1
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Nicholson JM, Orsso CE, Nourouzpour S, Elangeswaran B, Chohan K, Orchanian-Cheff A, Fidler L, Mathur S, Rozenberg D. Computed tomography-based body composition measures in COPD and their association with clinical outcomes: A systematic review. Chron Respir Dis 2022; 19:14799731221133387. [PMID: 36223552 PMCID: PMC9561670 DOI: 10.1177/14799731221133387] [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] [Indexed: 11/16/2022] Open
Abstract
Background Computed tomography (CT) is commonly utilized in chronic obstructive
pulmonary disease (COPD) for lung cancer screening and emphysema
characterization. Computed tomography-morphometric analysis of body
composition (muscle mass and adiposity) has gained increased recognition as
a marker of disease severity and prognosis. This systematic review aimed to
describe the CT-methodology used to assess body composition and identify the
association of body composition measures and disease severity,
health-related quality of life (HRQL), cardiometabolic risk factors,
respiratory exacerbations, and survival in patients with COPD. Methods Six databases were searched (inception-September 2021) for studies evaluating
adult COPD patients using thoracic or abdominal CT-muscle or adiposity body
composition measures. The systematic review was conducted in accordance with
the PRISMA guidelines. Results Twenty eight articles were included with 15,431 COPD patients, across all
GOLD stages with 77% males, age range (mean/median 59–78 years), and BMI
range 19.8–29.3 kg/m2. There was heterogeneity in assessment of
muscle mass and adiposity using thoracic (n = 22) and
abdominal (n = 8) CT-scans, capturing different muscle
groups, anatomic locations, and adiposity compartments (visceral,
subcutaneous, and epicardial). Low muscle mass and increased adiposity were
associated with increased COPD severity measures (lung function, exercise
capacity, dyspnea) and lower HRQL, but were not consistent across studies.
Increased visceral adiposity (n = 6) was associated with
cardiovascular disease or risk factors (hypertension, hyperlipidemia, and
diabetes). Low muscle CSA was prognostic of respiratory exacerbations or
mortality in three of six studies, whereas the relationship with increased
intermuscular adiposity and greater mortality was only observed in one of
three studies. Conclusion There was significant variability in CT-body composition measures. In several
studies, low muscle mass was associated with increased disease severity and
lower HRQL, whereas adiposity with cardiovascular disease/risk factors.
Given the heterogeneity in body composition measures and clinical outcomes,
the prognostic utility of CT-body composition in COPD requires further
study.
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Affiliation(s)
- John M Nicholson
- Department of Medicine,
Respirology, London
Health Science Center, London, ON,
Canada
| | - Camila E Orsso
- Department of Agricultural, Food
and Nutritional Science, University of
Alberta, Edmonton, AB, Canada
| | - Sahar Nourouzpour
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Brenawen Elangeswaran
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Karan Chohan
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada
| | - Ani Orchanian-Cheff
- Library and Information Services,
University
Health Network, Toronto, ON,
Canada
| | - Lee Fidler
- Department of Medicine,
Respirology, University
Health Network, Toronto, Canada,Respirology,
Sunnybrook
Health Sciences Centre, Toronto, ON,
Canada
| | - Sunita Mathur
- Deparment of Physical Therapy,
University
of Toronto, Toronto, ON, Canada,School of Rehabilitation Therapy,
Queen’s
University, Kingston, ON, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine,
Respirology, Lung Transplant Program, Toronto General Hospital Research
Institute, University
Health Network, Toronto, ON,
Canada,Dmitry Rozenberg, Temerty Faculty of
Medicine, Respirology, Lung Transplant Program, Toronto General Hospital
Research Institute, University Health Network, 200 Elizabeth Street, 13-EN 229,
Toronto ON M5G 2C4, Canada.
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2
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Wang R, Zhang X, Ren H, Zhou H, Yuan Y, Chai Y, Hou X. Effects of different exercise types on visceral fat in young individuals with obesity aged 6-24 years old: A systematic review and meta-analysis. Front Physiol 2022; 13:987804. [PMID: 36246116 PMCID: PMC9562999 DOI: 10.3389/fphys.2022.987804] [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: 07/06/2022] [Accepted: 08/29/2022] [Indexed: 12/14/2022] Open
Abstract
Introduction: The prevalence of pediatric obesity remains high all over the world. Various exercise interventions have been applied to decrease the visceral fat in young individuals with obesity. But the evidence remains controversial on the effect of the exercise on visceral fat. Moreover, it is unclear which type of the exercise is the most effective for young individuals with overweight or obesity to reduce visceral fat. Objective: The objective of this review and meta-analysis is to evaluate and compare the effectiveness of different exercise interventions on visceral fat in young individuals with overweight or obesity. Methods: Four databases consisting of PubMed, Web of Science, EBSCO, and Cochrane Library were searched prior to May 2022. Fifteen studies with a total of 30 data points involving 1,134 participants were included in this meta-analysis. And the interventions were limited to 4 exercise types [i.e., aerobic exercise (AE), resistance exercise (RE), aerobic exercise combined with resistance exercise (CE), and high-intensity interval training (HIIT)]. Data Synthesis: The results showed that AE (Standardized Mean Difference = -0.32; 95% CI = -0.50 to -0.13; p = 0.0007; I2 = 37%) and HIIT (SMD = -0.59; 95% CI = -0.87 to -0.31; p < 0.0001; I2 = 0%) had a significant reduction effect on visceral fat. And the effect of HIIT seemed better than AE. However, RE (SMD = -0.58; 95% CI = -1.34 to 0.17; p = 0.13; I2 = 76%) and CE (SMD = -0.21; 95% CI = -0.81 to 0.38; p = 0.48; I2 = 63%) had a non-significant effect on visceral fat decline. Additionally, compared with the control group, exercise interventions had a significant effect on reducing visceral fat in adolescents (SMD = -0.54; 95% CI = -0.82 to -0.26; p = 0.0001; I2 = 64%) and young adults (SMD = -0.42; 95% CI = -0.69 to -0.15; p = 0.003; I2 = 0%) rather than children (SMD = -0.15; 95% CI = -0.32 to 0.02; p = 0.08; I2 = 0%). And the gender-based subgroup analysis indicated that the effectiveness of the exercise on the reduction of visceral fat was more significant in males (SMD = -1.27; 95% CI = -1.67 to -0.87; p < 0.00001; I2 = 0%) than that in females (SMD = -0.31; 95% CI = -0.48 to -0.14; p = 0.0004; I2 = 0%). Conclusion: This review and meta-analysis demonstrates that exercise interventions are efficient to decrease visceral fat in adolescents (12-18 years old) and young adults (18-24 years old). Among different exercise types, AE and HIIT are helpful for young individuals with overweight or obesity to reduce visceral fat and HIIT appears to be the most effective exercise intervention. In addition, the effect of exercise interventions on the consumption of visceral fat is more significant in males than that in females. Systematic Review Registration: [http://www.crd.york.ac.uk/PROSPERO], identifier [CRD42022310878].
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Affiliation(s)
- Rong Wang
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Xiaoyuan Zhang
- Department of Physical Education, Peking University, Beijing, China
| | - Hong Ren
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Huixuan Zhou
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Yaqing Yuan
- College of Sports and Health, Shandong Sport University, Shandong, China
| | - Yunlong Chai
- Department of Physical Education, Peking University, Beijing, China
| | - Xiao Hou
- School of Sport Science, Beijing Sport University, Beijing, China,*Correspondence: Xiao Hou,
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3
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Liu W, Cao Y, Zhou X, Han D. Interstitial Fluid Behavior and Diseases. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2100617. [PMID: 34978164 PMCID: PMC8867152 DOI: 10.1002/advs.202100617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 10/18/2021] [Indexed: 06/14/2023]
Abstract
Living things comprise a typical hierarchical and porous medium, and their most fundamental logical architectures are interstitial structures encapsulating parenchymal structures. The recent discovery of the efficient transport mechanisms of interstitial streams has provided a new understanding of these complex activities. The substance transport of interstitial streams follows mesoscopic fluid behavior dynamics, which is intimately associated with material transfer in nanoconfined spaces and a unique signal transmission. Accordingly, the evaluation of interstitial stream transport behavior at the mesoscopic scale is essential. In this review, recent advances in physical and chemical properties, the substance transport model, and the characterization methods of interstitial streams at the mesoscopic scale, as well as the relationships between interstitial streams and disease are summarized. Interstitial stream transport can be used as a basis to fully mine hierarchal behavior in images to expand imaging behavior into an omics field. By starting from the perspective of soft matter, a new understanding can be gained of health and disease and quantitative physical markers for research, clinical diagnosis, and treatment can be provided, as well as prognosis evaluation in complex diseases such as cancer and Alzheimer's disease. This will provide a foundation for the development of medicine of soft matter.
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Affiliation(s)
- Wen‐Tao Liu
- CAS Center for Excellence in NanoscienceNational Center for Nanoscience and TechnologyBeijing100190P. R. China
| | - Yu‐Peng Cao
- CAS Center for Excellence in NanoscienceNational Center for Nanoscience and TechnologyBeijing100190P. R. China
- School of Future TechnologyUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Xiao‐Han Zhou
- CAS Center for Excellence in NanoscienceNational Center for Nanoscience and TechnologyBeijing100190P. R. China
- School of Future TechnologyUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Dong Han
- CAS Center for Excellence in NanoscienceNational Center for Nanoscience and TechnologyBeijing100190P. R. China
- School of Future TechnologyUniversity of Chinese Academy of SciencesBeijing100049P. R. China
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4
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Jeon YJ, Han S, Park GM, Lee TY, Park SE, Lee H, Kang BJ. Intramuscular and Intermuscular Abdominal Fat Infiltration in COPD: A Propensity Score Matched Study. Int J Chron Obstruct Pulmon Dis 2021; 16:1989-1999. [PMID: 34262269 PMCID: PMC8275100 DOI: 10.2147/copd.s312888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/16/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose Low-attenuation muscle area (LAMA) and normal-attenuation muscle area (NAMA) indicate lipid-rich and lipid-poor skeletal muscle areas, respectively. Additionally, intermuscular adipose tissue (IMAT) indicates localized fat between muscle groups. In this study, we aimed to evaluate the intramuscular and intermuscular fat infiltration in individuals with chronic obstructive pulmonary disease (COPD) by performing quantitative assessment of the LAMA, NAMA, and IMAT observed on abdominopelvic computed tomography (APCT) images. Patients and Methods We performed a cross-sectional study using data of subjects who underwent a general health examination with APCT at Ulsan University Hospital between March 2014 and June 2019. We classified the subjects into control and COPD groups based on age, smoking history, and pulmonary function results. We compared the attenuation and body mass index adjusted area of intra-abdominal components between the two groups using propensity score matching. We also evaluated these outcomes in COPD subgroups (mild and moderate stage subjects). Results Overall, 6,965 subjects were initially enrolled, and 250 pairs of control and COPD subjects were selected after propensity score matching. The NAMA attenuation (unstandardized β=−1.168, P<0.001) was lower, and the IMAT (unstandardized β=0.042, P=0.006) and LAMA (unstandardized β=0.120, P<0.001) indexes were greater in the COPD group than in the control group. In subgroup analysis, those with mild and moderate COPD also had high IMAT (unstandardized β=0.037, P=0.009 and unstandardized β=0.045, P<0.001) and LAMA (unstandardized β=0.089, P=0.002 and unstandardized β=0.147, P<0.001) indexes compared to the control subjects. However, the NAMA attenuation (unstandardized β=−1.075, P<0.001) and NAMA index (unstandardized β=−0.133, P=0.015) were significantly lower in moderate COPD subjects only. Conclusion Our study showed that intramuscular and intermuscular abdominal fat infiltration could be present in subjects with mild COPD, and it might be exacerbated in those with moderate COPD.
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Affiliation(s)
- Young-Jee Jeon
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sangyoung Han
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Gyung-Min Park
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Tae Young Lee
- Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyunho Lee
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Byung Ju Kang
- Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
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5
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Mathur S, Rozenberg D, Verweel L, Orsso CE, Singer LG. Chest computed tomography is a valid measure of body composition in individuals with advanced lung disease. Clin Physiol Funct Imaging 2020; 40:360-368. [PMID: 32544296 DOI: 10.1111/cpf.12652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 04/03/2020] [Accepted: 06/07/2020] [Indexed: 01/06/2023]
Abstract
There is growing interest in evaluating body composition using routine clinical computed tomography (CT) scans; however, the validity of this technique in lung transplant patients has not been described. The study objectives were to determine the reliability of measuring fat compartments from thoracic CT and evaluate the validity of muscle and fat cross-sectional area (CSA) from thoracic CT by comparing to bioelectrical impedance analysis (BIA). Thoracic CT scans from lung transplant assessments were obtained for analysis. Total thoracic muscle CSA, pectoral muscle CSA, subcutaneous adipose tissue (SAT), and mediastinal adipose tissue (MAT) were manually segmented by two independent raters. Reliability was analysed using intra-class correlation coefficient (ICC). Correlations were determined between CT measures with fat-free mass index (FFMI), body fat mass index (BFMI) and per cent body fat (%BF) from BIA; and anthropometrics [body mass index (BMI) and waist circumference (WC)]. High inter- and intra-rater reliability were found for SAT and MAT (ICCs = 0.99). Pectoral and total muscle CSA were correlated with FFMI (r = .41, p = .003 and r = .57, p < .001, respectively). SAT was associated with whole-body fat from BIA and with BMI and WC (r = .61 to .80, p < .001). MAT was associated with BMI (r = .58, p < .001) and WC (r = .61, p < .001). This study supports the reliability and validity of using thoracic CT to measure muscle and fat. Future studies are needed to investigate whether these CT-based measures are predictive of clinical and post-transplant outcomes in advanced lung disease.
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Affiliation(s)
- Sunita Mathur
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Division of Respirology, Toronto Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada
| | - Lee Verweel
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Camila E Orsso
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Lianne G Singer
- Division of Respirology, Toronto Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada
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6
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Tengvall S, Ohlsson C, Bygdell M, Martikainen J, Andersson A, Kindblom JM. Pubertal-onset overweight and COPD in men: a cohort study. ERJ Open Res 2020; 6:00326-2019. [PMID: 32154295 PMCID: PMC7049738 DOI: 10.1183/23120541.00326-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/27/2019] [Indexed: 01/06/2023] Open
Abstract
A global obesity epidemic has occurred among both adults and children during the last three decades [1]. Among patients with chronic obstructive pulmonary disease (COPD), low body mass index (BMI) is associated with poor prognosis and excess mortality [2], while obesity appears protective [3], a phenomenon known as the obesity paradox. Still, in milder forms of COPD, obesity is associated with increased risk of mortality, possibly mediated via the strong association with diabetes and hypertension [4]. Furthermore, abdominal fat accumulation is the strongest predictor of lung function impairment [5], and abdominal circumference is almost twice as high in COPD patients as in sex- and age-matched controls [6]. Thus, previous studies on the relationship between BMI and COPD have evaluated the associations for adult BMI, while it is unknown if BMI during childhood or adolescence, i.e. many years before onset of COPD, predicts the development of COPD later in life. Men who develop overweight specifically during puberty (i.e. normal weight at age 8, overweight at age 20 years) have 70% increased risk of COPD as adults compared to men without overweighthttp://bit.ly/2TradZA
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Affiliation(s)
- Sara Tengvall
- Närhälsan, Frölunda Vårdcentral, Gothenburg, Sweden.,These authors contributed equally
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Dept of Drug Treatment, Gothenburg, Sweden.,These authors contributed equally
| | - Maria Bygdell
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jari Martikainen
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Andersson
- COPD Center, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Jenny M Kindblom
- Centre for Bone and Arthritis Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Pediatric Clinical Research Center, Gothenburg, Sweden
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7
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Foumani AA, Neyaragh MM, Ranjbar ZA, Leyli EK, Ildari S, Jafari A. Waist Circumference and Spirometric Measurements in Chronic Obstructive Pulmonary Disease. Osong Public Health Res Perspect 2019; 10:240-245. [PMID: 31497496 PMCID: PMC6711712 DOI: 10.24171/j.phrp.2019.10.4.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives The aim of this study was to evaluate whether the waist circumference of patients with chronic obstructive pulmonary disease (COPD), had an impact on lung function. Methods There were 180 patients with COPD recruited into this prospective cross-sectional study. The age, weight, body mass index and waist circumference (WC) were measured. Spirometry parameters including forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), were measured and FEV1/FVC calculated. Results The mean FEV1/FVC in both normal weight and overweight patients, did not statistically significantly correlate with WC. The COPD assessment test, positively correlated with WC ( p = 0.031). A positive correlation with body mass index ( p < 0.001), smoking ( p = 0.027), and global initiative for chronic obstructive lung disease score ( p = 0.009), were observed to positively associate with WC. WC, age, C-reactive protein, duration of disease, and gender (male), were observed to be statistically significant risk factors for the severity of COPD. Conclusion WC was not observed to impact upon lung function in this study but it was a predictive factor for COPD severity in patients.
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Affiliation(s)
- Ali Alavi Foumani
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Masoud Neyaragh
- Department of Internal Medicine, Student Research Committee, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Abbasi Ranjbar
- Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Kazemnezhad Leyli
- Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Shima Ildari
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafari
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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8
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Sanders KJC, Degens JHRJ, Dingemans AMC, Schols AMWJ. Cross-sectional and longitudinal assessment of muscle from regular chest computed tomography scans: L1 and pectoralis muscle compared to L3 as reference in non-small cell lung cancer. Int J Chron Obstruct Pulmon Dis 2019; 14:781-789. [PMID: 31040657 PMCID: PMC6452800 DOI: 10.2147/copd.s194003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Computed tomography (CT) is increasingly used in clinical research for single-slice assessment of muscle mass to correlate with clinical outcome and evaluate treatment efficacy. The third lumbar level (L3) is considered as reference for muscle, but chest scans generally do not reach beyond the first lumbar level (L1). This study investigates if pectoralis muscle and L1 are appropriate alternatives for L3. Methods CT scans of 115 stage IV non-small cell lung cancer patients were analyzed before and during tumor therapy. Skeletal muscle assessed at pectoralis and L1 muscle was compared to L3 at baseline. Furthermore, the prognostic significance of changes in muscle mass determined at different locations was investigated. Results Pearson’s correlation coefficient between skeletal muscle at L3 and L1 was stronger (r=0.90, P<0.001) than between L3 and pectoralis muscle (r=0.71, P<0.001). Cox regression analysis revealed that L3 (HR 0.943, 95% CI: 0.92–0.97, P<0.001) and L1 muscle loss (HR 0.954, 95% CI: 0.93–0.98, P<0.001) predicted overall survival, whereas pectoralis muscle loss did not. Conclusion L1 is a better alternative than pectoralis muscle to substitute L3 for analysis of muscle mass from regular chest CT scans.
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Affiliation(s)
- Karin J C Sanders
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands,
| | - Juliette H R J Degens
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands,
| | - Anne-Marie C Dingemans
- Department of Respiratory Medicine, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre, Maastricht, the Netherlands,
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9
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Coats V, Després JP, Alméras N, Martin M, Sin DD, Rabasa-Lhoret R, Larose É, Tan WC, Bourbeau J, Maltais F. Ectopic adiposity and cardiometabolic health in COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3331-3340. [PMID: 30410322 PMCID: PMC6197246 DOI: 10.2147/copd.s168963] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rationale Obesity/overweight is the most prevalent body composition abnormality in COPD. However, little is known about the impact of fat distribution on cardiometabolic health in COPD. Objective To study the associations between ectopic adiposity, cardiometabolic health, and COPD. Methods A total of 263 subjects (166 males; age=65±9 years) were randomly selected from the general population. Subjects were classified as non-COPD controls and COPD, according to the Global initiative for chronic Obstructive Lung Disease (GOLD) classification, and the presence of cardiometabolic comorbidities was recorded. Ectopic fat accumulation was documented from computed tomography measurements of visceral adipose tissue cross-sectional areas and muscle mean attenuation, assessed at L4–L5. Blood glucose, lipid, and adipokine profiles were also evaluated. Results After correcting for age, sex, and tobacco exposure, visceral adipose tissue cross-sectional area was higher in GOLD 2+ compared to GOLD 1 individuals. Consistent with this, mean muscle tissue attenuation was lower in GOLD 2+ vs GOLD 1 and non-COPD controls (P<0.001). In multiple regression models, visceral adipose tissue cross-sectional area was strongly associated with hypertension (P<0.001) and diabetes (P<0.001), while muscle attenuation was associated with coronary artery disease (P<0.001). Blood glucose, lipid, and adipokine profiles were similar across groups with the exception of leptin level which was higher in GOLD 2+ subjects compared to GOLD 1 and controls. Conclusion GOLD 2+ COPD was associated with ectopic fat accumulation which modulated cardiometabolic health.
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Affiliation(s)
- Valérie Coats
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Jean-Pierre Després
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Natalie Alméras
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Mickaël Martin
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Don D Sin
- University of British Columbia, Vancouver, BC, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, Département de Nutrition et Service d'Endocrinologie, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Éric Larose
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
| | - Wan C Tan
- University of British Columbia, Vancouver, BC, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - François Maltais
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, QC, Canada,
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10
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Effects of Iodixanol on Respiratory Functions during Coronary Angiography and the Role of Body Composition. Cardiol Res Pract 2018; 2018:2140219. [PMID: 30026987 PMCID: PMC6031165 DOI: 10.1155/2018/2140219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The purposes of this study are to assess the acute effects of iodixanol, an iso-osmolar contrast media, on pulmonary functions and to evaluate the body composition in order to find out its role in causing this deterioration. Methods 35 male and 25 female patients undergoing diagnostic coronary angiography (CA) were enrolled in the study. Before CA, all patients' body compositions were evaluated by measuring their body mass indexes (BMIs) and waist-to-hip ratios (WHRs). Total body waters (TBWs), fat masses (FMs), fat-free masses (FFMs), and basal metabolism rates (BMRs) were measured via bioimpedance analysis. The CA was performed via radial artery route using iodixanol in every patient. The pulmonary function tests of these patients were performed before, during, and 2 hours after the CA. FEV1∆, FEF25–75%∆, and FVC∆ parameters were calculated by subtracting the measured baseline value from the measurement after the CA. Results Angiography caused significant reduction in forced expiratory volume in 1 sec (FEV1, from 94.17 ± 18.83 to 84.45 ± 18.31, p < 0.0001), forced vital capacity (FVC, from 96.57 ± 15.82 to 88.31 ± 17.96, p < 0.0001), and forced expiratory flow at 25–75% (FEF25–75% from 82.54 ± 24.26 to 72.11 ± 25.41, p=0.001) and remained lower after 2 h after CA in male patients, respectively. FEV1 values were 103.40 ± 17.79 to 94.96 ± 17.063 (p=0.004); FVC values were 107.20 ± 19.03 to 99.08 ± 20.56 (p=0.009); and FEF25–75% values were 83.92 ± 24.30 to 73.24 ± 20.45 (p=0.005) before and after CA and remained lower after 2 h after CA in female patients, respectively. FEV1/FVC ratio remained unchanged. FEF25–75%∆ was statistically correlated with FFM, TBW, and WHR (p < 0.05; r=−0.344, r=−0.347, and r=0.357, resp.), and FVC∆ was correlated with WHR in male patients (p=0.018, r=397). Conclusions Our data suggested that diagnostic CA using iodixanol, an iso-osmolar contrast media, leads significant impairment in respiratory functions. Due to the persistence of these reductions even 2 hours after CA, ventilatory functions should be considered especially in patients whose body compositions or hydration levels are not within the desired physiological range.
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Lee LW, Lin CM, Li HC, Hsiao PL, Chung AC, Hsieh CJ, Wu PC, Hsu SF. Body composition changes in male patients with chronic obstructive pulmonary disease: Aging or disease process? PLoS One 2017; 12:e0180928. [PMID: 28700654 PMCID: PMC5507284 DOI: 10.1371/journal.pone.0180928] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/25/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) mainly affects middle-age and elderly adults. It is unclear if the presence of muscle wasting and fat accumulation in patients with COPD is age or disease-related. This study investigated the effect of age and COPD disease severity on body composition with the aim of identifying a biomarker(s) for COPD. METHODS Healthy subjects and patients with COPD of different severity were recruited. Dual-energy X-ray absorptiometry was used to analyze total and segmental body composition. Subjects included in the analysis were classified into four groups: healthy young (aged 20-45 years) (n = 35), healthy old (aged ≥ 60 years) (n = 37), moderate COPD (n = 40), and severe COPD (n = 14). RESULTS In healthy old adults, leg and limb lean masses were lower by 10.6% and 8.5%, respectively, compared with healthy young adults (P < 0.05). Appendicular lean outcomes were significantly lower in the moderate COPD compared to the healthy old group and were significant lower in subjects with severe COPD compared to those with moderate COPD. All fat depots were similar for both young and old healthy subjects and subjects with moderate COPD, but significantly decreased in patients with severe COPD. CONCLUSIONS This study examined the changes in total and segmental body composition with aging and COPD severity. It found that aging and COPD altered the body composition differently, and the effect was most pronounced in leg lean mass. Remarkably, differences in appendicular lean masses were seen in mild COPD although no changes in body weight or BMI were apparent compared with healthy young adults. In contrast, fat depot changes were only observed in severe COPD. Aging and COPD processes are multifactorial and additional longitudinal studies are required to explore both the quantitative and qualitative changes in body composition with aging and disease process.
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Affiliation(s)
- Li-Wen Lee
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Chieh-Mo Lin
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Division of Pulmonary and Critical Care medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chou Li
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-Lin Hsiao
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - An-Chi Chung
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Jung Hsieh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pi-Chi Wu
- Department of Nursing, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shu-Feng Hsu
- Department of Nursing, Chang Gung Memorial Hospital, Chiayi, Taiwan
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12
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Khazraee T, Fararouei M, Daneshmandi H, Mobasheri F, Zamanian Z. Maximal Oxygen Consumption, Respiratory Volume and Some Related Factors in Fire-fighting Personnel. Int J Prev Med 2017; 8:25. [PMID: 28479967 PMCID: PMC5404355 DOI: 10.4103/ijpvm.ijpvm_299_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 02/19/2017] [Indexed: 12/25/2022] Open
Abstract
Background: Firefighters for difficult activities and rescue of damaged people must be in appropriate physical ability. Maximal oxygen capacity is an indicator for diagnosis of physical ability of workers. This study aimed to assess the cardiorespiratory system and its related factors in firefighters. Methods: This study was conducted on 110 firefighters from various stations. An self-administered questionnaire (respiratory disorders questionnaire, Tuxworth-Shahnavaz step test, and pulmonary function test) was used to collection of required data. Average of humidity and temperature was 52% and 17°C, respectively. Background average noise levels were between 55 and 65 dB. Data were analyzed using SPSS software (version 19). Results: The mean age of the study participants was 32 ± 6.2 years. The means of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/FVC were 92% ±9.4%, 87% ±9.2%, and 80% ±6.1%, respectively. The participants’ mean VO2-max was 2.79 ± 0.29 L/min or 37.34 ± 4.27 ml/kg body weight per minute. The results revealed that weight has a direct association with vital capacity (VC), FVC, and peak expiratory flow. In addition, height was directly associated with VC, FVC, and VO2-max (P < 0.05). However, there was an inverse and significant association between height and FEV1/FVC (r = −0.23, P < 0.05). Height, weight, body mass index, and waist circumference were directly associated with VO2-max. Conclusions: The findings of this study showed that the amount of maximum oxygen consumption is close with the proposed range of this parameter among firefighters in other studies. Furthermore, the results of the study revealed that individuals had normal amounts of lung volume index. This issue can be attributed to the appropriate usage of respiratory masks.
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Affiliation(s)
- Touraj Khazraee
- Deputy of Occupational Health, Fasa University of Medical Science, Fasa, Iran
| | - Mohammad Fararouei
- Department of Occupational Health Engineering, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Daneshmandi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzane Mobasheri
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zamanian
- Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Martin M, Almeras N, Després JP, Coxson HO, Washko GR, Vivodtzev I, Wouters EF, Rutten E, Williams MC, Murchison JT, MacNee W, Sin DD, Maltais F. Ectopic fat accumulation in patients with COPD: an ECLIPSE substudy. Int J Chron Obstruct Pulmon Dis 2017; 12:451-460. [PMID: 28203068 PMCID: PMC5293362 DOI: 10.2147/copd.s124750] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Obesity is increasingly associated with COPD, but little is known about the prevalence of ectopic fat accumulation in COPD and whether this can possibly be associated with poor clinical outcomes and comorbidities. The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) substudy tested the hypothesis that COPD is associated with increased ectopic fat accumulation and that this would be associated with COPD-related outcomes and comorbidities. METHODS Computed tomography (CT) images of the thorax obtained in ECLIPSE were used to quantify ectopic fat accumulation at L2-L3 (eg, cross-sectional area [CSA] of visceral adipose tissue [VAT] and muscle tissue [MT] attenuation, a reflection of muscle fat infiltration) and CSA of MT. A dose-response relationship between CSA of VAT, MT attenuation and CSA of MT and COPD-related outcomes (6-minute walking distance [6MWD], exacerbation rate, quality of life, and forced expiratory volume in 1 second [FEV1] decline) was addressed with the Cochran-Armitage trend test. Regression models were used to investigate possible relationships between CT body composition indices and comorbidities. RESULTS From the entire ECLIPSE cohort, we identified 585 subjects with valid CT images at L2-L3 to assess body composition. CSA of VAT was increased (P<0.0001) and MT attenuation was reduced (indicating more muscle fat accumulation) in patients with COPD (P<0.002). Progressively increasing CSA of VAT was not associated with adverse clinical outcomes. The probability of exhibiting low 6MWD and accelerated FEV1 decline increased with progressively decreasing MT attenuation and CSA of MT. In COPD, the probability of having diabetes (P=0.024) and gastroesophageal reflux (P=0.0048) at baseline increased in parallel with VAT accumulation, while the predicted MT attenuation increased the probability of cardiovascular comorbidities (P=0.042). Body composition parameters did not correlate with coronary artery scores or with survival. CONCLUSION Ectopic fat accumulation is increased in COPD, and this was associated with relevant clinical outcomes and comorbidities.
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Affiliation(s)
- Mickaël Martin
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Natalie Almeras
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Jean-Pierre Després
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
| | - Harvey O Coxson
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - George R Washko
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Isabelle Vivodtzev
- Hypoxia Pathophysiology Laboratory, Grenoble University Hospital, Grenoble, France
| | - Emiel Fm Wouters
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht
| | - Erica Rutten
- Research and Development, CIRO, Horn, the Netherlands
| | | | - John T Murchison
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - William MacNee
- Department of Respiratory Medicine, University of Edinburgh
| | - Don D Sin
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - François Maltais
- Research Centre, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC
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De Blasio F, Rutten EPA, Wouters EFM, Scalfi L, De Blasio F, Akkermans MA, Spruit MA, Franssen FME. Preliminary study on the assessment of visceral adipose tissue using dual-energy x-ray absorptiometry in chronic obstructive pulmonary disease. Multidiscip Respir Med 2016; 11:33. [PMID: 27729977 PMCID: PMC5048671 DOI: 10.1186/s40248-016-0070-3] [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: 05/31/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022] Open
Abstract
Background Visceral adipose tissue (VAT) was shown to be increased in patients with chronic obstructive pulmonary disease (COPD) compared to control subjects with comparable body mass index (BMI). Our aim was to determine the relation of VAT by dual-energy x-ray absorptiometry (DEXA) in patients with COPD by disease severity, BMI, other indices of body composition and static lung volumes. Methods 294 COPD patients admitted for rehabilitation were studied. Lung function, static lung volumes and body composition (i.e. BMI, waist circumference, fat-free mass, fat mass and fat distribution between android and gynoid fat mass) were assessed before entering pulmonary rehabilitation. VAT was estimated within the android region by using DEXA. Patients were stratified for gender, BMI (cut-off of 25 kg/m2) and GOLD stage. To assess the impact of VAT on lung volumes, patients were also stratified for VAT less and above 50th percentile. Results Both male and female patients with more severe airflow limitation had significantly lower VAT values, but these differences disappeared after stratification for BMI. VAT was significantly and strongly correlated with other body composition parameters (all p < 0.001). Patients with moderate to severe airflow limitation and lower VAT had increased static lung hyperinflation and lower diffusing capacity for carbon monoxide. Nevertheless, multivariate stepwise regression models including for BMI, age, gender and forced expiratory volume in 1 s (FEV1) as confounders did not confirm an independent role for VAT on static lung hyperinflation and diffusion capacity. Conclusion After stratification for BMI, VAT is comparable in moderate to very severe COPD patients. Furthermore, BMI and demographics, but not VAT, were independent predictors of static lung hyperinflation and diffusing capacity in COPD.
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Affiliation(s)
- Francesca De Blasio
- Department of Research and Education, CIRO, Horn, The Netherlands ; Department of Public Health, "Federico II" University of Naples Medical School, Naples, Italy
| | - Erica P A Rutten
- Department of Research and Education, CIRO, Horn, The Netherlands
| | | | - Luca Scalfi
- Department of Public Health, "Federico II" University of Naples Medical School, Naples, Italy
| | - Francesco De Blasio
- Respiratory Medicine and Pulmonary Rehabilitation Section, Clinic Center, Private Hospital, Naples, Italy
| | | | - Martijn A Spruit
- Department of Research and Education, CIRO, Horn, The Netherlands
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15
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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: 87] [Impact Index Per Article: 10.9] [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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16
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Higami Y, Ogawa E, Ryujin Y, Goto K, Seto R, Wada H, Tho NV, Lan LTT, Paré PD, Nakano Y. Increased Epicardial Adipose Tissue Is Associated with the Airway Dominant Phenotype of Chronic Obstructive Pulmonary Disease. PLoS One 2016; 11:e0148794. [PMID: 26866482 PMCID: PMC4750940 DOI: 10.1371/journal.pone.0148794] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/21/2016] [Indexed: 02/07/2023] Open
Abstract
Background Epicardial adipose tissue (EAT) has been shown to be a non-invasive marker that predicts the progression of cardiovascular disease (CVD). It has been reported that the EAT volume is increased in patients with chronic obstructive pulmonary disease (COPD). However, little is known about which phenotypes of COPD are associated with increased EAT. Methods One hundred and eighty smokers who were referred to the clinic were consecutively enrolled. A chest CT was used for the quantification of the emphysematous lesions, airway lesions, and EAT. These lesions were assessed as the percentage of low attenuation volume (LAV%), the square root of airway wall area of a hypothetical airway with an internal perimeter of 10 mm (√Aaw at Pi10) and the EAT area, respectively. The same measurements were made on 225 Vietnamese COPD patients to replicate the results. Results Twenty-six of the referred patients did not have COPD, while 105 were diagnosed as having COPD based on a FEV1/FVC<0.70. The EAT area was significantly associated with age, BMI, FEV1 (%predicted), FEV1/FVC, self-reported hypertension, self-reported CVD, statin use, LAV%, and √Aaw at Pi10 in COPD patients. The multiple regression analyses showed that only BMI, self-reported CVD and √Aaw at Pi10 were independently associated with the EAT area (R2 = 0.51, p<0.0001). These results were replicated in the Vietnamese population. Conclusions The EAT area is independently associated with airway wall thickness. Because EAT is also an independent predictor of CVD risk, these data suggest a mechanistic link between the airway predominant form of COPD and CVD.
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Affiliation(s)
- Yuichi Higami
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Emiko Ogawa
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
- Health Administration Center, Shiga University of Medical Science, Shiga, Japan
- * E-mail:
| | - Yasushi Ryujin
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Kenichi Goto
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Ruriko Seto
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hiroshi Wada
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Nguyen Van Tho
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Le Thi Tuyet Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Peter D. Paré
- University of British Columbia Center for Heart Lung Innovation, St Paul’s Hospital, Vancouver, BC, Canada
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
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Diaz AA, Young TP, Kurugol S, Eckbo E, Muralidhar N, Chapman JK, Kinney GL, Ross JC, San Jose Estepar R, Harmouche R, Black-Shinn JL, Budoff M, Bowler RP, Hokanson J, Washko GR. Abdominal Visceral Adipose Tissue is Associated with Myocardial Infarction in Patients with COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2015. [PMID: 25914898 DOI: 10.15326/jcopdf.2.1.2015.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cardiovascular diseases are frequent and a major cause of death in patients with chronic obstructive pulmonary disease (COPD). In the general population, various fat depots including abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat have been linked to increased risk of cardiovascular diseases. We hypothesize that these adipose tissue compartments are associated with myocardial infarction (MI) in patients with COPD. METHODS We collected measures of VAT and SAT areas and liver attenuation on the computed tomography scan of the chest from 1267 patients with COPD. MI was a self-reported physician-diagnosed outcome. The association between fat depots and self-reported history of MI was assessed by logistic regression analysis in which the patients within the 2 lowest tertiles of VAT and SAT areas were the reference group. RESULTS Eighty three patients (6.6%) reported a history of MI at the time of enrollment. Compared to patients who did not have an MI episode, those who had a prior MI had a higher VAT area (mean ± SD, 303.4 ± 208.5 vs. 226.8 ± 172.6 cm2; P=0.002) with no differences in SAT area and liver fat. After adjustment for age, gender, obesity, pack years of smoking, hypertension, high cholesterol, and diabetes, patients within the upper tertile (vs. those in the lower tertiles) of VAT area had increased odds of MI (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.02 - 3.41). CONCLUSION Increased abdominal visceral fat is independently associated with a history of MI in individuals with COPD.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tom P Young
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sila Kurugol
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erick Eckbo
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina Muralidhar
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua K Chapman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado- Denver, Aurora, Colorado
| | - James C Ross
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raul San Jose Estepar
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rola Harmouche
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer L Black-Shinn
- Department of Epidemiology, Colorado School of Public Health, University of Colorado- Denver, Aurora, Colorado
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Russell P Bowler
- Department of Medicine, University of Colorado School of Medicine, Aurora
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado- Denver, Aurora, Colorado
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Bae J, Kim N, Lee SM, Seo JB, Kim HC. Thoracic cavity segmentation algorithm using multiorgan extraction and surface fitting in volumetric CT. Med Phys 2014; 41:041908. [PMID: 24694139 DOI: 10.1118/1.4866836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To develop and validate a semiautomatic segmentation method for thoracic cavity volumetry and mediastinum fat quantification of patients with chronic obstructive pulmonary disease. METHODS The thoracic cavity region was separated by segmenting multiorgans, namely, the rib, lung, heart, and diaphragm. To encompass various lung disease-induced variations, the inner thoracic wall and diaphragm were modeled by using a three-dimensional surface-fitting method. To improve the accuracy of the diaphragm surface model, the heart and its surrounding tissue were segmented by a two-stage level set method using a shape prior. To assess the accuracy of the proposed algorithm, the algorithm results of 50 patients were compared to the manual segmentation results of two experts with more than 5 years of experience (these manual results were confirmed by an expert thoracic radiologist). The proposed method was also compared to three state-of-the-art segmentation methods. The metrics used to evaluate segmentation accuracy were volumetric overlap ratio (VOR), false positive ratio on VOR (FPRV), false negative ratio on VOR (FNRV), average symmetric absolute surface distance (ASASD), average symmetric squared surface distance (ASSSD), and maximum symmetric surface distance (MSSD). RESULTS In terms of thoracic cavity volumetry, the mean ± SD VOR, FPRV, and FNRV of the proposed method were (98.17 ± 0.84)%, (0.49 ± 0.23)%, and (1.34 ± 0.83)%, respectively. The ASASD, ASSSD, and MSSD for the thoracic wall were 0.28 ± 0.12, 1.28 ± 0.53, and 23.91 ± 7.64 mm, respectively. The ASASD, ASSSD, and MSSD for the diaphragm surface were 1.73 ± 0.91, 3.92 ± 1.68, and 27.80 ± 10.63 mm, respectively. The proposed method performed significantly better than the other three methods in terms of VOR, ASASD, and ASSSD. CONCLUSIONS The proposed semiautomatic thoracic cavity segmentation method, which extracts multiple organs (namely, the rib, thoracic wall, diaphragm, and heart), performed with high accuracy and may be useful for clinical purposes.
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Affiliation(s)
- JangPyo Bae
- Interdisciplinary Program, Bioengineering Major, Graduate School, Seoul National University, Seoul 110-744, South Korea and Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Namkug Kim
- Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Sang Min Lee
- Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Joon Beom Seo
- Department of Radiology, University of Ulsan College of Medicine, 388-1 Pungnap2-dong, Songpa-gu, Seoul 138-736, South Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, College of Medicine and Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul 110-744, South Korea
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Abstract
BACKGROUND Overweight⁄obesity is associated with longer survival in chronically ill patients, a phenomenon referred to as the 'obesity paradox'. OBJECTIVE To investigate whether the obesity paradox in patients with chronic obstructive pulmonary disease (COPD) is due to fat accumulation or confounding factors. METHODS A total of 190 patients with stable COPD who underwent a mean (± SD) follow-up period of 72±34 months were enrolled. Anthropometry, pulmonary function tests, midthigh muscle cross-sectional area obtained using computed tomography (MTCSACT), arterial blood gas and exercise testing data were measured at baseline. Patients were categorized into two subgroups according to body mass index (BMI) <25 kg⁄m2 or ≥25 kg⁄m2 (normal and overweight⁄obese, respectively). RESULTS Seventy-two patients (38%) died during the follow-up period. Survival tended to be better in the overweight⁄obese patients but this difference did not reach statistical significance. Overweight⁄obese patients had better lung function and a larger MTCSACT than those with normal BMI (P<0.001). Overweight⁄obese patients also had a significantly higher peak work rate than patients with normal BMI (P<0.001). PaO2 and PaCO2 were not significantly different in the two groups. When adjusted for PaCO2, peak work rate and MTCSACT, the tendency for improved survival in overweight⁄obese patients disappeared. In fact, when these variables were considered in the survival analysis, patients with lower BMI tended to have better survival. CONCLUSION These results suggest that important confounders, such as hypercapnia, exercise capacity and muscle mass, should be considered when interpreting the association between increased BMI and survival in patients with COPD.
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The impact of low subcutaneous fat in patients with nontuberculous mycobacterial lung disease. Lung 2014; 192:395-401. [PMID: 24549334 DOI: 10.1007/s00408-014-9565-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/04/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM) are pathogens that cause chronic respiratory disease, even in immunocompetent patients. We hypothesized that low subcutaneous fat is a predisposing factor for NTM lung disease. METHODS Following a retrospective review of medical records from between 2005 and 2012, a total of 148 patients with NTM lung disease and 142 age- and sex-matched controls were enrolled. We evaluated subcutaneous fat using chest computed tomography (CT) scans at the midpole level of the left kidney. RESULTS The median age of the patients was 62 years and 60.8 % were female. Approximately 71 % were classified into a nodular bronchiectatic group. The patient group had significantly less subcutaneous fat than the control group (39.3 vs. 53.0 cm(2), p = 0.001). Patients with both localized disease (43.5 vs. 53.0 cm(2), p = 0.042) and extensive disease (35.9 vs. 53.0 cm(2), p < 0.0001) had less subcutaneous fat compared with the control group. No difference in subcutaneous fat was observed with respect to the increasing bacterial load in sputum (p = 0.246). In 20 patients with prominent disease progression during the follow-up period, no significant difference was observed between subcutaneous fat at the initial diagnosis and that at the follow-up CT (36.2 vs. 42.0 cm(2), p = 0.47). CONCLUSION Our results suggest that lower subcutaneous fat may contribute to host susceptibility to NTM lung disease.
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21
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Koršić M, Kušec V. Serum leptin and skeletal differences between obese and non-obese patients with chronic obstructive pulmonary disease. Obes Facts 2014; 7:399-407. [PMID: 25428659 PMCID: PMC5644820 DOI: 10.1159/000369990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 09/15/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) affects body composition, adipokine secretion, and skeletal integrity. The aim was to determine the association between leptin, body mass (BM) and body composition parameters - fat mass (FM) and fat mass index (FMI), lean tissue mass (LTM), lean tissue mass index (LTMI) and bone mineral density (BMD) in 67 male COPD patients. METHODS BM, body composition and biochemical indicators were measured or calculated using standard methods. Data were analyzed according to groups: non-obese (N = 48, BMI 21.0-29.9 kg/m(2)) and obese (N = 19, BMI ≥ 30.0 kg/m(2)). RESULTS In the non-obese group statistically significant correlations were observed: negative ones of age with most BMD T scores, positive ones of BMI with all T scores, FM, FMI, LTMI and leptin, of FMI with leptin and all T scores, and of LTMI with most T scores. In the obese group also statistically significant correlations were found: positive ones of BMI with FMI, LTM, leptin and T scores (trochanter, total hip); of FMI with leptin; and of leptin with total hip T score. CONCLUSION A positive relationship between FMI and BMD was found only in non-obese but not in obese COPD patients. Leptin concentration was associated positively with the total hip T score only in obese COPD patients, suggesting its protective role on the skeleton of obese COPD patients.
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Affiliation(s)
- Marta Koršić
- Clinic for Lung Disease, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Vesna Kušec
- Clinical Institute of Laboratory Diagnosis, Clinical Hospital Centre Zagreb, Zagreb, Croatia
- *Vesna Kusec, MD PhD, Clinical Institute of Laboratory Diagnosis, Clinical Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb (Croatia),
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22
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Diaz AA, Young TP, Kurugol S, Eckbo E, Muralidhar N, Chapman JK, Kinney GL, Ross JC, San Jose Estepar R, Harmouche R, Black-Shinn JL, Budoff M, Bowler RP, Hokanson J, Washko GR. Abdominal Visceral Adipose Tissue is Associated with Myocardial Infarction in Patients with COPD. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2014; 2:1-3. [PMID: 25914898 DOI: 10.15326/jcopdf.2.1.2014.0127] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiovascular diseases are frequent and a major cause of death in patients with chronic obstructive pulmonary disease (COPD). In the general population, various fat depots including abdominal visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and liver fat have been linked to increased risk of cardiovascular diseases. We hypothesize that these adipose tissue compartments are associated with myocardial infarction (MI) in patients with COPD. METHODS We collected measures of VAT and SAT areas and liver attenuation on the computed tomography scan of the chest from 1267 patients with COPD. MI was a self-reported physician-diagnosed outcome. The association between fat depots and self-reported history of MI was assessed by logistic regression analysis in which the patients within the 2 lowest tertiles of VAT and SAT areas were the reference group. RESULTS Eighty three patients (6.6%) reported a history of MI at the time of enrollment. Compared to patients who did not have an MI episode, those who had a prior MI had a higher VAT area (mean ± SD, 303.4 ± 208.5 vs. 226.8 ± 172.6 cm2; P=0.002) with no differences in SAT area and liver fat. After adjustment for age, gender, obesity, pack years of smoking, hypertension, high cholesterol, and diabetes, patients within the upper tertile (vs. those in the lower tertiles) of VAT area had increased odds of MI (odds ratio [OR] 1.86, 95% confidence interval [CI] 1.02 - 3.41). CONCLUSION Increased abdominal visceral fat is independently associated with a history of MI in individuals with COPD.
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Affiliation(s)
- Alejandro A Diaz
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tom P Young
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sila Kurugol
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erick Eckbo
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nina Muralidhar
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joshua K Chapman
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gregory L Kinney
- Department of Epidemiology, Colorado School of Public Health, University of Colorado- Denver, Aurora, Colorado
| | - James C Ross
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Raul San Jose Estepar
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rola Harmouche
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jennifer L Black-Shinn
- Department of Epidemiology, Colorado School of Public Health, University of Colorado- Denver, Aurora, Colorado
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Torrance, California
| | - Russell P Bowler
- Department of Medicine, University of Colorado School of Medicine, Aurora
| | - John Hokanson
- Department of Epidemiology, Colorado School of Public Health, University of Colorado- Denver, Aurora, Colorado
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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23
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Zagaceta J, Zulueta JJ, Bastarrika G, Colina I, Alcaide AB, Campo A, Celli BR, de Torres JP. Epicardial adipose tissue in patients with chronic obstructive pulmonary disease. PLoS One 2013; 8:e65593. [PMID: 23762399 PMCID: PMC3675061 DOI: 10.1371/journal.pone.0065593] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/29/2013] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Epicardial Adipose Tissue (EAT) volume as determined by chest computed tomography (CT) is an independent marker of cardiovascular events in the general population. COPD patients have an increased risk of cardiovascular disease, however nothing is known about the EAT volume in this population. OBJECTIVES To assess EAT volume in COPD and explore its association with clinical and physiological variables of disease severity. METHODS We measured EAT using low-dose CT in 171 stable COPD patients and 70 controls matched by age, smoking history and BMI. We determined blood pressure, cholesterol, glucose and HbA1c levels, microalbuminuria, lung function, BODE index, co-morbidity index and coronary artery calcium score (CAC). EAT volume were compared between groups. Uni and multivariate analyses explored the relationship between EAT volume and the COPD related variables. RESULTS COPD patients had a higher EAT volume [143.7 (P25-75, 108.3-196.6) vs 129.1 (P25-75, 91.3-170.8) cm(3), p = 0.02)] and the EAT volume was significantly associated with CAC (r = 0.38, p<0.001) and CRP (r = 0.32, p<0.001) but not with microalbuminuria (r = 0.12, p = 0.13). In COPD patients, EAT volume was associated with: age, pack-years, BMI, gender, FEV1%, 6 MWD, MMRC and HTN. Multivariate analysis showed that only pack-years (B = 0.6, 95% CI: 0.5-1.3), BMI (B = 7.8, 95% CI: 5.7-9.9) and 6 MWD (B = -0.2, 95% CI: -0.3--0.1), predicted EAT volume. CONCLUSIONS EAT volume is increased in COPD patients and is independently associated with smoking history, BMI and exercise capacity, all modifiable risk factors of future cardiovascular events. EAT volume could be a non-invasive marker of COPD patients at high risk for future cardiovascular events.
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Affiliation(s)
- Jorge Zagaceta
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Javier J. Zulueta
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Gorka Bastarrika
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Inmaculada Colina
- Internal Medicine Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Ana B. Alcaide
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Arantza Campo
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
| | - Bartolome R. Celli
- Pulmonary Division, Brigham and Women’s Hospital, Boston, Massachussetts, United States of America
| | - Juan P. de Torres
- Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain
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de Lucas-Ramos P, Izquierdo-Alonso JL, Rodriguez-Gonzalez Moro JM, Frances JF, Lozano PV, Bellón-Cano JM. Chronic obstructive pulmonary disease as a cardiovascular risk factor. Results of a case-control study (CONSISTE study). Int J Chron Obstruct Pulmon Dis 2012; 7:679-86. [PMID: 23055717 PMCID: PMC3468057 DOI: 10.2147/copd.s36222] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) patients present a high prevalence of cardiovascular disease. This excess of comorbidity could be related to a common pathogenic mechanism, but it could also be explained by the existence of common risk factors. The objective of this study was to determine whether COPD patients present greater cardiovascular comorbidity than control subjects and whether COPD can be considered a risk factor per se. Methods 1200 COPD patients and 300 control subjects were recruited for this multicenter, cross-sectional, case–control study. Results Compared with the control group, the COPD group showed a significantly higher prevalence of ischemic heart disease (12.5% versus 4.7%; P < 0.0001), cerebrovascular disease (10% versus 2%; P < 0.0001), and peripheral vascular disease (16.4% versus 4.1%; P < 0.001). In the univariate risk analysis, COPD, hypertension, diabetes, obesity, and dyslipidemia were risk factors for ischemic heart disease. In the multivariate analysis adjusted for the remaining factors, COPD was still an independent risk factor (odds ratio: 2.23; 95% confidence interval: 1.18–4.24; P = 0.014). Conclusion COPD patients show a high prevalence of cardiovascular disease, higher than expected given their age and the coexistence of classic cardiovascular risk factors.
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Affiliation(s)
- Pilar de Lucas-Ramos
- Servicio de Neumologia, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
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van den Borst B, Gosker HR, Koster A, Yu B, Kritchevsky SB, Liu Y, Meibohm B, Rice TB, Shlipak M, Yende S, Harris TB, Schols AMWJ. The influence of abdominal visceral fat on inflammatory pathways and mortality risk in obstructive lung disease. Am J Clin Nutr 2012; 96:516-26. [PMID: 22811442 PMCID: PMC3417214 DOI: 10.3945/ajcn.112.040774] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Low-grade systemic inflammation, particularly elevated IL-6, predicts mortality in chronic obstructive pulmonary disease (COPD). Although altered body composition, especially increased visceral fat (VF) mass, could be a significant contributor to low-grade systemic inflammation, this remains unexplored in COPD. OBJECTIVE The objective was to investigate COPD-specific effects on VF and plasma adipocytokines and their predictive value for mortality. DESIGN Within the Health, Aging, and Body Composition (Health ABC) Study, an observational study in community-dwelling older persons, we used propensity scores to match n = 729 persons with normal lung function to n = 243 persons with obstructive lung disease (OLD; defined as the ratio of forced expiratory volume in 1 s to forced vital capacity < lower limit of normal). Matching was based on age, sex, race, clinic site, BMI, and smoking status. Within this well-balanced match, we compared computed tomography-acquired visceral fat area (VFA) and plasma adipocytokines, analyzed independent associations of VFA and OLD status on plasma adipocytokines, and studied their predictive value for 9.4-y mortality. RESULTS Whereas whole-body fat mass was comparable between groups, persons with OLD had increased VFA and higher plasma IL-6, adiponectin, and plasminogen activator inhibitor 1 (PAI-1). Both OLD status and VFA were independently positively associated with IL-6. Adiponectin was positively associated with OLD status but negatively associated with VFA. PAI-1 was no longer associated with OLD status after VFA was accounted for. Participants with OLD had increased risk of all-cause, respiratory, and cardiovascular mortality, of which IL-6 was identified as an independent predictor. CONCLUSION Our data suggest that excessive abdominal visceral fat contributes to increased plasma IL-6, which, in turn, is strongly associated with all-cause and cause-specific mortality in older persons with OLD.
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Affiliation(s)
- Bram van den Borst
- NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
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