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Bdaiwi AS, Svoboda AM, Murdock KE, Hendricks A, Hossain MM, Kramer EL, Brewington JJ, Willmering MM, Woods JC, Walkup LL, Cleveland ZI. Quantifying abnormal alveolar microstructure in cystic fibrosis lung disease via hyperpolarized 129Xe diffusion MRI. J Cyst Fibros 2024:S1569-1993(24)00786-0. [PMID: 38997823 DOI: 10.1016/j.jcf.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/05/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
RATIONALE Cystic Fibrosis (CF) progresses through recurrent infection and inflammation, causing permanent lung function loss and airway remodeling. CT scans reveal abnormally low-density lung parenchyma in CF, but its microstructural nature remains insufficiently explored due to clinical CT limitations. To this end, diffusion-weighted 129Xe MRI is a non-invasive and validated measure of lung microstructure. In this work, we investigate microstructural changes in people with CF (pwCF) relative to age-matched, healthy subjects using comprehensive imaging and analysis involving pulmonary-function tests (PFTs), and 129Xe MRI. METHODS 38 healthy subjects (age 6-40; 17.2 ± 9.5 years) and 39 pwCF (age 6-40; 15.6 ± 8.0 years) underwent 129Xe-diffusion MRI and PFTs. The distribution of diffusion measurements (i.e., apparent diffusion coefficients (ADC) and morphometric parameters) was assessed via linear binning (LB). The resulting volume percentages of bins were compared between controls and pwCF. Mean ADC and morphometric parameters were also correlated with PFTs. RESULTS Mean whole-lung ADC correlated significantly with age (P < 0.001) for both controls and CF, and with PFTs (P < 0.05) specifically for pwCF. Although there was no significant difference in mean ADC between controls and pwCF (P = 0.334), age-adjusted LB indicated significant voxel-level diffusion (i.e., ADC and morphometric parameters) differences in pwCF compared to controls (P < 0.05). CONCLUSIONS 129Xe diffusion MRI revealed microstructural abnormalities in CF lung disease. Smaller microstructural size may reflect compression from overall higher lung density due to interstitial inflammation, fibrosis, or other pathological changes. While elevated microstructural size may indicate emphysema-like remodeling due to chronic inflammation and infection.
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Affiliation(s)
- Abdullah S Bdaiwi
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Alexandra M Svoboda
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; College of Medicine, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Kyle E Murdock
- Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Alexandra Hendricks
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Md M Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Elizabeth L Kramer
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - John J Brewington
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States; Department of Physics, University of Cincinnati, Cincinnati, United States
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, United States; Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Zackary I Cleveland
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, United States; Imaging Research Center, Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, United States; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States.
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Shimada T, Chubachi S, Otake S, Sakurai K, Sasaki M, Iijima H, Tanabe N, Tanimura K, Shimizu K, Shirahata T, Suzuki M, Sato S, Nakamura H, Asano K, Fukunaga K. Differential impacts between fat mass index and fat-free mass index on patients with COPD. Respir Med 2023; 217:107346. [PMID: 37390978 DOI: 10.1016/j.rmed.2023.107346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Differences in the clinical impacts of fat mass index (FMI) and fat-free mass index (FFMI) remain unclear in patients with chronic obstructive pulmonary disease (COPD). We hypothesized that FMI and FFMI have different impacts on 1) emphysema and 2) pulmonary function and health-related quality of life of COPD patients. METHODS Patients with COPD (n = 228), enrolled in a multicenter prospective 3-year cohort were classified into four groups based on baseline median FMI and FFMI values. Emphysema assessed as the ratio of low attenuation area to total lung volume (LAA%) on computed tomography, pulmonary function, and health-related quality of life assessed using the St. George's Respiratory Questionnaire (SGRQ) were compared. RESULTS The four groups had statistically significant differences in LAA%, pulmonary function, and SGRQ scores. The Low FMI Low FFMI group exhibited the highest LAA%, lowest pulmonary function, and worst SGRQ scores among the four groups. In addition, these differences were consistent over 3 years. Multivariate analysis showed that low FMI was associated with high LAA%, low inspiratory capacity/total lung capacity (IC/TLC), and carbon monoxide transfer coefficient (KCO). In contrast, low FFMI was associated with these factors as well as worse SGRQ scores. CONCLUSION FMI and FFMI have different effects on the clinical manifestations of COPD. Both low fat and muscle mass contributed to severe emphysema, whereas only low muscle mass contributed to worse health-related quality of life in patients with COPD.
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Affiliation(s)
- Takashi Shimada
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kaori Sakurai
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Sasaki
- Department of Internal Medicine, JCHO (Japan Community Health Care Organization) Saitama Medical Center, Saitama, Japan
| | - Hiroaki Iijima
- Department of Respiratory Medicine, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Tanimura
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Toru Shirahata
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Hokkaido University, Sapporo, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University, School of Medicine, Kanagawa, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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3
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Kotlyarov S. The Role of Smoking in the Mechanisms of Development of Chronic Obstructive Pulmonary Disease and Atherosclerosis. Int J Mol Sci 2023; 24:ijms24108725. [PMID: 37240069 DOI: 10.3390/ijms24108725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Tobacco smoking is a major cause of chronic obstructive pulmonary disease (COPD) and atherosclerotic cardiovascular disease (ASCVD). These diseases share common pathogenesis and significantly influence each other's clinical presentation and prognosis. There is increasing evidence that the mechanisms underlying the comorbidity of COPD and ASCVD are complex and multifactorial. Smoking-induced systemic inflammation, impaired endothelial function and oxidative stress may contribute to the development and progression of both diseases. The components present in tobacco smoke can have adverse effects on various cellular functions, including macrophages and endothelial cells. Smoking may also affect the innate immune system, impair apoptosis, and promote oxidative stress in the respiratory and vascular systems. The purpose of this review is to discuss the importance of smoking in the mechanisms underlying the comorbid course of COPD and ASCVD.
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Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
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4
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Nitsch A, Kearns M, Mehler P. Pulmonary complications of eating disorders: a literature review. J Eat Disord 2023; 11:12. [PMID: 36717849 PMCID: PMC9887828 DOI: 10.1186/s40337-023-00735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/11/2023] [Indexed: 02/01/2023] Open
Abstract
The medical complications of eating disorders (EDs) have been described in the literature; however, the pulmonary system has historically been described as relatively spared from the ravages of eating disorders and thus neglected in the literature. Here we review the pulmonary complications that have been described in the literature, including the effects of starvation on the lungs of nutritionally deprived animals and patients with anorexia nervosa. There is clear evidence of weakness of respiratory muscles with starvation in both groups. However, there is discordance in the literature as to whether starvation results in "nutritional emphysema," and if so, by what mechanism and at what degree of malnutrition it develops. We also explore the growing concern for the risk of non-tuberculosis mycobacterium infection as well as risk for pneumomediastinum and pneumothorax in patients with restrictive EDs. From the limited literature, it is clear the lungs, in fact, are not spared and that further research is needed to fully understand the full extent of pulmonary complications instigated by EDs.
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Affiliation(s)
- Allison Nitsch
- ACUTE Center for Eating Disorders at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.,Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Mark Kearns
- Department of Pulmonary and Critical Care Medicine, Denver Health, Denver, USA.,Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Philip Mehler
- ACUTE Center for Eating Disorders at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA. .,Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA. .,Eating Recovery Center, 7351 E Lowry Blvd, Denver, CO, 80230, USA.
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5
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Uchida T, Ishizawa K, Yogi S, Katayama K, Sekiya R, Takahara M, Hoshino Y, Nakagome K, Soma T, Nakamura H, Nagata M. Simultaneous bilateral spontaneous pneumothorax in a patient with anorexia nervosa. Respir Med Case Rep 2023; 43:101841. [PMID: 37008195 PMCID: PMC10064438 DOI: 10.1016/j.rmcr.2023.101841] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
Anorexia nervosa causes various complications accompanying weight loss and malnutrition. Although bilateral spontaneous pneumothorax (SBSP) is uncommon, caution is needed in anorexia nervosa because this complication can be fatal. We encountered a 17-year-old girl with SBSP from emphysematous pulmonary changes due to anorexia nervosa. She was hospitalized with SBSP during treatment for anorexia nervosa. Chest tube drainage was started on admission, but no improvement was achieved. Surgery was therefore performed. Lung lesions on surgical specimens demonstrated malnutrition-induced emphysematous changes, a risk factor for SBSP. Attention should be paid to the occurrence of SBSP during the clinical course of anorexia nervosa.
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Affiliation(s)
- Takahiro Uchida
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
- Corresponding author. Department of Respiratory Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan.
| | - Keisuke Ishizawa
- Division of Diagnostic Pathology, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Sanehiro Yogi
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Kazuki Katayama
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Ryu Sekiya
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Masakazu Takahara
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Yuki Hoshino
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Kazuyuki Nakagome
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Tomoyuki Soma
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Hidetoshi Nakamura
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
| | - Makoto Nagata
- Department of Respiratory Medicine, Saitama Medical University Hospital, Iruma-gun, Saitama, Japan
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Solomon N, Sailer A, Dixe de Oliveira Santo I, Pillai A, Heng LXX, Jha P, Katz DS, Zulfiqar M, Sugi M, Revzin MV. Sequelae of Eating Disorders at Imaging. Radiographics 2022; 42:1377-1397. [PMID: 35930473 DOI: 10.1148/rg.220018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although eating disorders are common, they tend to be underdiagnosed and undertreated because social stigma tends to make patients less likely to seek medical attention and less compliant with medical treatment. Diagnosis is crucial because these disorders can affect any organ system and are associated with the highest mortality rate of any psychiatric disorder. Because of this, imaging findings, when recognized, can be vital to the diagnosis and management of eating disorders and their related complications. The authors familiarize the radiologist with the pathophysiology and sequelae of eating disorders and provide an overview of the related imaging findings. Some imaging findings associated with eating disorders are nonspecific, and others are subtle. The presence of these findings should alert the radiologist to correlate them with the patient's medical history and laboratory results and the clinical team's findings at the physical examination. The combination of these findings may suggest a diagnosis that might otherwise be missed. Topics addressed include (a) the pathophysiology of eating disorders, (b) the clinical presentation of patients with eating disorders and their medical complications and sequelae, (c) the imaging features associated with common and uncommon sequelae of eating disorders, (d) an overview of management and treatment of eating disorders, and (e) conditions that can mimic eating disorders (eg, substance abuse, medically induced eating disorders, and malnourishment in patients with cancer). Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Anne Sailer
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Irene Dixe de Oliveira Santo
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Aishwarya Pillai
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Lauren Xuan Xin Heng
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Priyanka Jha
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Maria Zulfiqar
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Mark Sugi
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (N.S., A.S., I.D.d.O.S., A.P., M.V.R.); Department of Science, Northern Arizona University, Flagstaff, Ariz (L.X.X.H.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (P.J., M.S.); Department of Radiology, New York University Long Island School of Medicine, Mineola, NY (D.S.K.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.Z.)
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Kotlyarov S. High-Density Lipoproteins: A Role in Inflammation in COPD. Int J Mol Sci 2022; 23:8128. [PMID: 35897703 PMCID: PMC9331387 DOI: 10.3390/ijms23158128] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a widespread disease associated with high rates of disability and mortality. COPD is characterized by chronic inflammation in the bronchi as well as systemic inflammation, which contributes significantly to the clinically heterogeneous course of the disease. Lipid metabolism disorders are common in COPD, being a part of its pathogenesis. High-density lipoproteins (HDLs) are not only involved in lipid metabolism, but are also part of the organism's immune and antioxidant defense. In addition, HDL is a versatile transport system for endogenous regulatory agents and is also involved in the removal of exogenous substances such as lipopolysaccharide. These functions, as well as information about lipoprotein metabolism disorders in COPD, allow a broader assessment of their role in the pathogenesis of heterogeneous and comorbid course of the disease.
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Affiliation(s)
- Stanislav Kotlyarov
- Department of Nursing, Ryazan State Medical University, 390026 Ryazan, Russia
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8
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Dauty M, Menu P, Jolly B, Lambert S, Rocher B, Le Bras M, Jirka A, Guillot P, Pretagut S, Fouasson-Chailloux A. Inpatient Rehabilitation during Intensive Refeeding in Severe Anorexia Nervosa. Nutrients 2022; 14:nu14142951. [PMID: 35889908 PMCID: PMC9322979 DOI: 10.3390/nu14142951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023] Open
Abstract
Severe forms of anorexia nervosa are responsible for weight loss and life-threatening consequences. Refeeding represents a real psychiatric and somatic challenge. Physical activities are usually not recommended during intensive refeeding in order to avoid energy expenditure. This study assessed the interest in an early return to controlled physical activities, during a hospitalization in a Physical Medicine and Rehabilitation (PMR) department, including continuous nasogastric refeeding and psychiatric care. A total of 37 subjects aged 32 ± 11 years old performed inpatient physical activities during nasogastric refeeding initiated after intensive care. The physical activity program was adapted according to the hyperactivity of the patients. Evaluation parameters were weight, body mass index (BMI), body composition (fat, lean, and bone masses), and function (strength, balance, walking, ventilation). Patient satisfaction, re-hospitalizations, and physical activities continuation were assessed at 12 months of follow-up. Weight, BMI, and body fat increased significantly (+2.7 ± 1.7 kg; +1.0 ± 0.6 kg/m2; +1.7 ± 2.5 kg, respectively). Muscle strength increased even if the lean mass did not. Walking distance, balance, and respiratory function were significantly improved. Weight and fat mass gains did not differ according to the presence or absence of hyperactivity. At 12 months, 46% of the patients continued to be physically active, but 21% of the patients had been re-hospitalized. The early return to controlled physical activities in PMR hospitalization does not compromise the efficiency of intensive refeeding in severe anorexia nervosa patients.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
| | - Baptiste Jolly
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
| | - Sylvain Lambert
- Psychiatrie et Santé Mentale, UIC 18, CHU Nantes, Nantes Université, 44000 Nantes, France; (S.L.); (B.R.)
| | - Bruno Rocher
- Psychiatrie et Santé Mentale, UIC 18, CHU Nantes, Nantes Université, 44000 Nantes, France; (S.L.); (B.R.)
| | - Maëlle Le Bras
- Service d’Endocrinologie, Diabétologie et Nutrition, Institut du Thorax, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Adam Jirka
- Equipe Transversale D’assistance Nutritionnelle, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Pascale Guillot
- Service de Rhumatologie, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Stéphane Pretagut
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
- Correspondence:
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Baranauskas M, Kupčiūnaitė I, Stukas R. Potential Triggers for Risking the Development of Eating Disorders in Non-Clinical Higher-Education Students in Emerging Adulthood. Nutrients 2022; 14:2293. [PMID: 35684093 PMCID: PMC9182964 DOI: 10.3390/nu14112293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Nowadays, eating disorders (ED) among individuals during emerging adulthood have become a crucial challenge to public health, taking into account the fact that the global prevalence of the ED risk in student-aged populations already stands at 10.4% and has been sharply increasing during the COVID-19 pandemic. In all, from 50% to 80% of all the ED cases go undetected or are not correctly diagnosed; moreover, these individuals do not receive specialized treatment. Therefore, early diagnosis detected via screening questionnaires for ED is highly recommended. This study aimed to identify the triggers for ED risk development in emerging-adulthood individuals and to reveal the factors significant not only for ED prevention but also for assessing individuals with subthreshold symptoms. This cross-sectional study provides the results for the ED symptom screening in 1716 Lithuanian higher-education students aged 21.2 ± 3.9, during emerging adulthood. According to the results of this study, 19.2% of students were at risk for ED. Potential risk factors such as sex (odds ratio (OR): 3.1, 95% CI: 1.9-4.9), body weight (self-reported body mass index) (adjusted (A) OR: 1.4; 95% CI: 1.2-1.7) and comorbidities such as smoking (AOR: 2.1; 95% CI: 1.6-2.8), and perceived stress during the pandemic (AOR: 1.4; 95% CI: 1.1-1.8) are involved in anticipating the symptomatology of ED during emerging adulthood. Regular initial screenings with universally adopted questionnaires and further referral to a psychiatrist must be applied to promote both the diagnosis of early-onset symptomatology and the treatment of these ED in student-aged populations. Preventive programs for reducing the prevalence of overweight or obesity among students during emerging adulthood should focus on integration directions for the development of a positive body image.
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Affiliation(s)
- Marius Baranauskas
- Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 35200 Panevėžys, Lithuania;
| | - Ingrida Kupčiūnaitė
- Faculty of Biomedical Sciences, Panevėžys University of Applied Sciences, 35200 Panevėžys, Lithuania;
| | - Rimantas Stukas
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania;
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Role of Short-Chain Fatty Acids Produced by Gut Microbiota in Innate Lung Immunity and Pathogenesis of the Heterogeneous Course of Chronic Obstructive Pulmonary Disease. Int J Mol Sci 2022; 23:ijms23094768. [PMID: 35563159 PMCID: PMC9099629 DOI: 10.3390/ijms23094768] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 02/06/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a widespread socially significant disease. The development of COPD involves the innate immune system. Interestingly, the regulation of the innate lung immune system is related to the gut microbiota. This connection is due to the production by gut microorganisms of short-chain fatty acids (SCFAs) such as acetate, propionate, and butyrate. Nutritional disturbances and changes in the structure of the intestinal microbiota lead to a decrease in SCFAs production and their effect on pulmonary immunity. The presence of a metabolic and immune axis linking the lungs and gut plays an important role in the pathogenesis of COPD. In addition, the nature of nutrition and SCFAs may participate in the development of the clinically heterogeneous course of COPD.
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11
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Air Pollution Exposure and Risk of Spontaneous Pneumothorax in Children: A Longitudinal, Nationwide Study. CHILDREN 2022; 9:children9010061. [PMID: 35053686 PMCID: PMC8774040 DOI: 10.3390/children9010061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/17/2022]
Abstract
Spontaneous pneumothorax (SP) involves the spontaneous appearance of air in the pleural space. Atmospheric pressure, temperature change, and seasonal factors may precipitate SP, but its association with air pollution remains unclear. Therefore, we conducted this nationwide, retrospective population-based study to evaluate the risk of SP in Taiwanese children exposed to air pollution. We collected data on SP incidence from the Longitudinal Health Insurance Database; the Taiwan Air Quality-Monitoring Database provided daily concentrations of nitric oxide (NO), nitrogen dioxide (NO2), and hydrocarbons in 2000–2012. SP risk was evaluated for four quartiles (Q1, Q2, Q3, Q4). The NO adjusted hazard ratios (aHRs) for Q2, Q3, and Q4 compared to Q1 were 1.11 (95% confidence interval (CI): 0.77–1.61), 1.24 (95% CI: 0.88–1.76), and 1.66 (95% CI: 1.17–2.34), respectively. The NO2 aHRs for Q2, Q3, and Q4 were 1.12 (95% CI: 0.77–1.64), 1.31 (95% CI: 0.0.90–1.90), and 1.51 (95% CI: 1.04–2.19), respectively. Hydrocarbons aHRs for Q2, Q3, and Q4 were 0.87 (95% CI: 0.64–1.18), 1.16 (95% CI: 0.90–1.49), and 1.40 (95% CI: 1.06–1.85), respectively. Increased exposure to NO, NO2, and hydrocarbons is associated with increased SP risk in Taiwanese children.
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12
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Trethewey RE, Spartano NL, Vasan RS, Larson MG, O’Connor GT, Esliger DW, Petherick ES, Steiner MC. Body mass index across adulthood and the development of airflow obstruction and emphysema. Chron Respir Dis 2022; 19:14799731221139294. [DOI: 10.1177/14799731221139294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background Low body mass index (BMI) is associated with COPD, but temporal relationships between airflow obstruction (AO) development and emphysematous change are unclear. We investigated longitudinal changes in BMI, AO, and lung density throughout adulthood using data from the Framingham Offspring Cohort (FOC). Methods BMI trajectories were modelled throughout adulthood in 4587 FOC participants from Exam 2 (mean age = 44), through Exam 9 (mean age = 71), in AO participants and non-AO participants (AO n = 1036), determined by spirometry, using fractional polynomial growth curves. This process was repeated for low lung density (LLD) and non LLD participants (LLD n = 225) determined by Computed Tomography. Spirometry decline was compared separately between tertiles of BMI in those aged <40 years and associations between fat and lean mass (measured using Dual Energy X-ray Absorptiometry, DEXA) and development of AO and LLD were also assessed. Additional analyses were performed with adjustment for smoking volume. Results The BMI trajectory from 30 years of age was visually lower in the AO group than both non-AO smokers (non-<AO-S) and non-AO non-smokers (non-AO-N). Similarly, BMI trajectories were visually lower in participants with LLD throughout adulthood compared to normal lung density smokers and non-smokers. Differences remained after adjustment for smoking volume. The lowest BMI tertile in ages <40 years was associated with the steepest subsequent decline in FEV1/FVC ratio in both sexes. Conclusion Mean BMI is lower throughout adulthood in AO and LLD participants. Lower BMI is associated with a steeper decline in the ratio of FEV1/FVC. These findings suggest body mass may precede and potentially have a role in the development of COPD lung pathophysiology.
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Affiliation(s)
- Ruth E Trethewey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Nicole L Spartano
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - Ramachandran S Vasan
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - Martin G Larson
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - George T O’Connor
- Lung and Blood Institute’s Framingham Heart Study, Boston University and National Heart, Framingham, MA, USA
| | - Dale W Esliger
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Emily S Petherick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
| | - Michael C Steiner
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, UK
- Centre for Exercise and Rehabilitation Services, Leicester, UK
- NIHR Leicester Biomedical Research Centre––Respiratory, University of Leicester, Leicester, UK
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13
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Abe Y, Suzuki M, Shima H, Shiraishi Y, Tanabe N, Sato S, Shimizu K, Kimura H, Makita H, Hirai T, Konno S, Nishimura M. Annual Body Weight Change and Prognosis in Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:3243-3253. [PMID: 34876811 PMCID: PMC8643147 DOI: 10.2147/copd.s338908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose Low body mass index (BMI) has been reported to be associated with poor prognosis in patients with chronic obstructive pulmonary disease (COPD). In contrast, a detailed analysis of the association between body weight change over time and prognosis is not sufficient, particularly in Japanese patients with COPD who have been reported to be much thinner compared to Westerners. This study aimed to investigate the relationship between annual body weight change and long-term prognosis in Japanese patients with COPD in two independent cohorts. Patients and Methods We analyzed 279 patients with COPD who participated in the Hokkaido COPD cohort study as a discovery cohort. We divided participants into three groups according to quartiles of annual body weight change calculated by the data from the first 5 years: weight loss group (<-0.17 kg/year), no change group (−0.17 to ≤0.20 kg/year), and weight gain group (>0.20 kg/year). The association between annual body weight change and prognosis was replicated in the Kyoto University cohort (n = 247). Results In the Hokkaido COPD cohort study, the weight loss group had significantly worse mortality than the other groups, whereas there was no difference in BMI at baseline. In the multivariate analysis, annual body weight change was an independent risk factor for all-cause mortality, which was confirmed in the Kyoto University cohort. Conclusion Annual body weight loss is associated with poor prognosis in Japanese patients with COPD, independent of baseline BMI. Longitudinal assessment of body weight is important for the management of COPD.
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Affiliation(s)
- Yuki Abe
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Shima
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Susumu Sato
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Kaoruko Shimizu
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan
| | - Hirokazu Kimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan
| | - Hironi Makita
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan.,Hokkaido Medical Research Institute for Respiratory Diseases, Chuo-ku, Sapporo, 060-0063, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Sapporo, 060-8638, Japan.,Hokkaido Medical Research Institute for Respiratory Diseases, Chuo-ku, Sapporo, 060-0063, Japan
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Lipid Metabolism Disorders in the Comorbid Course of Nonalcoholic Fatty Liver Disease and Chronic Obstructive Pulmonary Disease. Cells 2021; 10:cells10112978. [PMID: 34831201 PMCID: PMC8616072 DOI: 10.3390/cells10112978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is currently among the most common liver diseases. Unfavorable data on the epidemiology of metabolic syndrome and obesity have increased the attention of clinicians and researchers to the problem of NAFLD. The research results allow us to emphasize the systemicity and multifactoriality of the pathogenesis of liver parenchyma lesion. At the same time, many aspects of its classification, etiology, and pathogenesis remain controversial. Local and systemic metabolic disorders are also a part of the pathogenesis of chronic obstructive pulmonary disease and can influence its course. The present article analyzes the metabolic pathways mediating the links of impaired lipid metabolism in NAFLD and chronic obstructive pulmonary disease (COPD). Free fatty acids, cholesterol, and ceramides are involved in key metabolic and inflammatory pathways underlying the pathogenesis of both diseases. Moreover, inflammation and lipid metabolism demonstrate close links in the comorbid course of NAFLD and COPD.
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15
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Puckett L, Grayeb D, Khatri V, Cass K, Mehler P. A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa. J Clin Med 2021; 10:jcm10122555. [PMID: 34207744 PMCID: PMC8226688 DOI: 10.3390/jcm10122555] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 02/08/2023] Open
Abstract
Anorexia nervosa is a complex and deadly psychiatric disorder. It is characterized by a significant degree of both co-occurring psychiatric diseases and widespread physiological changes which affect nearly every organ system. It is important for clinicians to be aware of the varied consequences of this disorder. Given the high rate of mortality due to AN, there is a need for early recognition so that patients can be referred for appropriate medical and psychiatric care early in the course of the disorder. In this study, we present a comprehensive review of the recent literature describing medical findings commonly encountered in patients with AN. The varied and overlapping complications of AN affect pregnancy, psychological well-being, as well as bone, endocrine, gastrointestinal, cardiovascular, and pulmonary systems.
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Affiliation(s)
- Leah Puckett
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Daniela Grayeb
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Vishnupriya Khatri
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Kamila Cass
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Philip Mehler
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
- Eating Recovery Center, Denver, CO 80230, USA
- Correspondence: ; Tel.: +1-(303)-602-4972
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Michels N, De Backer F, Dimakopoulou M, Mane K, Indave I, Huybrechts I. Eating disorders and the risk of developing cancer: a systematic review. Eat Weight Disord 2021; 26:1021-1035. [PMID: 33025526 DOI: 10.1007/s40519-020-01020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer. METHODS A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types. RESULTS From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa). CONCLUSIONS The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex). LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Fien De Backer
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | | | - Katerina Mane
- International Agency for Research on Cancer, Lyon, France
| | - Iciar Indave
- International Agency for Research on Cancer, Lyon, France
| | - Inge Huybrechts
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
- International Agency for Research on Cancer, Lyon, France
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Avoidant/Restrictive Food Intake Disorder (ARFID): Its Medical Complications and Their Treatment—an Emerging Area. CURRENT PEDIATRICS REPORTS 2021. [DOI: 10.1007/s40124-021-00239-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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18
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Lee JM, Lee SA, Han CH, Lee SM, Kim CJ, Lee SC, Park SC. Body mass index as a predictor of mortality in bronchiectasis: A nationwide population-based study. Respir Med 2021; 180:106370. [PMID: 33765620 DOI: 10.1016/j.rmed.2021.106370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/06/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The prognosis of bronchiectasis is not well known. The purpose of this study was to evaluate the association between body mass index (BMI) and mortality in bronchiectasis using a large nationwide population-based cohort. MATERIAL AND METHODS Using the National Health Insurance Service-Health Screening Cohort in Korea, individuals with bronchiectasis were identified from 2004 to 2006 and monitored for up to 10 years. Mortality in bronchiectasis was analyzed based on a BMI score <18.5 kg/m2 (underweight), 1.85-22.9 kg/m2 (normal weight), 23.0-24.9 kg/m2 (overweight), and >25.0 kg/m2 (obese). RESULTS A total of 2769 individuals with bronchiectasis were included. The underweight, normal weight, overweight, and obese accounted for 5.1%, 40.4%, 25.4%, and 29.3% of all patients with bronchiectasis, respectively. Compared to normal weight, underweight in bronchiectasis was associated with increased all-cause mortality (hazard ratio [HR] = 2.60; 95% confidence interval [CI] = 1.92-3.54), while obese was associated with decreased all-cause mortality (HR = 0.71; 95% CI = 0.55-0.93). This relationship between BMI and mortality was more prominent in respiratory disease-related mortality. CONCLUSIONS BMI is a predictor of mortality in bronchiectasis. Underweight is associated with increased mortality among individuals with bronchiectasis while obese is associated with decreased mortality.
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Affiliation(s)
- Jung Mo Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Sang Ah Lee
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Sun Min Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Cheong Ju Kim
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Sang Chul Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
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Chen T, Chen F, Wang K, Ma X, Wei X, Wang W, Huang P, Yang D, Xia Z, Zhao Z. Acute respiratory response to individual particle exposure (PM 1.0, PM 2.5 and PM 10) in the elderly with and without chronic respiratory diseases. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 271:116329. [PMID: 33370612 DOI: 10.1016/j.envpol.2020.116329] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
Limited data were on the acute respiratory responses in the elderly in response to personal exposure of particulate matter (PM). In order to evaluate the changes of airway inflammation and pulmonary functions in the elderly in response to individual exposure of particles (PM1.0, PM2.5 and PM10), we analyzed 43 elderly subjects with either asthma, chronic obstructive pulmonary disease (COPD) or Asthma COPD Overlap (ACO) and 40 age-matched subjects without asthma nor COPD in an urban community in Shanghai, China. Data were collected at the baseline and in 6 follow-ups from August 2016 to December 2018, once every 3 months except for the last twice with a 6-month interval. In each follow-up, pulmonary functions, fractional exhaled nitric oxide (FeNO), 7-day continuous personal exposure to airborne particles were measured. Multivariate linear mixed effect regression models were applied to investigate the quantitative changes of pulmonary functions and FeNO in two respective groups. The results showed that on average 4.7 follow-up visits were completed in each participant. In subjects with CRDs, an inter-quartile range (IQR) increase of personal exposure to PM1.0, PM2.5 and PM10 was significantly associated with an average increase of FeNO(Lag1) of 6.7 ppb (95%CI 1.2, 9.9 ppb), 6.2 ppb (95%CI 1.5, 12.0 ppb) and 5.6 ppb (95%CI 1.5, 11.0 ppb), respectively, and an average decrease of FEV1(Lag2) of -3.6 L (95%CI -6.0, -1.1 L), -3.6 L (95%CI -6.4, -0.8 L) and -3.2 L (95%CI -5.8, -0.6 L), respectively, in the single-pollutant model. These associations remained consistent in the two-pollutant models adjusting for gaseous air pollutants. Stratified analysis showed that subjects with lower BMI, females and non-allergies were more sensitive to particle exposure. No robust significant effects were observed in the subjects without CRDs. Our study provided data on the susceptibility of the elderly with CRDs to particle exposure of PM1.0 and PM2.5, and the modification effects by BMI, gender and history of allergies.
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Affiliation(s)
- Tianyi Chen
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Fei'er Chen
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Kan Wang
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Xuedong Ma
- Shanghai Minhang District Gumei Community Health Center affiliated to Fudan University, Shanghai, 201102, China
| | - Xinping Wei
- Shanghai Minhang District Gumei Community Health Center affiliated to Fudan University, Shanghai, 201102, China
| | - Weigang Wang
- Shanghai Minhang District Gumei Community Health Center affiliated to Fudan University, Shanghai, 201102, China
| | - Pengyu Huang
- Shanghai Minhang District Gumei Community Health Center affiliated to Fudan University, Shanghai, 201102, China
| | - Dong Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zhaolin Xia
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China
| | - Zhuohui Zhao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, 200032, China; Key Laboratory of Public Health Safety of the Ministry of Education, NHC Key Laboratory of Health Technology Assessment (Fudan University), Shanghai Typhoon Institute/CMA, Shanghai Key Laboratory of Meteorology and Health, Shanghai, 200030, China.
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Low BMI and weight loss aggravate COPD mortality in men, findings from a large prospective cohort: the JACC study. Sci Rep 2021; 11:1531. [PMID: 33452329 PMCID: PMC7810869 DOI: 10.1038/s41598-020-79860-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/12/2020] [Indexed: 12/18/2022] Open
Abstract
To clarify how low BMI and weight loss were associated with risk of chronic obstructive pulmonary disease (COPD) mortality, in a large prospective cohort of the general population across Japan, the Japan Collaborative Cohort Study, conducted between 1988 and 2009. A total of 45,837 male residents were observed for a median period of 19.1 years. Self-administered questionnaires, collecting information on BMI, weight loss since the age of 20, lifestyles, history of diseases, as well as records of COPD mortality, were analysed at 2019. During follow-up, 268 participants died from COPD. The multivariate-adjusted hazard ratio (95% confidence interval) of COPD mortality associated with a 1-SD increment of body mass index (BMI) was 0.48 (0.41–0.57), while for weight change from age of 20 (+ 2.0 kg) it was 0.63 (0.59–0.68). These associations were persistently observed after stratifications with smoking status, excluding those having airway symptoms in the baseline survey, and excluding early COPD deaths within 5, 10 and 15 years. Our study suggests that BMI and weight change since the age of 20 could be markers for COPD prognosis, indicated by risk of COPD mortality.
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21
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Iyoda A, Azuma Y, Sakai T, Koezuka S, Otsuka H, Sano A. A novel finding related to bulla and bleb formation in patients with primary spontaneous pneumothorax. BMC Pulm Med 2021; 21:20. [PMID: 33422030 PMCID: PMC7797130 DOI: 10.1186/s12890-021-01402-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/04/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax is a common problem globally. Bullas and blebs have been implicated in this problem, but the etiology of their formation is unknown. We aim to show the relation between a novel clinical finding, the pulmonary delayed inflation (PDI) sign, and the etiology of bulla and bleb formation in young patients. METHODS We retrospectively analyzed data from 111 patients with pneumothorax and a control group of 27 patients. We evaluated the relation between the PDI sign and other clinical factors. RESULTS The PDI sign was observed in 78 patients. Of these, 75 exhibited the PDI sign in only the upper lobe. Regardless of smoking status, patients 34 years of age or younger had a significantly higher incidence of the PDI sign than, patients 55 years of age or older and control patients. The inflation time in patients 34 years of age or younger, regardless of smoking status, was significantly longer than in patients 55 years of age or older and patients in the control group. There was no significant association between inflation time and the presence of asthma. CONCLUSIONS The novel PDI sign is seen in patients 34 years of age or younger. Because this sign may indicate a peripheral bronchial abnormality and may be related to the formation of blebs and bullae in young patients with spontaneous pneumothorax, it is possible that it can be used to develop effective treatments for pneumothorax in young patients.
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Affiliation(s)
- Akira Iyoda
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan.
| | - Yoko Azuma
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Takashi Sakai
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Satoshi Koezuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Hajime Otsuka
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
| | - Atsushi Sano
- Division of Chest Surgery, Department of Surgery, Toho University School of Medicine, 6-11-1, Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan
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22
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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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23
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Severe bronchiectasis and inflammatory lung disease in a patient with anorexia nervosa and severe and enduring malnutrition - a case report. J Eat Disord 2020; 8:72. [PMID: 33292553 PMCID: PMC7672942 DOI: 10.1186/s40337-020-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 11/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent structural changes of the lungs in anorexia nervosa (AN) patients are rarely described in contemporary medical literature. The objective of our paper is to report a rare case of severe bronchiectasis and inflammatory changes to the lungs resulting from chronic malnutrition in a AN patient. CASE PRESENTATION We describe a patient with severe inflammatory lung disease caused by malnutrition, resulting in persistent bronchiectasis accompanying AN. We performed an analysis of the patient's medical records including radiological findings and laboratory results. A review of available literature shows very little data available on this topic. CONCLUSION Bronchiectasis and other structural changes of the lungs are rare, but severe complications of severe, chronic malnutrition. As exemplified by our case report, they may require extensive differential diagnosis and pose a significant clinical challenge due to their non-reversible character. A successful treatment relies heavily on the patient's compliance and may be hard to achieve. Clinicians managing patients with anorexia nervosa should be wary of early respiratory tract dysfunction-related symptoms and always consider malnutrition bronchiectasis as a differential diagnosis option.
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24
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Burney P, Patel J, Minelli C, Gnatiuc L, Amaral AFS, Kocabaş A, Cherkaski HH, Gulsvik A, Nielsen R, Bateman E, Jithoo A, Mortimer K, Sooronbaev TM, Lawin H, Nejjari C, Elbiaze M, El Rhazi K, Zheng JP, Ran P, Welte T, Obaseki D, Erhabor G, Elsony A, Osman NB, Ahmed R, Nizankowska-Mogilnicka E, Mejza F, Mannino DM, Bárbara C, Wouters EFM, Idolor LF, Loh LC, Rashid A, Juvekar S, Gislason T, Al Ghobain M, Studnicka M, Harrabi I, Denguezli M, Koul PA, Jenkins C, Marks G, Jõgi R, Hafizi H, Janson C, Tan WC, Aquart-Stewart A, Mbatchou B, Nafees A, Gunasekera K, Seemungal T, Padukudru Anand M, Enright P, Vollmer WM, Blangiardo M, Elfadaly FG, Buist AS. Prevalence and Population Attributable Risk for Chronic Airflow Obstruction in a Large Multinational Study. Am J Respir Crit Care Med 2020; 203:1353-1365. [PMID: 33171069 DOI: 10.1164/rccm.202005-1990oc] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: The Global Burden of Disease programme identified smoking, and ambient and household air pollution as the main drivers of death and disability from Chronic Obstructive Pulmonary Disease (COPD). Objective: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a post-bronchodilator one-second forced expiratory volume to forced vital capacity ratio < lower limit of normal, and the relative risks associated with different risk factors. Local RR were estimated using a Bayesian hierarchical model borrowing information from across sites. From these RR and the prevalence of risk factors, we estimated local Population Attributable Risks (PAR). Measurements and Main Results: Mean prevalence of CAO was 11.2% in men and 8.6% in women. Mean PAR for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index (BMI), and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: While smoking remains the most important risk factor for CAO, in some areas poor education, low BMI and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.
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Affiliation(s)
- Peter Burney
- Imperial College, Respiratory Epidemiology and Public Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Jaymini Patel
- Imperial College London, NHLI - Respiratory Epidemiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Cosetta Minelli
- Imperial College, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland
| | - Louisa Gnatiuc
- University of Oxford, 6396, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - André F S Amaral
- Imperial College London, 4615, National Heart and Lung Institute, London, United Kingdom of Great Britain and Northern Ireland;
| | - Ali Kocabaş
- Cukurova Universitesi Tip Fakultesi, 63988, Pulmonary Disease, Adana, Turkey
| | | | - Amund Gulsvik
- University of Bergen, 1658, Department of Thoracic Medicine, Institute of Medicine, Bergen, Norway
| | | | | | - Anamika Jithoo
- University of Cape Town Lung Institute, 108145, Cape Town, South Africa
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine and Aintree University Hospital NHS Foundation Trust, Respiratory Medicine, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | | | - Hervé Lawin
- University of Abomey-Calavi, 107790, Unit of Teaching and Research in Occupational and Environmental Health, Faculty of Health Sciences, Cotonou, Benin
| | - Chakib Nejjari
- Laboratoire d'épidémiologie, Recherche Clinique et Santé Communautaire, Fes, Morocco
| | - Mohammed Elbiaze
- Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
| | - Karima El Rhazi
- Universite Sidi Mohamed Ben Abdellah Faculte de Medecine et de Pharmacie de Fes Bibliotheque, 548123, Fes, Morocco
| | - Jin-Ping Zheng
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pixin Ran
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China, Guangzhou, China
| | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | | | | | | | | | | | | | - Filip Mejza
- Jagiellonian University Medical College, 49573, Krakow, Poland
| | - David M Mannino
- Medical Expert at GlaxoSmithKline, Lexington, Kentucky, United States.,University of Ketucky, Epidemiology , Lexington, Kentucky, United States
| | - Cristina Bárbara
- Hospital Pulido Valente, 70896, Unidade de Técnicas Invasivas Pneumológicas, Pneumologia II, Lisboa, Portugal.,Universidade de Lisboa Faculdade de Medicina, 37811, Instituto de Saúde Ambiental, Lisboa, Portugal
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
| | | | - Li-Cher Loh
- Penang Medical College, 26696, Georgetown, Malaysia
| | - Abdul Rashid
- Royal College of Surgeons of Ireland and University College Dublin, Malaysia Campus, Penang, Malaysia
| | | | | | | | | | - Imed Harrabi
- Faculty of Medicine, Sousse, Tunisia, Sousse, Tunisia
| | - Meriam Denguezli
- Universite de Sousse Faculte de Medecine de Sousse, 280226, Sousse, Tunisia
| | - Parvaiz A Koul
- Sher-i-Kashmir Institute of Medical Sciences, 29078, Internal Medicine, Srinagar, India
| | | | - Guy Marks
- Institute of Respiratory Medicine, Campertown, New South Wales, Australia
| | - Rain Jõgi
- Foundation Tartu University Clinics, Lung Clinic, Tartu, Estonia
| | | | - Christer Janson
- Uppsala Uiversity, Dep of Respiratory Medicine, Uppsala, Sweden
| | - Wan C Tan
- Univ British Columbia, icapture center, vancouver, British Columbia, Canada
| | | | | | | | | | - Terry Seemungal
- University of the West Indies, Clinical Medical Sciences, Champs Fleurs, Trinidad and Tobago
| | - Mahesh Padukudru Anand
- JSS Academy of Higher Education and Research, Department of Pulmonary Medicine, JSS Medical College, , Mysore, India
| | - Paul Enright
- University of Arizona, Medicine, Tucson, Arizona, United States
| | | | - Marta Blangiardo
- Imperial College London School of Public Health, 156430, Department of Epidemiology and Biostatistics, London, United Kingdom of Great Britain and Northern Ireland
| | - Fadlalla G Elfadaly
- The Open University, 5488, Milton Keynes, United Kingdom of Great Britain and Northern Ireland
| | - A Sonia Buist
- Oregon Health Sciences University, Medicine / Pulmonary & Critical Care, Portland, Oregon, United States
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25
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Affiliation(s)
- Hee Chul Yang
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Seonghum Jung
- Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
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26
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Smith C, Matoba K, Hyodoh H, Murakami M, Saito A, Matoba T, Okuya N, Jin S. Post-mortem computed tomography in sudden death by asthma. Leg Med (Tokyo) 2020; 44:101694. [PMID: 32220784 DOI: 10.1016/j.legalmed.2020.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/25/2020] [Accepted: 03/16/2020] [Indexed: 11/29/2022]
Abstract
Ground glass attenuation (GGA) of the lungs is a common finding of post-mortem computed tomography (PMCT) that is associated with pulmonary congestion and edema due to cardiac failure during the agonal period, or due to post-mortem hypostasis. However, hypo-attenuation of the lung is an atypical finding of PMCT, and is usually a consequence of hypovolemic states before death or postmortem body posture after death. Previous studies have shown a few differential diagnoses, such as hypothermia, massive hemorrhage, asphyxiation by hanging, and dehydration, for hypo-attenuation of the lung. This report presents the case of a woman who died suddenly because of an asthma attack. Our PMCT analysis demonstrated hypoattenuation of the lung in this case. We suggest fatal asthma as a differential diagnosis for the appearance of hypo-attenuation of lungs on PMCT.
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Affiliation(s)
- Casey Smith
- School of Medicine, University of Otago, Christchurch, New Zealand
| | - Kotaro Matoba
- Dep. Forensic Medicine, Graduate School of Medicine, Hokkaido University, Japan; Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Japan.
| | - Hideki Hyodoh
- Dep. Forensic Medicine, Graduate School of Medicine, Hokkaido University, Japan; Center for Cause of Death Investigation, Graduate School of Medicine, Hokkaido University, Japan.
| | - Manabu Murakami
- International Relations Office Graduate School of Medicine, Hokkaido University, Japan.
| | - Atsuko Saito
- Dep. Forensic Medicine, Graduate School of Medicine, Hokkaido University, Japan.
| | - Tomoko Matoba
- Dep. Forensic Medicine, Graduate School of Medicine, Hokkaido University, Japan.
| | - Nahoko Okuya
- Dep. Forensic Medicine, Graduate School of Medicine, Hokkaido University, Japan
| | - Shigeki Jin
- Dep. Forensic Medicine, Graduate School of Medicine, Hokkaido University, Japan.
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27
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Pires SAP, Soares JC, Luz AMBD, Moleiro P. OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA - THE IMPORTANCE OF VENOUS BLOOD GASES. ACTA ACUST UNITED AC 2020; 38:e2018358. [PMID: 31939517 PMCID: PMC6958540 DOI: 10.1590/1984-0462/2020/38/2018358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. METHODS Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. RESULTS A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). CONCLUSIONS Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.
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28
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Park HJ, Cho JH, Kim HJ, Park JY, Lee HS, Byun MK. The effect of low body mass index on the development of chronic obstructive pulmonary disease and mortality. J Intern Med 2019; 286:573-582. [PMID: 31215064 DOI: 10.1111/joim.12949] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sarcopenia may worsen disease progression and lead to poor outcomes in chronic obstructive pulmonary disease (COPD). OBJECTIVES We aimed to determine the effect of BMI on the development of COPD and mortality. METHODS We enrolled 437 584 participants registered in the physical health check-up cohort database of the Korean National Health Interview Survey from 2002 to 2003, and we defined COPD diagnosis based on the ICD-10 code and prescribed medication. BMI (kg m-2 ) classified them to five groups (low BMI < 18.5, normal BMI 18.5-23, overweight 23-25, obesity 25-30, severe obesity ≥30) at baseline. RESULTS Participants in the low BMI group had a significantly higher rate of COPD development for 13 years (7.6%) than those in other groups (3.4-4.1%, P < 0.0001). Amongst never or light smokers, COPD development in the low BMI group (5.6-6.7%) was significantly higher than that in other groups (2.8-4.7%). Similarly, amongst participants with a smoking history of ≥30 years, COPD development in the low BMI group (20.1%) was higher than those in other groups (8.4-12.4%). On multivariable analysis, normal or higher than normal body weight was significantly protective against the development of COPD (hazard ratio [HR], 0.609-0.739,) compared to low BMI. COPD-free-survival (HR, 0.491-0.622) and overall survival (HR, 0.440-0.585) were also better in them compared to those with low BMI (all P < 0.0001). CONCLUSIONS Low BMI is an important risk factor for COPD development and mortality. Maintaining adequate body weight may reduce the risk for COPD development and mortality.
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Affiliation(s)
- H J Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - J H Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - H J Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - J-Y Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - H S Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - M K Byun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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29
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Sun Y, Milne S, Jaw JE, Yang CX, Xu F, Li X, Obeidat M, Sin DD. BMI is associated with FEV 1 decline in chronic obstructive pulmonary disease: a meta-analysis of clinical trials. Respir Res 2019; 20:236. [PMID: 31665000 PMCID: PMC6819522 DOI: 10.1186/s12931-019-1209-5] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
Background There is considerable heterogeneity in the rate of lung function decline in chronic obstructive pulmonary disease (COPD), the determinants of which are largely unknown. Observational studies in COPD indicate that low body mass index (BMI) is associated with worse outcomes, and overweight/obesity has a protective effect – the so-called “obesity paradox”. We aimed to determine the relationship between BMI and the rate of FEV1 decline in data from published clinical trials in COPD. Methods We performed a systematic review of the literature, and identified 5 randomized controlled trials reporting the association between BMI and FEV1 decline. Four of these were included in the meta-analyses. We analyzed BMI in 4 categories: BMI-I (< 18.5 or < 20 kg/m2), BMI-II (18.5 or 20 to < 25 kg/m2), BMI-III (25 to < 29 or < 30 kg/m2) and BMI-IV (≥29 or ≥ 30 kg/m2). We then performed a meta-regression of all the estimates against the BMI category. Results The estimated rate of FEV1 decline decreased with increasing BMI. Meta-regression of the estimates showed that BMI was significantly associated with the rate of FEV1 decline (linear trend p = 1.21 × 10− 5). Conclusions These novel findings support the obesity paradox in COPD: compared to normal BMI, low BMI is a risk factor for accelerated lung function decline, whilst high BMI has a protective effect. The relationship may be due to common but as-of-yet unknown causative factors; further investigation into which may reveal novel endotypes or targets for therapeutic intervention.
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Affiliation(s)
- Yilan Sun
- The Respiratory Department of the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.,Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Stephen Milne
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Jen Erh Jaw
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Chen Xi Yang
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Feng Xu
- Centre for Heart Lung Innovation, St. Paul's Hospital & Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Xuan Li
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Ma'en Obeidat
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital & Division of Respiratory Medicine, University of British Columbia, Rm 166-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Collins PF, Yang IA, Chang YC, Vaughan A. Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update. J Thorac Dis 2019; 11:S2230-S2237. [PMID: 31737350 DOI: 10.21037/jtd.2019.10.41] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) primarily affects the lungs but due to the accompanying chronic systematic inflammation and the symptoms associated with the disease there are many extrapulmonary effects which include complex physical and metabolic adaptations. These changes have been associated with reduced exercise capacity, increased nutritional requirements, altered metabolic processes and compromised nutritional intake. As a result, nutritional depletion in COPD is multi-faceted and can involve imbalances of energy (weight loss), protein (sarcopenia), and periods of markedly increased inflammation (pulmonary cachexia) which can increase nutritional losses. As a result, depletion of both fat-mass (FM) and fat-free mass (FFM) can occur. There is good evidence that nutritional support, in the form of oral nutritional supplements (ONS), can overcome energy and protein imbalances resulting in improved nutritional status and functional capacity. However, in order to treat the aetiology of sarcopenia, frailty and cachexia, it is likely that targeted multi-modal interventions are required to address energy and protein imbalance, specific nutrient deficiencies, reduced androgens and targeted exercise training. Furthermore, interventions taking a disease-course approach, are likely to hold the key to effectively managing the common and costly problem of nutritional depletion in COPD.
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Affiliation(s)
- Peter F Collins
- School of Human Movement and Nutrition Science, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A Yang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Yuan-Chin Chang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Annalicia Vaughan
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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Affiliation(s)
- Alvar Agustí
- From the Respiratory Institute, Hospital Clinic, Institut d'Investigació Agustí Pi i Sunyer, and the University of Barcelona, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (A.A.); and the Center for Heart and Lung Innovation, University of British Columbia at St. Paul's Hospital, Vancouver, Canada (J.C.H.)
| | - James C Hogg
- From the Respiratory Institute, Hospital Clinic, Institut d'Investigació Agustí Pi i Sunyer, and the University of Barcelona, Barcelona; and Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid (A.A.); and the Center for Heart and Lung Innovation, University of British Columbia at St. Paul's Hospital, Vancouver, Canada (J.C.H.)
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Chen H, Li Z, Dong L, Wu Y, Shen H, Chen Z. Lipid metabolism in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2019; 14:1009-1018. [PMID: 31190786 PMCID: PMC6524761 DOI: 10.2147/copd.s196210] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
Dysregulated lipid metabolism plays crucial roles in various diseases, including diabetes mellitus, cancer, and neurodegeneration. Recent studies suggest that alterations in major lipid metabolic pathways contribute to pathogenesis of lung diseases, including chronic obstructive pulmonary disease (COPD). These changes allow lung tissue to meet the energy needs and trigger anabolic pathways that initiate the synthesis of active molecules directly involved in the inflammation. In this review, we summarize the changes of catabolism and anabolism of lipids, lipid molecules including lipid mediators, lipid synthesis transcription factors, cholesterol, and phospholipids, and how those lipid molecules participate in the initiation and resolution of inflammation in COPD.
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Affiliation(s)
- Haipin Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Zhouyang Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Lingling Dong
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Yinfang Wu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China.,State Key Lab of Respiratory Disease, Guangzhou, Guangdong, People's Republic of China
| | - Zhihua Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Institute of Respiratory Diseases, Hangzhou, Zhejiang, People's Republic of China
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Parker MM, Lutz SM, Hobbs BD, Busch R, McDonald MN, Castaldi PJ, Beaty TH, Hokanson JE, Silverman EK, Cho MH. Assessing pleiotropy and mediation in genetic loci associated with chronic obstructive pulmonary disease. Genet Epidemiol 2019; 43:318-329. [PMID: 30740764 DOI: 10.1002/gepi.22192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/10/2018] [Accepted: 10/10/2018] [Indexed: 12/14/2022]
Abstract
Genetic association studies have increasingly recognized variant effects on multiple phenotypes. Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with environmental and genetic causes. Multiple genetic variants have been associated with COPD, many of which show significant associations to additional phenotypes. However, it is unknown if these associations represent biological pleiotropy or if they exist through correlation of related phenotypes ("mediated pleiotropy"). Using 6,670 subjects from the COPDGene study, we describe the association of known COPD susceptibility loci with other COPD-related phenotypes and distinguish if these act directly on the phenotypes (i.e., biological pleiotropy) or if the association is due to correlation (i.e., mediated pleiotropy). We identified additional associated phenotypes for 13 of 25 known COPD loci. Tests for pleiotropy between genotype and associated outcomes were significant for all loci. In cases of significant pleiotropy, we performed mediation analysis to test if SNPs had a direct association to phenotype. Most loci showed a mediated effect through the hypothesized causal pathway. However, many loci also had direct associations, suggesting causal explanations (i.e., emphysema leading to reduced lung function) are incomplete. Our results highlight the high degree of pleiotropy in complex disease-associated loci and provide novel insights into the mechanisms underlying COPD.
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Affiliation(s)
- Margaret M Parker
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sharon M Lutz
- Department of Biostatistics and Informatics, University of Colorado, Anschutz Medical Campus, Denver, Colorado
| | - Brian D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert Busch
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - MerryLynn N McDonald
- Division of Pulmonary, Allergy, and Critical Care Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Peter J Castaldi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Terri H Beaty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - John E Hokanson
- Department of Epidemiology, University of Colorado, Denver, Aurora, Colorado
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
The lung is often overlooked as a metabolically active organ, yet biochemical studies have long demonstrated that glucose utilization surpasses that of many other organs, including the heart, kidney, and brain. For most cells in the lung, energy consumption is relegated to performing common cellular tasks, like mRNA transcription and protein translation. However, certain lung cell populations engage in more specialized types of energy-consuming behaviors, such as the beating of cilia or the production of surfactant. While many extrapulmonary diseases are now linked to abnormalities in cellular metabolism, the pulmonary community has only recently embraced the concept of metabolic dysfunction as a driver of respiratory pathology. Herein, we provide an overview of the major metabolic pathways in the lung and discuss how cells sense and adapt to low-energy states. Moreover, we review some of the emerging evidence that links alterations in cellular metabolism to the pathobiology of several common respiratory diseases.
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Affiliation(s)
- Gang Liu
- Division of Pulmonary, Allergy and Critical Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294, USA
| | - Ross Summer
- Center for Translational Medicine and Jane and Leonard Korman Lung Center, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA;
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Schittny JC. How high resolution 3-dimensional imaging changes our understanding of postnatal lung development. Histochem Cell Biol 2018; 150:677-691. [PMID: 30390117 PMCID: PMC6267404 DOI: 10.1007/s00418-018-1749-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2018] [Indexed: 12/24/2022]
Abstract
During the last 10 + years biologically and clinically significant questions about postnatal lung development could be answered due to the application of modern cutting-edge microscopic and quantitative histological techniques. These are in particular synchrotron radiation based X-ray tomographic microscopy (SRXTM), but also 3Helium Magnetic Resonance Imaging, as well as the stereological estimation of the number of alveoli and the length of the free septal edge. First, the most important new finding may be the following: alveolarization of the lung does not cease after the maturation of the alveolar microvasculature but continues until young adulthood and, even more important, maybe reactivated lifelong if needed to rescue structural damages of the lungs. Second, the pulmonary acinus represents the functional unit of the lung. Because the borders of the acini could not be detected in classical histological sections, any investigation of the acini requires 3-dimensional (imaging) methods. Based on SRXTM it was shown that in rat lungs the number of acini stays constant, meaning that their volume increases by a factor of ~ 11 after birth. The latter is very important for acinar ventilation and particle deposition.
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Affiliation(s)
- Johannes C Schittny
- Institute of Anatomy, University of Bern, Baltzerstrasse 2, 3012, Bern, Switzerland.
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Abstract
Animal models of disease help accelerate the translation of basic science discoveries to the bedside, because they permit experimental interrogation of mechanisms at relatively high throughput, while accounting for the complexity of an intact organism. From the groundbreaking observation of emphysema-like alveolar destruction after direct instillation of elastase in the lungs to the more clinically relevant model of airspace enlargement induced by chronic exposure to cigarette smoke, animal models have advanced our understanding of alpha-1 antitrypsin (AAT) function. Experimental in vivo models that, at least in part, replicate clinical human phenotypes facilitate the translation of mechanistic findings into individuals with chronic obstructive pulmonary disease and with AAT deficiency. In addition, unexpected findings of alveolar enlargement in various transgenic mice have led to novel hypotheses of emphysema development. Previous challenges in manipulating the AAT genes in mice can now be overcome with new transgenic approaches that will likely advance our understanding of functions of this essential, lung-protective serine protease inhibitor (serpin).
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Agustí A, Noell G, Brugada J, Faner R. Lung function in early adulthood and health in later life: a transgenerational cohort analysis. THE LANCET RESPIRATORY MEDICINE 2017; 5:935-945. [PMID: 29150410 DOI: 10.1016/s2213-2600(17)30434-4] [Citation(s) in RCA: 226] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/09/2017] [Accepted: 10/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early life events can affect health in later life. We hypothesised that low lung function (FEV1 <80% predicted) in early adulthood (25-40 years) is associated with higher prevalence and earlier incidence of respiratory, cardiovascular, and metabolic abnormalities, and premature death. METHODS In this cohort analysis, we tested this hypothesis using data from the Framingham Offspring Cohort (FOC) and validated our observations in CARDIA (an independent cohort) and GenIII (which includes the direct descendants of FOC participants). These were three general population cohorts that included men and women, who were regularly and prospectively followed up to collect extensive clinical, physiological, biological, and imaging information. Main outcomes were prevalence (in early adulthood) and incidence (during follow-up) of comorbidity, and all-cause mortality. χ2 test, unpaired t test, Fisher's exact test, and Cox proportional hazards models were used for data analysis. Differential dropout rates during follow-up were regarded as a potential source of bias. FINDINGS We found that 111 (10%) of 1161 participants in FOC, 338 (13%) of 2648 participants in CARDIA, and 71 (4%) of 1912 participants in GenIII had FEV1 of less than 80% predicted at the age of 25-40 years. These individuals also had higher prevalence of respiratory, cardiovascular, and metabolic abnormalities in early adulthood; higher and earlier (about a decade) incidence of comorbidities during follow-up (39 years vs 47 years in FOC; 30 years vs 37 years in CARDIA, p<0·0001); and higher all-cause mortality than individuals with normal lung function in early adulthood (in FOC, hazard ratio 2·3 [95% CI 1·4-3·7], p=0·001), which was independent of, but additive with, cumulative smoking exposure. In GenIII, we observed that individuals with at least one parent stratified as having low lung function in early adulthood in FOC (n=115) had lower FEV1 in early adulthood (10% had FEV1 of less than 80% predicted; this proportion was 3% in those with both parents classified as normal in FOC [n=248]; p<0·0001); and early adulthood FEV1 of GenIII participants was related (R2=0·28, p<0·0001) to FOC parents' average FEV1 in early adulthood. INTERPRETATION Low peak lung function in early adulthood is common in the general population and could identify a group of individuals at risk of early comorbidities and premature death. FUNDING Fondo de Investigacion Sanitaria, Sociedad Española de Neumologia y Cirurgia Torácica, Formació Personal Investigador, Agencia de Gestió d'Ajuts de Recerca 2016, and AstraZeneca Foundation Young Researcher Award.
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Affiliation(s)
- Alvar Agustí
- Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Guillaume Noell
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Josep Brugada
- Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Rosa Faner
- Institut d'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
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38
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Jensen VM, Støving RK, Andersen PE. Anorexia nervosa with massive pulmonary air leak and extraordinary propagation. Int J Eat Disord 2017; 50:451-453. [PMID: 28170116 DOI: 10.1002/eat.22674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/29/2016] [Accepted: 12/29/2016] [Indexed: 11/10/2022]
Abstract
A rare case combining pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, pneumorrhachis, air in retroperitoneum and extensive subcutaneous emphysema simultaneously in a severely anorectic male with BMI 9.2 (22.8 kg) and multiple vomitings is presented. This unusual condition was treated successfully with conservative medical approach in a specialized somatic unit for anorexia nervosa.
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Affiliation(s)
- V M Jensen
- Department of Radiology, Odense University Hospital, Sdr. Boulevard, 5000 Odense C, Denmark
| | - R K Støving
- Centre for Eating Disorders, Elite Research Center for Medical Endocrinology, Odense University Hospital and Psychiatry of Region Southern Denmark, University of Southern Denmark, Denmark
| | - P E Andersen
- Department of Radiology, Cardiovascular Section, Odense University Hospital, Sdr. Boulevard, 5000 Odense C, Denmark
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Chronic obstructive pulmonary disease and malnutrition in developing countries. Curr Opin Pulm Med 2017; 23:139-148. [DOI: 10.1097/mcp.0000000000000356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
To fulfill the task of gas exchange, the lung possesses a huge inner surface and a tree-like system of conducting airways ventilating the gas exchange area. During lung development, the conducting airways are formed first, followed by the formation and enlargement of the gas exchange area. The latter (alveolarization) continues until young adulthood. During organogenesis, the left and right lungs have their own anlage, an outpouching of the foregut. Each lung bud starts a repetitive process of outgrowth and branching (branching morphogenesis) that forms all of the future airways mainly during the pseudoglandular stage. During the canalicular stage, the differentiation of the epithelia becomes visible and the bronchioalveolar duct junction is formed. The location of this junction stays constant throughout life. Towards the end of the canalicular stage, the first gas exchange may take place and survival of prematurely born babies becomes possible. Ninety percent of the gas exchange surface area will be formed by alveolarization, a process where existing airspaces are subdivided by the formation of new walls (septa). This process requires a double-layered capillary network at the basis of the newly forming septum. However, in parallel to alveolarization, the double-layered capillary network of the immature septa fuses to a single-layered network resulting in an optimized setup for gas exchange. Alveolarization still continues, because, at sites where new septa are lifting off preexisting mature septa, the required second capillary layer will be formed instantly by angiogenesis. The latter confirms a lifelong ability of alveolarization, which is important for any kind of lung regeneration.
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Lim JU, Lee JH, Kim JS, Hwang YI, Kim TH, Lim SY, Yoo KH, Jung KS, Kim YK, Rhee CK. Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients. Int J Chron Obstruct Pulmon Dis 2017; 12:2465-2475. [PMID: 28860741 PMCID: PMC5571887 DOI: 10.2147/copd.s141295] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION A low body mass index (BMI) is associated with increased mortality and low health-related quality of life in patients with COPD. The Asia-Pacific classification of BMI has a lower cutoff for overweight and obese categories compared to the World Health Organization (WHO) classification. The present study assessed patients with COPD among different BMI categories according to two BMI classification systems: WHO and Asia-Pacific. PATIENTS AND METHODS Patients with COPD aged 40 years or older from the Korean COPD Subtype Study cohort were selected for evaluation. We enrolled 1,462 patients. Medical history including age, sex, St George's Respiratory Questionnaire (SGRQ-C), the modified Medical Research Council (mMRC) dyspnea scale, and post-bronchodilator forced expiratory volume in 1 second (FEV1) were evaluated. Patients were categorized into different BMI groups according to the two BMI classification systems. RESULT FEV1 and the diffusing capacity of the lung for carbon monoxide (DLCO) percentage revealed an inverse "U"-shaped pattern as the BMI groups changed from underweight to obese when WHO cutoffs were applied. When Asia-Pacific cutoffs were applied, FEV1 and DLCO (%) exhibited a linearly ascending relationship as the BMI increased, and the percentage of patients in the overweight and obese groups linearly decreased with increasing severity of the Global Initiative for Chronic Obstructive Lung Disease criteria. From the underweight to the overweight groups, SGRQ-C and mMRC had a decreasing relationship in both the WHO and Asia-Pacific classifications. The prevalence of comorbidities in the different BMI groups showed similar trends in both BMI classifications systems. CONCLUSION The present study demonstrated that patients with COPD who have a high BMI have better pulmonary function and health-related quality of life and reduced dyspnea symptoms. Furthermore, the Asia-Pacific BMI classification more appropriately reflects the correlation of obesity and disease manifestation in Asian COPD patients than the WHO classification.
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Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St Paul’s Hospital, College of Medicine, The Catholic University of Korea
| | - Jae Ha Lee
- Division of Pulmonology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan
| | - Ju Sang Kim
- Division of Pulmonary Medicine, Department of Internal Medicine, Incheon St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon
| | - Yong Il Hwang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang
| | - Tae-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri
| | - Seong Yong Lim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Kwang Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University School of Medicine
| | - Ki-Suck Jung
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang
| | - Young Kyoon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Young Kyoon Kim; Chin Kook Rhee, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 222, Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea, Tel +82 2 2258 6059; +82 2 2258 6067, Fax +82 2 599 3589, Email ;
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Correspondence: Young Kyoon Kim; Chin Kook Rhee, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, 222, Banpo-daero Seocho-gu, Seoul 06591, Republic of Korea, Tel +82 2 2258 6059; +82 2 2258 6067, Fax +82 2 599 3589, Email ;
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Solmi M, Veronese N, Sergi G, Luchini C, Favaro A, Santonastaso P, Vancampfort D, Correll CU, Ussher M, Thapa-Chhetri N, Fornaro M, Stubbs B. The association between smoking prevalence and eating disorders: a systematic review and meta-analysis. Addiction 2016; 111:1914-1922. [PMID: 27206671 DOI: 10.1111/add.13457] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/25/2016] [Accepted: 05/18/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND AIMS Cigarette smoking is associated with severe mental illness, including schizophrenia and bipolar disorder, and with morbidity and mortality, but the association with anorexia (AN), bulimia nervosa (BN) and binge eating disorder (BED) is unclear. This meta-analysis compared the odds of smoking in eating disorders (ED) (ED = AN or BN or BED) versus healthy controls (HC) and calculated the prevalence of smokers in people with ED. METHODS Three independent authors searched PubMed, MEDLINE and Scopus from database inception until 31 December 2015 for studies reporting data on life-time or current smoking prevalence in BED, BN and AN with or without control group. Meta-analyses were undertaken, calculating odds ratios (ORs) of life-time smoking in BED, BN, AN versus healthy controls (HCs) or prevalence of smoking in BED, BN and AN with 95% confidence intervals (CI). RESULTS Thirty-one studies (ED = 8517, controls = 68 335) were meta-analysed. Compared with HCs, there were significantly more smokers among people with BN (life-time OR = 2.165) and BED (life-time OR = 1.792) but not AN (life-time OR = 0.927). BED was associated with smoking the most (life-time prevalence = 47.73%) followed by BN (life-time prevalence = 39.4%) and AN (life-time prevalence = 30.8%). In BN, life-time smoking prevalence was highest in Europe. In AN, higher age moderated both life-time and current smoking prevalence, and body mass index moderated higher life-time smoking prevalence. In BN, female sex moderated higher life-time smoking prevalence. CONCLUSIONS People with binge eating disorder and bulimia nervosa are significantly more likely to be life-time smokers than healthy controls, which is not the case for anorexia nervosa.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy.,Local Health Unit ULSS 17, Mental Health Department, Monselice, Padova, Italy.,Institute of Clinical Research, and Education in Medicine (IREM), Padova, Italy
| | - Nicola Veronese
- Department of Medicine, DIMED, University of Padua, Padova, Italy.,Institute of Clinical Research, and Education in Medicine (IREM), Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine, DIMED, University of Padua, Padova, Italy
| | - Claudio Luchini
- Department of Pathology and Diagnostics, Verona University and Hospital Trust, Verona, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Davy Vancampfort
- University of Leuven, KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium.,University of Leuven-KU Leuven, University Psychiatric Centre, Kortenberg-, Leuven, Belgium
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health System, Glen Oaks, New York, USA.,Hofstra Northwell School of Medicine, Hempstead, New York, USA.,The Feinstein Institute for Medical Research, Manhasset, New York, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
| | | | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, NYC, USA
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK. .,Health Service and Population Research Department, Institute of Psychiatry, King's College, London, De Crespigny Park, London, UK.
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43
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Exercise and physical therapy help restore body and self in clients with severe anorexia nervosa. J Bodyw Mov Ther 2016; 21:481-494. [PMID: 28750954 DOI: 10.1016/j.jbmt.2016.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 08/21/2016] [Accepted: 09/02/2016] [Indexed: 11/18/2022]
Abstract
Exercise in the context of anorexia nervosa is a multifaceted endeavour surrounded by controversy and uncertainty. A broader comprehension of this poorly understood phenomenon is required. Informed by the findings of a body examination of six individuals with anorexia nervosa, as well as exercise science, phenomenology and neurocognition, the purpose of this article is to elaborate on the potential role of exercise and physical therapy in the treatment of anorexia nervosa. The findings of the body assessment include constriction of posture, muscles and pattern of breathing. These bodily restraints are not necessarily merely associated with high levels of exercise, they may also reflect psychological strain accompanying the illness. The restricted breathing in particular is assumed to be associated with difficult thoughts and suppressed feelings. Based on the results of the body examination, as well as medical and psychological considerations accompanying the illness, it is suggested that interventions should focus on improving postural stability and restoring related muscular function. Integral to engaging in these activities, the potential to integrate proprioceptive information in this process may generate a more coherent experience of the body, as well as of the self, in these clients. Accordingly, constrictions of the body may have a vital role in constraining the experience of the self. As such, addressing bodily restraints in these clients may facilitate the experience of being the subject causing and controlling the movements. This is in marked contrast to clients' previous exercise experiences, which were associated with compulsion, rigidity and the absence of coherence and control.
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Llapur CJ, Martínez MR, Grassino PT, Stok A, Altieri HH, Bonilla F, Caram MM, Krowchuk NM, Kirby M, Coxson HO, Tepper RS. Chronic Hypoxia Accentuates Dysanaptic Lung Growth. Am J Respir Crit Care Med 2016; 194:327-32. [DOI: 10.1164/rccm.201509-1851oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hair AB, Bergner EM, Lee ML, Moreira AG, Hawthorne KM, Rechtman DJ, Abrams SA, Blanco CL. Premature Infants 750-1,250 g Birth Weight Supplemented with a Novel Human Milk-Derived Cream Are Discharged Sooner. Breastfeed Med 2016; 11:133-7. [PMID: 26982282 PMCID: PMC4827298 DOI: 10.1089/bfm.2015.0166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Infants may benefit from early nutritional intervention to decrease hospital stay. To evaluate the effects of adding a human milk (HM)-derived cream (Cream) product to a standard feeding regimen in preterm infants. MATERIALS AND METHODS In a prospective multicenter randomized study, infants with birth weights 750-1,250 g were assigned to a Control or Cream group. The Control group received a standard feeding regimen consisting of mother's own milk or donor HM with donor HM-derived fortifier. The Cream group received the standard feeding regimen along with an additional HM-derived cream supplement when the HM they received was <20 kcal/oz. Primary outcomes of this secondary analysis included comorbidities, length of stay (LOS), and postmenstrual age (PMA) at discharge. RESULTS We enrolled 75 infants (Control n = 37, Cream n = 38) with gestational age 27.7 ± 1.8 weeks and birth weight 973 ± 145 g (mean ± SD). After adjusting for gestational age, birth weight, and presence of bronchopulmonary dysplasia (BPD), the Cream group had a decreased PMA at discharge (39.9 ± 4.8 versus 38.2 ± 2.7 weeks, p = 0.03) and LOS (86 ± 39 versus 74 ± 22 days, p = 0.05). For 21 infants with BPD, these values trended toward significance for PMA at discharge (44.2 ± 6.1 versus 41.3 ± 2.7 weeks, p = 0.08) and LOS (121 ± 49 versus 104 ± 23 days, p = 0.08). CONCLUSIONS Very preterm infants who received an HM-derived cream supplement were discharged earlier. Infants with BPD may have benefited the most.
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Affiliation(s)
- Amy B Hair
- 1 Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | - Erynn M Bergner
- 1 Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital , Houston, Texas
| | | | - Alvaro G Moreira
- 3 Department of Pediatrics, University of Texas Health Science Center , San Antonio, Texas
| | - Keli M Hawthorne
- 4 Department of Pediatrics, Dell Medical School at the University of Texas at Austin , Austin, Texas
| | | | - Steven A Abrams
- 4 Department of Pediatrics, Dell Medical School at the University of Texas at Austin , Austin, Texas
| | - Cynthia L Blanco
- 3 Department of Pediatrics, University of Texas Health Science Center , San Antonio, Texas
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Ozawa Y, Ichimura H, Sakai M. Reexpansion pulmonary edema after surgery for spontaneous pneumothorax in a patient with anorexia nervosa. Ann Med Surg (Lond) 2016; 7:20-3. [PMID: 27158490 PMCID: PMC4843096 DOI: 10.1016/j.amsu.2016.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/05/2016] [Accepted: 02/13/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction Several adverse effects on the pulmonary system in patients with anorexia nervosa (AN) have been reported. We present a case of AN who presented with a complicated reexpansion pulmonary edema (RPE) after video-assisted thoracic surgery (VATS) for spontaneous pneumothorax. Presentation of case A 23-year-old woman with severe anorexia nervosa (weight: 25 kg, body mass index: 8.96 kg/m2) underwent VATS for spontaneous pneumothorax. Five hours after the surgery, she immediately presented acute cardiorespiratory insufficiency. Chest radiography showed an infiltrating shadow in the entire right lung. She was diagnosed with reexpansion pulmonary edema that was treated with methylprednisolone pulse therapy and mechanical ventilation. She recovered and was extubated on postoperative day 4. The chest drain tube was removed on postoperative day 5. Discussion Bullectomy or ligation of bullae for spontaneous pneumothorax in a patient with AN has never been reported. In our case, bullae were identified in preoperative CT and we chose ligation of the bullae instead of the bullectomy using automatic suture device because of poor wound healing concerned. Conclusion We present a case of RPE after VATS for spontaneous pneumothorax in a patient with AN. Malnutrition owing to AN results in critical complications such as RPE. Ligation of bullae for spontaneous pneumothorax in a patient with AN has never been reported. Anorexia nervosa results in critical complications such as RPE. Malnutrition due to AN changes the architectural changes in the lung.
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Affiliation(s)
- Yuichiro Ozawa
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
| | - Hideo Ichimura
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
| | - Mitsuaki Sakai
- Department of General Thoracic Surgery, Tsukuba Medical Center Hospital, Japan
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Sanders KJC, Kneppers AEM, van de Bool C, Langen RCJ, Schols AMWJ. Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective. J Cachexia Sarcopenia Muscle 2016; 7:5-22. [PMID: 27066314 PMCID: PMC4799856 DOI: 10.1002/jcsm.12062] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Revised: 07/05/2015] [Accepted: 07/12/2015] [Indexed: 12/19/2022] Open
Abstract
Cachexia and muscle wasting are well recognized as common and partly reversible features of chronic obstructive pulmonary disease (COPD), adversely affecting disease progression and prognosis. This argues for integration of weight and muscle maintenance in patient care. In this review, recent insights are presented in the diagnosis of muscle wasting in COPD, the pathophysiology of muscle wasting, and putative mechanisms involved in a disturbed energy balance as cachexia driver. We discuss the therapeutic implications of these new insights for optimizing and personalizing management of COPD-induced cachexia.
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Affiliation(s)
- Karin J C Sanders
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht The Netherlands
| | - Anita E M Kneppers
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht The Netherlands
| | - Coby van de Bool
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht The Netherlands
| | - Ramon C J Langen
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine NUTRIM School of Nutrition and Translational Research in Metabolism Maastricht The Netherlands
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Vanfleteren LE, Lamprecht B, Studnicka M, Kaiser B, Gnatiuc L, Burney P, Wouters EF, Franssen FM. Body mass index and chronic airflow limitation in a worldwide population-based study. Chron Respir Dis 2016; 13:90-101. [PMID: 26768010 DOI: 10.1177/1479972315626012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nutritional status has been associated with clinical outcome in chronic airflow limitation (CAL), but epidemiological studies are scarce. We aimed to assess the relationship between body mass index (BMI) and CAL, taking into account confounding factors. 18,606 participants (49% male, 21% smokers, mean age: 55.8 ± 11.2 years, mean BMI: 26.7 ± 5.5 kg/m(2)) of the BOLD initiative from 26 sites in 23 countries were included. CAL was defined as post-bronchodilator forced expiratory volume in the first second/forced vital capacity < lower limit of normal. Low and obese BMI were defined as <21 kg/m(2) and ≥30 kg/m(2), respectively. Multivariate logistic regression analysis controlled for confounders age, sex and smoking, and meta-analysis of between-site heterogeneity and clustering. Prevalence of low and obese BMI, smoking history and prevalence of CAL were highly variable between sites. After adjustment for confounders, the meta-analysis of all sites showed that compared to subjects without CAL, low BMI was more frequent, (adjusted odds ratio (OR): 2.23 (95% confidence interval: 1.75, 2.85)) and conversely, obesity was less frequent in subjects with CAL (adjusted OR: 0.78 (0.65, 0.94)). In a worldwide population sample, CAL was associated with lower BMI, even after adjusting for confounding factors age, gender, smoking and between-site heterogeneity. These results indicate a CAL-specific association with body composition.
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Affiliation(s)
- Lowie Egw Vanfleteren
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Bernd Lamprecht
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria Faculty of Medicine, Johannes Kepler University, Linz, Austria
| | - Michael Studnicka
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Kaiser
- Department of Pulmonary Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Louisa Gnatiuc
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Peter Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Emiel Fm Wouters
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Frits Me Franssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, the Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
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Araki T, Nishino M, Gao W, Dupuis J, Putman RK, Washko GR, Hunninghake GM, O'Connor GT, Hatabu H. Pulmonary cysts identified on chest CT: are they part of aging change or of clinical significance? Thorax 2015; 70:1156-62. [PMID: 26514407 DOI: 10.1136/thoraxjnl-2015-207653] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/01/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the prevalence and natural course of pulmonary cysts in a population-based cohort and to describe the CT image characteristics in association with participant demographics and pulmonary functions. MATERIALS AND METHODS Chest CT scans of 2633 participants (mean age 59.2 years; 50% female) of the Framingham Heart Study (FHS) were visually evaluated for the presence of pulmonary cysts and their image characteristics. These findings were correlated with participant demographics and results of pulmonary function tests as well as the presence of emphysema independently detected on CT. The interval change was investigated by comparison with previous CT scans (median interval 6.1 years). RESULTS Pulmonary cysts were seen in 7.6% (95% CI 6.6% to 8.7%; 200/2633). They were not observed in participants younger than 40 years old, and the prevalence increased with age. Multiple cysts (at least five) were seen in 0.9% of all participants. Participants with pulmonary cysts showed significantly lower body mass index (BMI) (p<0.001). Pulmonary cysts were most likely to appear solitary in the peripheral area of the lower lobes and remain unchanged or slightly increase in size over time. Pulmonary cysts showed no significant influence on pulmonary functions (p=0.07-0.6) except for diffusing capacity of the lung for carbon monoxide (DLCO) (p=0.03) and no association with cigarette smoking (p=0.1-0.9) or emphysema (p=0.7). CONCLUSIONS Pulmonary cysts identified on chest CT may be a part of the aging changes of the lungs, occurring in asymptomatic individuals older than 40 years, and are associated with decreased BMI and DLCO. Multiple pulmonary cysts may need to be evaluated for the possibility of cystic lung diseases.
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Affiliation(s)
- Tetsuro Araki
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mizuki Nishino
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wei Gao
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Josée Dupuis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA
| | - Rachel K Putman
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George R Washko
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gary M Hunninghake
- The Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - George T O'Connor
- The National Heart Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts, USA Pulmonary Center and Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Hiroto Hatabu
- Department of Radiology, Center for Pulmonary Functional Imaging, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Saito H, Nomura K, Abe S, Motegi T, Ishii T, Hattori K, Kusunoki Y, Gemma A, Kida K. Long-term effects of gastrectomy in patients with spirometry-defined COPD and patients at risk of COPD: a case-control study. Int J Chron Obstruct Pulmon Dis 2015; 10:2311-8. [PMID: 26604730 PMCID: PMC4631414 DOI: 10.2147/copd.s87135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Comorbidities are characteristic of COPD. However, little is known about the secondary manifestations of COPD in the gastrointestinal tract. Therefore, we aimed to explore the long-term effects of gastrectomy in patients with spirometry-defined COPD or those at risk of COPD. PARTICIPANTS Subjects included 87 patients either with COPD or at risk of COPD (symptomatic) who underwent gastrectomy between December 2003 and October 2013 (group A), and 174 patients either with COPD or at risk of COPD, matched by age (±5 years), sex, and forced expiratory volume in 1 second (FEV1) as percentage of predicted (FEV1% predicted) (±5%) (group B). METHODS All patients underwent routine blood chemistry and pulmonary function tests, arterial blood gas analysis, 6-minute walk test (6MWT), high-resolution chest computed tomography scans, and nutritional assessments. RESULTS The mean duration postgastrectomy was 18.3±15.4 years. The mean FEV1 and FEV1% predicted were 2.07±0.76 L and 74.6±24.5%, respectively. Univariate analysis indicated that group A patients had significantly lower body mass index, fat-free mass index, and serum hemoglobin and albumin concentration (all P=0.00), and walked a significantly shorter distance in the 6MWT (P<0.05). Multivariate linear regression analysis for the distance in the 6MWT indicated that increased residual volume (RV) to total lung capacity (TLC) as percentage of predicted (%RV/TLC) alone was an independent and significant predictor of reduced distances in the 6MWT. CONCLUSION We concluded that nutritional insufficiency in patients with COPD (or those at risk of COPD) who previously underwent gastrectomy might lead to hyperinflation and consequently, decreased exercise capacity.
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Affiliation(s)
- Hitoshi Saito
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Koichiro Nomura
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Shinji Abe
- Department of Respiratory Medicine, Tokyo Metropolitan Hiroo Hospital, Tokyo, Japan
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Takashi Motegi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Takeo Ishii
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Kumiko Hattori
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Yuji Kusunoki
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
| | - Kozui Kida
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Tokyo, Japan
- Respiratory Care Clinic, Nippon Medical School, Tokyo, Japan
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