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Metabolic Syndrome and Impaired Lung Function FREE TO VIEW

Simone Scarlata, MD; Filippo Luca Fimognari, MD; Leo Moro, MD; Ruggiero Pastorelli, MD; Raffaele Antonelli-Incalzi, MD
Author and Funding Information

From the Health Center for Elderly (Centro per la Salute dell’Anziano) (Drs Scarlata, Moro, and Fimognari), Unit of Respiratory Pathophysiology, Università Campus Biomedico; the “Alberto Sordi” Foundation – Onlus (Drs Scarlata and Moro); the Unit of Respiratory Diseases (Drs Fimognari and Pastorelli), Division of Internal Medicine, ASL Roma G Leopoldo Parodi-Delfi no Hospital, Colleferro; and the S. Raffaele – Cittadella della Carità Foundation (Dr Antonelli-Incalzi).

Correspondence to: Simone Scarlata, MD, c_o Centro per la Salute dell'Anziano, Via Alvaro del Portillo, 21, 00128 Rome, Italy; e-mail: s.scarlata@unicampus.it


Financial/nonfinancial disclosures:The authors have reported to CHEST that no potential conflicts of interest exist with any companies_organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):494. doi:10.1378/chest.09-1539
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To the Editor:

We read with great interest the recent article in CHEST (October 2009)1 by Watz and colleagues showing an independent association between metabolic syndrome and systemic inflammatory markers in chronic bronchitis and patients with COPD. The authors also demonstrate that the prevalence of metabolic syndrome does not increase for increasing COPD severity, as expressed by the Global Initiative for Chronic Obstructive Lung Disease stage.

Interestingly, metabolic syndrome is also associated with a restrictive ventilatory pattern at spirometry, especially in patients with the highest waist circumference.2 In this population, visceral fat is known to produce prothrombotic and inflammatory mediators, including C-reactive protein, fibrinogen, interleukin-6, and tumor necrosis factor-α. Since lung restriction is frequently associated with systemic inflammation independent of obesity, the inflammatory burden due to restriction may add to that related to visceral obesity in patients having both diseases.3 For this reason we believe that the authors should have provided information on the prevalence of a mixed ventilatory pattern in their population instead of classifying patients only on the basis of the FEV1/FVC ratio and FEV1%. This would have required the measurement of total lung capacity. Nonetheless, based on the available data, it would be of interest at least to know how prevalent was a spirometric pattern suggesting a restrictive component, which is known to be associated with systemic inflammation.4 Indeed, recent evidence is consistent with an FVC based on presumptive diagnosis of lung restriction being comparably accurate in people with and without obstruction.5 Finally, the authors provide the Charlson index of comorbidity, but they do not list individual comorbidities and their prevalences; selected conditions, such as renal failure, could per se promote systemic inflammation.

Providing such information would allow the authors and the readers to verify whether the inflammatory pattern changes for different combinations of COPD, a restrictive component and visceral obesity. Otherwise, the authors might ascribe to COPD an inflammatory status, which in a relevant proportion of patients likely is multifactorial in origin.

Watz H, Waschki B, Kirsten A, et al. The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic inflammation and physical inactivity. Chest. 2009;1364:1039-1046. [CrossRef] [PubMed]
 
Fimognari FL, Pasqualetti P, Moro L, et al. The association between metabolic syndrome and restrictive ventilatory dysfunction in older persons. J Gerontol A Biol Sci Med Sci. 2007;627:760-765. [CrossRef] [PubMed]
 
Lin WY, Yao CA, Wang HC, Huang KC. Impaired lung function is associated with obesity and metabolic syndrome in adults. Obesity (Silver Spring). 2006;149:1654-1661. [CrossRef] [PubMed]
 
Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination. Am J Med. 2003;1149:758-762. [CrossRef] [PubMed]
 
Vandevoorde J, Verbanck S, Schuermans D, et al. Forced vital capacity and forced expiratory volume in six seconds as predictors of reduced total lung capacity. Eur Respir J. 2008;312:391-395. [CrossRef] [PubMed]
 

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References

Watz H, Waschki B, Kirsten A, et al. The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic inflammation and physical inactivity. Chest. 2009;1364:1039-1046. [CrossRef] [PubMed]
 
Fimognari FL, Pasqualetti P, Moro L, et al. The association between metabolic syndrome and restrictive ventilatory dysfunction in older persons. J Gerontol A Biol Sci Med Sci. 2007;627:760-765. [CrossRef] [PubMed]
 
Lin WY, Yao CA, Wang HC, Huang KC. Impaired lung function is associated with obesity and metabolic syndrome in adults. Obesity (Silver Spring). 2006;149:1654-1661. [CrossRef] [PubMed]
 
Mannino DM, Ford ES, Redd SC. Obstructive and restrictive lung disease and markers of inflammation: data from the Third National Health and Nutrition Examination. Am J Med. 2003;1149:758-762. [CrossRef] [PubMed]
 
Vandevoorde J, Verbanck S, Schuermans D, et al. Forced vital capacity and forced expiratory volume in six seconds as predictors of reduced total lung capacity. Eur Respir J. 2008;312:391-395. [CrossRef] [PubMed]
 
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