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Kim J, Lee CH, Lee HY, Kim H. Association between Comorbidities and Preserved Ratio Impaired Spirometry: Using the Korean National Health and Nutrition Examination Survey IV-VI. Respiration 2021; 101:25-33. [PMID: 34320510 DOI: 10.1159/000517599] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) patients have more frequent respiratory symptoms and an increased risk of mortality. However, studies on comorbidities in these patients are lacking. OBJECTIVES We investigated the association between PRISm and comorbidities using the Korea National Health and Nutrition Examination Survey (KNHANES). METHOD This cross-sectional study included participants aged ≥50 years from the KNHANES (2007-2015). Participants who did not undergo spirometry or performed inadequately were excluded. We classified participants into 3 groups according to spirometry: PRISm (forced expiratory volume in one second [FEV1] /forced vital capacity [FVC] ≥ 0.7 and FEV1 <80%), chronic obstructive pulmonary disease (COPD) (FEV1/ FVC <0.7), and normal. Multivariate logistic regression analyses were used to evaluate the risk of comorbidities in the PRISm group compared to that in the normal group. RESULT The study included 17,515 participants: 12,777 (73.0%), 1,563 (8.9%), and 3,175 (18.1%) in normal, PRISm, and COPD groups, respectively. After adjustment for known risk factors of each disease, hypertension (adjusted odds ratio [95% confidence interval]; 1.31 [1.14-1.50]), diabetes (1.51 [1.29-1.78]), hypercholesterolemia (1.20 [1.04-1.37]), obesity (1.31 [1.15-1.48]), ischemic heart disease (1.58 [1.13-2.22]), chronic renal disease (2.31 [1.09-4.88]), and thyroid disease (1.41 [1.09-1.83]) risks were significantly higher in the PRISm group than in the normal group. The average number of comorbidities was 2.45 in the PRISm group, which was higher than that in the normal (2.1) and COPD (2.03) groups (p < 0.05). CONCLUSION The number of comorbidities was significantly higher in the PRISm group than in others. Hypertension, diabetes, obesity, ischemic heart disease, chronic renal disease, and thyroid disease were associated with PRISm after adjustment for risk factors.
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Affiliation(s)
- Joohae Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea, .,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea,
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ha Youn Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Serim Hospital, Incheon, Republic of Korea
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,Institute for Sustainable Development, Seoul National University, Seoul, Republic of Korea
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Terruzzi I, Senesi P. Does intestinal dysbiosis contribute to an aberrant inflammatory response to severe acute respiratory syndrome coronavirus 2 in frail patients? Nutrition 2020; 79-80:110996. [PMID: 33002653 PMCID: PMC7462523 DOI: 10.1016/j.nut.2020.110996] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/02/2020] [Accepted: 08/15/2020] [Indexed: 02/07/2023]
Abstract
In a few months, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has become the main health problem worldwide. Epidemiologic studies revealed that populations have different vulnerabilities to SARS-CoV-2. Severe outcomes of the coronavirus disease 2019 (COVID-19) with an increased risk of death are observed in patients with metabolic syndrome, as well as diabetic and heart conditions (frail population). Excessive proinflammatory cytokine storm could be the main cause of increased vulnerability in this frail population. In patients with diabetes and/or heart disease, a low inflammatory state is often associated with gut dysbiosis. The increase amount of microbial metabolites (i.e., trimethylamine N-oxide and lipopolysaccharide), which generate an inflammatory microenvironment, is probably associated with an improved risk of severe illness from COVID-19. Nutritional interventions aimed at restoring the gut microbial balance could represent preventive strategies to protect the frail population from COVID-19. This narrative review presents the possible molecular mechanisms by which intestinal dysbiosis that enhances the inflammatory state could promote the spread of SARS-CoV-2 infection. Some nutritional strategies to counteract inflammation in frail patients are also analyzed.
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Affiliation(s)
- Ileana Terruzzi
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy.
| | - Pamela Senesi
- Department of Biomedical Sciences and Health, Università degli Studi di Milano, Milan, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
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Sakhamuri S, Lutchmansingh F, Simeon D, Conyette L, Burney P, Seemungal T. Reduced forced vital capacity is independently associated with ethnicity, metabolic factors and respiratory symptoms in a Caribbean population: a cross-sectional study. BMC Pulm Med 2019; 19:62. [PMID: 30866890 PMCID: PMC6416949 DOI: 10.1186/s12890-019-0823-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 12/05/2022] Open
Abstract
Background Relationships between low forced vital capacity (FVC), and morbidity have previously been studied but there are no data available for the Caribbean population. This study assessed the association of low FVC with risk factors, health variables and socioeconomic status in a community-based study of the Trinidad and Tobago population. Methods A cross-sectional survey was conducted using the Burden of Obstructive Lung Disease (BOLD) study protocol. Participants aged 40 years and above were selected using a two-stage stratified cluster sampling. Generalized linear models were used to examine associations between FVC and risk factors. Results Among the 1104 participants studied a lower post-bronchodilator FVC was independently associated with a large waist circumference (− 172 ml; 95% CI, − 66 to − 278), Indo-Caribbean ethnicity (− 180 ml; 95% CI, − 90 to − 269) and being underweight (− 185 ml; 95% CI, − 40 to − 330). A higher FVC was associated with smoking cannabis (+ 155 ml; 95% CI, + 27 to + 282). Separate analyses to examine associations with health variables indicated that participants with diabetes (p = 0∙041), history of breathlessness (p = 0∙007), and wheeze in the past 12 months (p = 0∙040) also exhibited lower post-bronchodilator FVC. Conclusion These findings suggest that low FVC in this Caribbean population is associated with ethnicity, low body mass index (BMI), large waist circumference, chronic respiratory symptoms, and diabetes. Electronic supplementary material The online version of this article (10.1186/s12890-019-0823-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sateesh Sakhamuri
- Faculty of Medical Sciences, Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Fallon Lutchmansingh
- Faculty of Medical Sciences, Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Donald Simeon
- Dean's Office, Faculty of Medical Sciences, The University of The West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Liane Conyette
- South-West Regional Health Authority, San Fernando, Trinidad and Tobago
| | - Peter Burney
- National Heart and Lung Institute, Imperial College, London, UK
| | - Terence Seemungal
- Faculty of Medical Sciences, Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
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Rambaran K, Bhagan B, Ali A, Ali F, Toolsie S, Lobin R, Beharry S, Ghany S, Mohammed S, Davis G, Sakhamuri S, Teelucksingh S, Seemungal T. High Prevalence of Diabetes Mellitus in a Cohort of Patients with Chronic Obstructive Pulmonary Disease in Trinidad, West Indies. Turk Thorac J 2019; 20:12-17. [PMID: 30664421 DOI: 10.5152/turkthoracj.2018.18036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/04/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Both chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are highly prevalent in Trinidad, West Indies. Our objective was to evaluate the prevalence of DM in a cohort of Trinidadian patients with COPD and investigate the possible impact of diabetes on COPD using standard outcome measures, that is, lung function, exacerbations, quality of life and depression questionnaires, as well as mortality. MATERIALS AND METHODS This was a cross-sectional follow-up study utilizing a cohort of 105 patients from chest clinics in the three major general hospitals in Trinidad. RESULTS Diabetes was diagnosed based on a glycated hemoglobin (HbA1c) level of ≥6.5% (or a prior self-reported history), and for pre-diabetes, of 5.7%-6.4%. Of 105 patients, 40% fulfilled the criteria for diabetes and 40% for pre-diabetes. Of those diagnosed with diabetes, 38% obtained this diagnosis de novo. A history of intravenous corticosteroid use was associated with higher HbA1c levels (p=0.043) upon diagnosis. The percentage of predicted forced vital capacity was negatively related to HbA1c (p=0.033), but those with diabetes also had a greater body mass index (p=0.001). After a 1-year follow-up, mortality was significantly greater among patients with diabetes (p=0.026). Patients with at least one exacerbation in the past year or poorer lung function parameters had worse quality of life (p≤0.040) and depression (p≤0.018) scores. Notably, 31.4% of the total cohort exhibited clinically significant depression scores. CONCLUSION This study revealed that a high proportion of COPD patients in tertiary care had diabetes or pre-diabetes.
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Affiliation(s)
- Kirin Rambaran
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Bryan Bhagan
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Amanda Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Firas Ali
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Shivan Toolsie
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Rekha Lobin
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Shivani Beharry
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Sabrina Ghany
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Saeeda Mohammed
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Gershwin Davis
- Department of Para-clinical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Sateesh Sakhamuri
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Surujpal Teelucksingh
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
| | - Terence Seemungal
- Department of Clinical Medical Sciences, Faculty of Medical Sciences, the University of the West Indies (St Augustine Campus), Trinidad and Tobago
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Liu P, Ye Z, Lu H, Lu J, Huang L, Gong J, Deng Q, Xu L. Association between body mass index (BMI) and vital capacity of college students of Zhuang nationality in China: a cross-section study. Oncotarget 2017; 8:80923-80933. [PMID: 29113355 PMCID: PMC5655250 DOI: 10.18632/oncotarget.20758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Our study is to evaluate the association between body mass index (BMI) and vital capacity of college students of Zhuang Nationality in China. Methods 463 college students of Zhuang Nationality from Guangxi Medical University were selected. Basic information, body composition and vital capacity of college students were measured. According to the level of BMI, college students were divided into four groups (BMI<18.5, 18.5≤BMI<23.9, 23.9≤BMI<27.9 and BMI≥27.9). Multivariate logistic regression analysis was performed to assess the association between BMI and vital capacity. Results In male college students, there was no significant difference in vital capacity between the four groups (3029.54±869.25, 3347.06±784.54, 3540.00±805.35 and 3966.50±350.2, P=0.0727, respectively). Multivariate regression analysis showed that after adjusting for confounding factors, no significant association was observed between BMI and vital capacity (OR=115.02, 95% CI: -555.58∼785.63; OR=-166.58, 95% CI: -1684.56∼1351.41; OR=-484.01, 95% CI:-3504.53, 2536.51, respectively. BMI<18.5 group served as reference group). In female college students, there was also no significant difference in vital capacity between the four groups (2455.15±574.4, 2555.06±637.03, 2750.33±1224.05 and 2473.00±159.06, P=0.4011, respectively). Multivariate regression analysis showed that after adjusting for confounding factors, no significant association was observed between BMI and vital capacity (OR=-88.88, 95% CI: -333.59∼155.84; OR=20.00, 95% CI: -694.39∼734.39; OR=2.86, 95% CI: -1830.58, 1836.3, respectively. BMI<18.5 group served as reference group). Conclusion There was no evidence that BMI is associated with vital capacity in college students of Zhuang Nationality.
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Affiliation(s)
- Peng Liu
- Department of Anatomy, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Ziliang Ye
- Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Haili Lu
- Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Jingjing Lu
- Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Liqian Huang
- Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Jiangu Gong
- Department of Anatomy, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Qiongying Deng
- Department of Anatomy, Guangxi Medical University, Nanning, Guangxi 530021, China
| | - Lin Xu
- Department of Anatomy, Guangxi Medical University, Nanning, Guangxi 530021, China
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Papinska AM, Soto M, Meeks CJ, Rodgers KE. Long-term administration of angiotensin (1-7) prevents heart and lung dysfunction in a mouse model of type 2 diabetes (db/db) by reducing oxidative stress, inflammation and pathological remodeling. Pharmacol Res 2016; 107:372-380. [PMID: 26956523 PMCID: PMC4867244 DOI: 10.1016/j.phrs.2016.02.026] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/03/2016] [Accepted: 02/25/2016] [Indexed: 10/22/2022]
Abstract
Congestive heart failure is one of the most prevalent and deadly complications of type 2 diabetes that is frequently associated with pulmonary dysfunction. Among many factors that contribute to development and progression of diabetic complications is angiotensin II (Ang2). Activation of pathological arm of renin-angiotensin system results in increased levels of Ang2 and signaling through angiotensin type 1 receptor. This pathway is well recognized for its role in induction of oxidative stress (OS), inflammation, hypertrophy and fibrosis. Angiotensin (1-7) [A(1-7)], through activation of Mas receptor, opposes the actions of Ang2 which can result in the amelioration of diabetic complications; enhancing the overall welfare of diabetic patients. In this study, 8 week-old db/db mice were administered A(1-7) daily via subcutaneous injections. After 16 weeks of treatment, echocardiographic assessment of heart function demonstrated significant improvement in cardiac output, stroke volume and shortening fraction in diabetic animals. A(1-7) also prevented cardiomyocyte hypertrophy, apoptosis, lipid accumulation, and decreased diabetes-induced fibrosis and OS in the heart tissue. Treatment with A(1-7) reduced levels of circulating proinflammatory cytokines that contribute to the low grade inflammation observed in diabetes. In addition, lung pathologies associated with type 2 diabetes, including fibrosis and congestion, were decreased with treatment. OS and macrophage infiltration were also reduced in the lungs after treatment with A(1-7). Long-term administration of A(1-7) to db/db mice is effective in improving heart and lung function in db/db mice. Treatment prevented pathological remodeling of the tissues and reduced OS, fibrosis and inflammation.
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Affiliation(s)
- Anna M Papinska
- University of Southern California, School of Pharmacy, 1985 Zonal Ave., Los Angeles, CA 90033, USA
| | - Maira Soto
- University of Southern California, School of Pharmacy, 1985 Zonal Ave., Los Angeles, CA 90033, USA
| | - Christopher J Meeks
- University of Southern California, School of Pharmacy, 1985 Zonal Ave., Los Angeles, CA 90033, USA
| | - Kathleen E Rodgers
- University of Southern California, School of Pharmacy, 1985 Zonal Ave., Los Angeles, CA 90033, USA.
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Oh IH, Park JH, Lee CH, Park JS. The association of normal range glycated hemoglobin with restrictive lung pattern in the general population. PLoS One 2015; 10:e0117725. [PMID: 25658743 PMCID: PMC4319889 DOI: 10.1371/journal.pone.0117725] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 12/31/2014] [Indexed: 01/22/2023] Open
Abstract
Glycated hemoglobin (HbA1c) is an important diagnostic indicator of diabetes mellitus, and some authors have argued that it is related to impaired lung function in the diabetic population. However, there was rare study for association between lung function and HbA1c in the non-diabetic population. We investigated whether HbA1c below the diagnostic threshold is related to deficits in lung function. We analyzed biochemical and spirometry data from a nation-wide, population-based, case-control study (the KNHANES IV and V). Eligible as cases were all native Koreans aged 40 years or more with no medical illness. A total of 3670 participants were divided into 4 groups according to HbA1c (%) as follows: Group I (n = 842), ≥ 4.0 and ≤ 5.3; Group II (n = 833), > 5.3 and ≤ 5.5; Group III (n = 898), > 5.5 and ≤ 5.7; and Group IV (n = 1097), > 5.7 and ≤ 6.4. Group I had the greatest forced vital capacity (FVC, 96.3 ± 0.5% pred, P < 0.0001), forced expiratory volume per second (FEV1, 93.8 ± 0.5% pred, P < 0.0001) and FEV1/FVC (0.792 ± 0.003, P < 0.0001) compared with the other groups. Linear regression showed that HbA1c was closely related to FVC (β = -6.972154, P < 0.0001) and FEV1 (β = -5.591589, P < 0.0001), but not to FEV1/FVC. Logistic regression analysis revealed a significant association between HbA1c and a restrictive spirometric pattern (FVC < 80% pred., FEV1/FVC ≥ 0.70; OR = 3.772, 95% CI = 1.234-11.53), indicating that elevated HbA1c is closely associated with lung impairment in the non-diabetic population. In the healthy population, relatively high HbA1c level is associated with decrements of FVC and FEV1 and may be a reliable predictor of poor lung function, especially the restrictive pattern.
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Affiliation(s)
- Il Hwan Oh
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Jung Hwan Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Chang Hwa Lee
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Joon-Sung Park
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
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