Submitted 1 May 2015 Accepted 10 June 2015 Published 2 July 2015 Corresponding author Evgeni Mekov, dr [email protected]Academic editor Teresa Seccia Additional Information and Declarations can be found on page 13 DOI 10.7717/peerj.1068 Copyright 2015 Mekov et al. Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS Metabolic syndrome in hospitalized patients with chronic obstructive pulmonary disease Evgeni Mekov 1 , Yanina Slavova 1 , Adelina Tsakova 2 , Marianka Genova 2 , Dimitar Kostadinov 1 , Delcho Minchev 1 and Dora Marinova 1 1 Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria 2 Central Clinical Laboratory, Medical University—Sofia, Sofia, Bulgaria ABSTRACT Introduction. The metabolic syndrome (MS) affects 21–53% of patients with chronic obstructive pulmonary disease (COPD) with a higher prevalence in the early stages of COPD, with results being highly variable between studies. MS may also affect natural course of COPD—number of exacerbations, quality of life and lung function. Aim. To examine the prevalence of MS and its correlation with comorbidities and COPD characteristics in patients with COPD admitted for exacerbation. Material and methods. 152 patients with COPD admitted for exacerbation were studied for presence of MS. All of them were also assessed for vitamin D status and diabetes mellitus type 2 (DM). Data were gathered for smoking status and exacerbations during the last year. All patients completed CAT (COPD assessment test) and mMRC (Modified Medical Research Council Dyspnea scale) questionnaires and underwent spirometry. Duration of current hospital stay was recorded. Results. 25% of patients have MS. 23.1% of the male and 29.5% of the female patients have MS (p > 0.05). The prevalence of MS in this study is significantly lower when compared to a national representative study (44.6% in subjects over 45 years). 69.1% of all patients and 97.4% from MS patients have arterial hypertension. The presence of MS is associated with significantly worse cough and sleep (1st and 7th CAT questions; p = 0.002 and p = 0.001 respectively) and higher total CAT score (p = 0.017). Average BMI is 27.31. None of the patients have MS and BMI <25. There is a correlation between the presence of MS and DM (p = 0.008) and with the number of exacerbations in the last year (p = 0.015). There is no correlation between the presence of MS and the pulmonary function. Conclusion. This study among hospitalized COPD patients finds comparable but relatively low prevalence of MS (25%) compared to previously published data (21–53%) and lower prevalence compared to general population (44.6%). MS may impact quality of life and the number of exacerbations of COPD. Having in mind that MS is more common in the early stages and decreases with COPD progression, the COPD patients admitted for exacerbation may be considered as having advanced COPD. Subjects Diabetes and Endocrinology, Epidemiology, Internal Medicine, Respiratory Medicine Keywords Metabolic syndrome, COPD, Prevalence, Exacerbations, Quality of life How to cite this article Mekov et al. (2015), Metabolic syndrome in hospitalized patients with chronic obstructive pulmonary disease. PeerJ 3:e1068; DOI 10.7717/peerj.1068
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Submitted 1 May 2015Accepted 10 June 2015Published 2 July 2015
Additional Information andDeclarations can be found onpage 13
DOI 10.7717/peerj.1068
Copyright2015 Mekov et al.
Distributed underCreative Commons CC-BY 4.0
OPEN ACCESS
Metabolic syndrome in hospitalizedpatients with chronic obstructivepulmonary diseaseEvgeni Mekov1, Yanina Slavova1, Adelina Tsakova2, Marianka Genova2,Dimitar Kostadinov1, Delcho Minchev1 and Dora Marinova1
1 Clinical Center for Pulmonary Diseases, Medical University—Sofia, Sofia, Bulgaria2 Central Clinical Laboratory, Medical University—Sofia, Sofia, Bulgaria
ABSTRACTIntroduction. The metabolic syndrome (MS) affects 21–53% of patients withchronic obstructive pulmonary disease (COPD) with a higher prevalence in theearly stages of COPD, with results being highly variable between studies. MS may alsoaffect natural course of COPD—number of exacerbations, quality of life and lungfunction.Aim. To examine the prevalence of MS and its correlation with comorbidities andCOPD characteristics in patients with COPD admitted for exacerbation.Material and methods. 152 patients with COPD admitted for exacerbation werestudied for presence of MS. All of them were also assessed for vitamin D statusand diabetes mellitus type 2 (DM). Data were gathered for smoking status andexacerbations during the last year. All patients completed CAT (COPD assessmenttest) and mMRC (Modified Medical Research Council Dyspnea scale) questionnairesand underwent spirometry. Duration of current hospital stay was recorded.Results. 25% of patients have MS. 23.1% of the male and 29.5% of the female patientshave MS (p > 0.05). The prevalence of MS in this study is significantly lower whencompared to a national representative study (44.6% in subjects over 45 years).69.1% of all patients and 97.4% from MS patients have arterial hypertension. Thepresence of MS is associated with significantly worse cough and sleep (1st and 7thCAT questions; p = 0.002 and p = 0.001 respectively) and higher total CAT score(p = 0.017). Average BMI is 27.31. None of the patients have MS and BMI <25.There is a correlation between the presence of MS and DM (p = 0.008) and with thenumber of exacerbations in the last year (p = 0.015). There is no correlation betweenthe presence of MS and the pulmonary function.Conclusion. This study among hospitalized COPD patients finds comparable butrelatively low prevalence of MS (25%) compared to previously published data(21–53%) and lower prevalence compared to general population (44.6%). MS mayimpact quality of life and the number of exacerbations of COPD. Having in mindthat MS is more common in the early stages and decreases with COPD progression,the COPD patients admitted for exacerbation may be considered as having advancedCOPD.
Subjects Diabetes and Endocrinology, Epidemiology, Internal Medicine, Respiratory MedicineKeywords Metabolic syndrome, COPD, Prevalence, Exacerbations, Quality of life
How to cite this article Mekov et al. (2015), Metabolic syndrome in hospitalized patients with chronic obstructive pulmonary disease.PeerJ 3:e1068; DOI 10.7717/peerj.1068
• Dimitar Kostadinov and Delcho Minchev contributed reagents/materials/analysis tools,
reviewed drafts of the paper.
• Dora Marinova contributed reagents/materials/analysis tools, wrote the paper, reviewed
drafts of the paper.
Human EthicsThe following information was supplied relating to ethical approvals (i.e., approving body
and any reference numbers):
Medical University-Sofia Research Ethics Commission approved the study
(#2976/2014).
Data DepositionThe following information was supplied regarding the deposition of related data:
http://figshare.com/articles/MS in COPD/1439301.
REFERENCESAbdelghaffar H, Tangour E, Fenniche S, Fekih L, Greb D, Akrout I, Hassene H, Ben
Hamad W, Kammoun H, Belhabib D, Megdiche M. 2012. Relation between metabolicsyndrome and acute exacerbation of COPD. European Respiratory Journal 40(Suppl.56):886s. DOI 10.1183/09031936.00197511.
Akpinar EE, Akpinar S, Ertek S, Sayin E, Gulhan M. 2012. Systemic inflammation and metabolicsyndrome in stable COPD patients. Tuberk Toraks 60(3):230–237 DOI 10.5578/tt.4018.
Alberti KGMM, Eckel RH, Grundy SM, Zimmet PZ, Cleeman JI, Donato KA, Fruchart J-C,James PT, Loria CM, Smith Jr SC. 2009. Harmonizing the metabolic syndrome: a jointinterim statement of the International Diabetes Federation Task Force on Epidemiology andPrevention; National Heart, Lung, and Blood Institute; American Heart Association; WorldHeart Federation; International Atherosclerosis Society; and International Association for theStudy of Obesity. Circulation 120:1640–1645 DOI 10.1161/CIRCULATIONAHA.109.192644.
American Diabetes Association. 2012. Diagnosis and classification of diabetes mellitus. DiabetesCare 35:S64–S71 DOI 10.2337/dc12-s064.
Arne M, Janson C, Janson S. 2009. Physical activity and quality of life in subjects withchronic disease: chronic obstructive pulmonary disease compared with rheumatoidarthritis and diabetes mellitus. Scandinavian Journal of Primary Health Care 27(3):141–147DOI 10.1080/02813430902808643.
Borissova A-M, Kovatcheva R, Shinkov A, Atanassova I, Vukov M, Aslanova N, Vlahov J,Dakovska L. 2007. Prevalence and features of the metabolic syndrome in unselected Bulgarianpopulation. Endocrinologia 12(2):68–77.
Borissova A-M, Shinkov A, Vlahov J, Dakovska L, Todorov L, Svinarov D, Kasabova L. 2012.Determination of the optimal level of 25(OH)D in the Bulgarian population. Endocrinologia17(3):135–142.
Brennan AL, Gyi KM, Wood DM, Johnson J, Holliman R, Baines DL, Philips BJ, Geddes DM,Hodson ME, Baker EH. 2007. Airway glucose concentrations and effect on growthof respiratory pathogens in cystic fibrosis. Journal of Cystic Fibrosis 6:101–109DOI 10.1016/j.jcf.2006.03.009.
Mekov et al. (2015), PeerJ, DOI 10.7717/peerj.1068 14/17
Calverley PM, Anderson JA, Celli B, Ferguson G, Jenkins C, Jones P, Yates J, Vestbo J. 2007.Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.New England Journal of Medicine 356:775–789 DOI 10.1056/NEJMoa063070.
Chiolero A, Faeh D, Paccaud F, Cornuz J. 2008. Consequences of smoking for body weight,body fat distribution, and insulin resistance. The American Journal of Clinical Nutrition87(4):801–809.
Fimognari FL, Pasqualetti P, Moro L, Franco A, Piccirillo G, Pastorelli R, Rossini PM,Incalzi RA. 2007. The association between metabolic syndrome and restrictive ventilatorydysfunction in older persons. The Journals of Gerontology Series A: Biological Sciences andMedical Sciences 62:760–765 DOI 10.1093/gerona/62.7.760.
Ford E, Li C. 2008. Metabolic syndrome and health-related quality of life among U.S. adults.Annals of Epidemiology 18(3):165–171 DOI 10.1016/j.annepidem.2007.10.009.
Funakoshi Y, Omori H, Mihara S, Marubayashi T, Katoh T. 2010. Association between airflowobstruction and the metabolic syndrome or its components in Japanese men. Internal Medicine49:2093–2099 DOI 10.2169/internalmedicine.49.3882.
Ginsberg HN, Stalenhoef AF. 2003. The metabolic syndrome: targeting dyslipidaemia to reducecoronary risk. Journal of Cardiovascular Risk 10:121–128DOI 10.1097/00043798-200304000-00007.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2014. Available at http://www.goldcopd.org/ (accessed 20 April 2015).
Ju S, Jeong H, Kim H. 2014. Blood vitamin D status and metabolic syndrome in the general adultpopulation: a dose–response meta-analysis. Journal of Clinical Endocrinology and Metabolism99(3):1053–1063 DOI 10.1210/jc.2013-3577.
Kupeli E, Ulubay G, Ulasli SS, Sahin T, Erayman Z, Gursoy A. 2010. Metabolic syndrome isassociated with increased risk of acute exacerbation of COPD: a preliminary study. Endocrine38:76–82 DOI 10.1007/s12020-010-9351-3.
Lam KB, Jordan RE, Jiang CQ, Thomas GN, Miller MR, Zhang WS, Lam TH, Cheng KK,Adab P. 2010. Airflow obstruction and metabolic syndrome: the Guangzhou Biobank CohortStudy. European Respiratory Journal 35:317–323 DOI 10.1183/09031936.00024709.
Leone N, Courbon D, Thomas F, Bean K, Jego B, Leynaert B, Guize L, Zureik M. 2009.Lung function impairment and metabolic syndrome: the critical role of abdominalobesity. American Journal of Respiratory and Critical Care Medicine 179:509–516DOI 10.1164/rccm.200807-1195OC.
Lin WY, Yao CA, Wang HC, Huang KC. 2006. Impaired lung function is associated with obesityand metabolic syndrome in adults. Obesity 14:1654–1661 DOI 10.1038/oby.2006.190.
Marquis K, Debigare R, Lacasse Y, LeBlanc P, Jobin J, Carrier G, Maltais F. 2002. Midthighmuscle cross-sectional area is a better predictor of mortality than body mass index in patientswith chronic obstructive pulmonary disease. American Journal of Respiratory and Critical CareMedicine 166:809–813 DOI 10.1164/rccm.2107031.
Marquis K, Maltais F, Duguay V, Bezeau AM, LeBlanc P, Jobin J, Poirier P. 2005. The metabolicsyndrome in patients with chronic obstructive pulmonary disease. Journal of CardiopulmonaryRehabilitation 25:226–232 DOI 10.1097/00008483-200507000-00010.
McFarlane SI. 2006. Bone metabolism and the cardiometabolic syndrome: pathophysiologicinsights. Journal of the CardioMetabolic Syndrome 1:53–57DOI 10.1111/j.0197-3118.2006.05457.x.
Mekov E, Slavova Y. 2013. Diabetes mellitus and metabolic syndrome in COPD—part 1:introduction and epidemiology. Thoracic Medicine 5(4):6–18.
Mekov et al. (2015), PeerJ, DOI 10.7717/peerj.1068 15/17
Mekov E, Slavova Y. 2014. Diabetes mellitus and metabolic syndrome in COPD—part 3:consequences. Thoracic Medicine 6(4):23–36.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P,Van der Grinten C, Gustafsson P, Jensen R, Johnson D, MacIntyre N, McKay R, Navajas D,Pedersen O, Pellegrino R, Viegi G, Wanger J. 2005. Standardisation of spirometry. EuropeanRespiratory Journal 26:319–338 DOI 10.1183/09031936.05.00034805.
Minas M, Kostikas K, Papaioannou AI, Mystridou P, Karetsi E, Georgoulias P, Liakos N,Pournaras S, Gourgoulianis KI. 2011. The association of metabolic syndrome withadipose tissue hormones and insulin resistance in patients with COPD withoutco-morbidities. COPD: Journal of Chronic Obstructive Pulmonary Disease 8:414–420DOI 10.3109/15412555.2011.619600.
Nakajima K, Kubouchi Y, Muneyuki T, Ebata M, Eguchi S, Munakata H. 2008. A possibleassociation between suspected restrictive pattern as assessed by ordinary pulmonary functiontest and the metabolic syndrome. Chest 134:712–718 DOI 10.1378/chest.07-3003.
O’Byrne PM, Rennard S, Gerstein H, Radner F, Peterson S, Lindberg B, Carlsson LG, Sin DD.2012. Risk of new onset diabetes mellitus in patients with asthma or COPD taking inhaledcorticosteroids. Respiratory Medicine 106(11):1487–1493 DOI 10.1016/j.rmed.2012.07.011.
Ozgen Alpaydin A, Konyar Arslan I, Serter S, Sakar Coskun A, Celik P, Taneli F, Yorgancioglu A.2013. Metabolic syndrome and carotid intima-media thickness in chronic obstructive pul-monary disease. Multidisciplinary Respiratory Medicine 8(1):61 DOI 10.1186/2049-6958-8-61.
Park BH, Park MS, Chang J, Kim SK, Kang YA, Jung JY, Kim YS, Kim C. 2012. Chronicobstructive pulmonary disease and metabolic syndrome: a nationwide survey in Korea.International Journal of Tuberculosis and Lung Disease 16:694–700 DOI 10.5588/ijtld.11.0180.
Park Y-W, Zhu S, Palaniappan L, Heshka S, Carnethon M, Heymsfield S. 2003. The metabolicsyndrome prevalence and associated risk factor findings in the US population from the thirdnational health and nutrition examination survey, 1988–1994. Archives of Internal Medicine163(4):427–436 DOI 10.1001/archinte.163.4.427.
Pavlov P, Ivanov Y, Glogovska P, Popova T, Borissova E, Hristova P. 2010. Metabolic syndromeand COPD. European Respiratory Journal 36(Suppl. 54):66s.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, Jones DW, Kurtz T, Sheps SG,Roccella EJ. 2005. Subcommittee of Professional and Public Education of the American HeartAssociation Council on High Blood Pressure Research. Recommendations for blood pressuremeasurement in humans and experimental animals. Part 1: blood pressure measurement inhumans. Hypertension 45:142–161 DOI 10.1161/01.HYP.0000150859.47929.8e.
Poulain M, Doucet M, Drapeau V, Fournier G, Tremblay A, Poirier P, Maltais F. 2008. Metabolicand inflammatory profile in obese patients with chronic obstructive pulmonary disease. ChronicRespiratory Disease 5:35–41 DOI 10.1177/1479972307087205.
Romme EA, Rutten EP, Smeenk FW, Spruit MA, Menheere PP, Wouters EF. 2013. VitaminD status is associated with bone mineral density and functional exercise capacity inpatients with chronic obstructive pulmonary disease. Annals of Medicine 45(1):91–96DOI 10.3109/07853890.2012.671536.
Schoenborn CA, Adams PF. 2010. Health behaviors of adults: United States, 2005–2007. NationalCenter for Health Statistics. Vital Health Statistics 10(245):79–80. Available at http://www.cdc.gov/nchs/data/series/sr 10/sr10 245.pdf.
Stratev V, Petev J, Galcheva S, Peneva M. 2012. Chronic inflammation and metabolic syndrome(MS) in patients with chronic obstructive pulmonary disease (COPD). Thoracic Medicine4(3):50–57.
Mekov et al. (2015), PeerJ, DOI 10.7717/peerj.1068 16/17
Vestbo J. 2014. COPD: definition and phenotypes. Clinics in Chest Medicine 35(1):1–6DOI 10.1016/j.ccm.2013.10.010.
Watz H, Waschki B, Kirsten A, Muller KC, Kretschmar G, Meyer T, Holz O, Magnussen H.2009. The metabolic syndrome in patients with chronic bronchitis and COPD: frequencyand associated consequences for systemic inflammation and physical inactivity. Chest136:1039–1046 DOI 10.1378/chest.09-0393.
WHO. 2008. WHO STEPwise approach to surveillance (STEPS). Geneva: World HealthOrganization (WHO). Available at http://www.who.int/chp/steps/en/.
Yamamoto Y, Oya J, Nakagami T, Uchigata Y. 2014. Association between lung function andmetabolic syndrome independent of insulin in Japanese men and women. Japanese ClinicalMedicine 5:1–8 DOI 10.4137/JCM.S13564.
Yeh F, Dixon AE, Marion S, Schaefer C, Zhang Y, Best LG, Calhoun D, Rhoades ER, Lee ET.2011. Obesity in adults is associated with reduced lung function in metabolic syndrome anddiabetes: the strong heart study. Diabetes Care 34:2306–2313 DOI 10.2337/dc11-0682.
Zhou J, Zhang Q, Yuan X, Wang J, Li C, Sheng H, Qu S, Li H. 2013. Associationbetween metabolic syndrome and osteoporosis: a meta-analysis. Bone 57(1):30–35DOI 10.1016/j.bone.2013.07.013.
Mekov et al. (2015), PeerJ, DOI 10.7717/peerj.1068 17/17