol.00508.2012] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Being well-established in advanced chronic obstructive pulmonary disease (COPD), skeletal muscle dysfunction and its underlying pathology have been scarcely investigated in patients with mild-to-moderate airflow obstruction. We hypothesized that a loss of oxidative phenotype (oxphen) associated with decreased endurance is present in the skeletal muscle of patients with mild-to-moderate COPD. In quadriceps muscle biopsies from 29 patients with COPD (forced expiratory volume in 1 s [FEV1] 58 ± 16%pred, body mass index [BMI] 26 ± 4 kg/m2) and 15 controls (BMI 25 ± 3 kg/m2) we assessed fiber type distribution, fiber cross-sectional areas (CSA), oxidative and glycolytic gene expression, OXPHOS protein levels, metabolic enzyme activity, and levels of oxidative stress markers. Quadriceps function was assessed by isokinetic dynamometry, body composition by dual-energy X-ray absorptiometry, exercise capacity by an incremental load test, and physical activity level by accelerometry. Compared with controls, patients had comparable fat-free mass index, quadriceps strength, and fiber CSA, but quadriceps endurance was decreased by 29% ( P = 0.002). Patients with COPD had a clear loss of muscle oxphen: a fiber type I-to-II shift, decreased levels of OXPHOS complexes IV and V subunits (47% and 31%, respectively; P < 0.05), a decreased ratio of 3-hydroxyacyl-CoA dehydrogenase/phosphofructokinase (PFK) enzyme activities (38%, P < 0.05), and decreased peroxisome proliferator-activated receptor-γ coactivator-1α (40%; P < 0.001) vs. increased PFK (67%; P < 0.001) gene expression levels. Within the patient group, markers of oxphen were significantly positively correlated with quadriceps endurance and inversely with the increase in plasma lactate relative to work rate during the incremental test. Levels of protein carbonylation, tyrosine nitration, and malondialdehyde protein adducts were comparable between patients and controls. However, among patients, oxidative stress levels were significantly inversely correlated with markers of oxphen and quadriceps endurance. Reduced muscle endurance associated with underlying loss of muscle oxphen is already present in patients with mild-to-moderate COPD without muscle wasting.
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Affiliation(s)
- Bram van den Borst
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Ilse G. M. Slot
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Valéry A. C. V. Hellwig
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bettine A. H. Vosse
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marco C. J. M. Kelders
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Esther Barreiro
- Pulmonology Department-Muscle and Respiratory System Research Unit (URMAR), IMIM-Hospital del Mar, Universitat Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona, Barcelona, Spain, and Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Bunyola, Majorca, Balearic Islands, Spain
| | - Annemie M. W. J. Schols
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Harry R. Gosker
- Department of Respiratory Medicine, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
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Levine S, Bashir MH, Clanton TL, Powers SK, Singhal S. COPD elicits remodeling of the diaphragm and vastus lateralis muscles in humans. J Appl Physiol (1985) 2012; 114:1235-45. [PMID: 23264538 DOI: 10.1152/japplphysiol.01121.2012] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A profound remodeling of the diaphragm and vastus lateralis (VL) occurs in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD). In this mini-review, we discuss the following costal diaphragm remodeling features noted in patients with moderate-to-severe COPD: 1) deletion of serial sarcomeres, 2) increased proportion of slow-twitch fibers, 3) fast-to-slow isoform shift in sarco(endo)plasmic reticulum Ca(2+)-ATPase, 4) increased capacity of oxidative metabolism, 5) oxidative stress, and 6) myofiber atrophy. We then present the sole feature of diaphragm remodeling noted in mild-to-moderate COPD under the heading "MyHC and contractile remodeling noted in mild-to-moderate COPD." The importance of VL remodeling in COPD patients as a prognostic indicator as well as a major determinant of the ability to carry out activities of daily living is well accepted. We present the remodeling of the VL noted in COPD patients under the following headings: 1) Decrease in proportion of slow-twitch fibers, 2) Decreased activity of oxidative pathways, 3) Oxidative and nitrosative stress, and 4) Myofiber atrophy. For each of the remodeling features noted in both the VL and costal diaphragm of COPD patients, we present mechanisms that are currently thought to mediate these changes as well as the pathophysiology of each remodeling feature. We hope that our mechanistic presentation stimulates research in this area that focuses on improving the ability of COPD patients to carry out increased activities of daily living.
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Affiliation(s)
- Sanford Levine
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania 19035, USA.
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de Theije C, Costes F, Langen RC, Pison C, Gosker HR. Hypoxia and muscle maintenance regulation: implications for chronic respiratory disease. Curr Opin Clin Nutr Metab Care 2011; 14:548-53. [PMID: 21934612 DOI: 10.1097/mco.0b013e32834b6e79] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE OF REVIEW Muscle wasting and impaired muscle oxidative metabolism are common extrapulmonary features of chronic respiratory failure (CRF) that significantly increase disease burden. This review aims to address the question whether hypoxia, an obvious consequence of this disease, actually plays a causal role in these muscle impairments. RECENT FINDINGS In experimental models, a causal role for hypoxia in muscle atrophy and metabolic impairments has clearly been shown. Although the hypoxia-inducible factors and nuclear factor kappa B are putative mediators of these hypoxia-induced alterations, their true involvement remains to be proven. Molecular signatures of disrupted regulation of muscle mass and oxidative metabolism observed in these experimental models also have been shown in muscles of patients suffering from CRF, suggestive of but not conclusive for a causal role of hypoxia. Therapies, including but not restricted to those aimed at alleviating hypoxia, have been shown to partially but not completely restore muscle mass and oxidative capacity in CRF patients, which may imply an additive effect of nutritional modulation of substrate metabolism. SUMMARY Although hypoxia clearly affects skeletal muscle maintenance, it remains to be confirmed whether and by which underlying molecular mechanisms hypoxia is causally involved in CRF-related muscle atrophy and impaired oxidative capacity.
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Affiliation(s)
- Chiel de Theije
- Nutrim School for Nutrition, Toxicology and Metabolism, Department of Anatomy and Embryology, Maastricht University Medical Centre, Maastricht, The Netherlands
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19
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Affiliation(s)
- Alison Shepherd
- Florence Nightingale School of Nursing & Midwifery, King’s College London
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Aquino EDS, Peres TM, Lopes IBDV, Castro FDMRE, Coelho CC, Cunha Filho IT. Correlação entre a composição corporal e força, resistência da musculatura respiratória e capacidade de exercício em pacientes com doença pulmonar obstrutiva crônica. FISIOTERAPIA E PESQUISA 2010. [DOI: 10.1590/s1809-29502010000100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Este estudo buscou correlações entre a composição corporal (aferida por métodos indiretos) e força, resistência da musculatura respiratória e capacidade de exercício em portadores de doença pulmonar obstrutiva crônica (DPOC). Os 30 voluntários, idosos, foram divididos em três grupos, dois de pacientes com DPOC, estáveis e controlados clinicamente, e um grupo controle, com indivíduos sem doenças pulmonares, selecionados na mesma faixa etária e biótipo daqueles com DPOC. Todos foram submetidos a espirometria e medidas das pressões respiratórias máximas para avaliação da força dos músculos respiratórios, teste de resistência dos músculos respiratórios, teste de caminhada de seis minutos (TC6'), medidas de dobras cutâneas e índice de massa corporal (IMC). Os sujeitos (6 mulheres e 24 homens) foram divididos em: grupo A, n=11, com DPOC moderado a grave (idade 69,5±10,5 anos, IMC 24,00±3,66 kg/m²); grupo B, n=10, com DPOC leve (71,1±8,1 anos, IMC 24,41±0,58 kg/m²); e grupo C controle, n=9 (70,1±5,9 anos, IMC 27,44±1,33 kg/m²). Apenas os valores de porcentagem de gordura corporal e distância caminhada (no TC6') apresentaram diferenças significativas entre os grupos. Os resultados não indicaram correlação significativa entre as variáveis analisadas. Embora a literatura aponte o estado nutricional como um dos fatores do comprometimento respiratório na DPOC, não foi encontrada correlação entre a composição corporal e os parâmetros respiratórios nos pacientes estudados.
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Kvamme JM, Wilsgaard T, Florholmen J, Jacobsen BK. Body mass index and disease burden in elderly men and women: the Tromsø Study. Eur J Epidemiol 2010; 25:183-93. [PMID: 20087630 DOI: 10.1007/s10654-009-9422-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 12/31/2009] [Indexed: 12/12/2022]
Abstract
Chronic health problems may be related to body mass index (BMI, kg/m(2)), but this has been best documented in overweight and obese adults. The primary objective of this study was to identify factors associated with different categories of BMI in elderly men and women from the general population, also including the lower categories of BMI. In a cross-sectional population survey from the municipality of Tromsø, Norway we analyzed associations between BMI and a wide range of chronic disease conditions, lifestyle and socioeconomic factors. BMI was categorized into six groups (<20, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, > or =30.0 kg/m(2)). The study included 4,259 men and women aged 65 years and older from the general population. We found low relative weight (BMI < 20 kg/m(2)) to be associated with increasing prevalence of mental distress, hip fracture, smoking and low handgrip strength. A U-shaped relation to BMI was found for asthma and chronic bronchitis, poor current health and low physical activity. The higher categories of BMI were associated with low education level, a difficult economical situation, diabetes mellitus and ischemic heart disease. These results demonstrate that both low and high BMI are associated with a wide range of prevalent conditions and diseases in elderly men and women. For the clinician the findings emphasize the importance of nutritional assessment as part of the medical evaluation of elderly patients.
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Affiliation(s)
- Jan-Magnus Kvamme
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
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