Blum Arnon, Simsolo Claudia, Sirchan Rizak, Haiek Samah
Department of Medicine, Padeh Poria Hospital, Lower Galilee, Israel.
Isr Med Assoc J. 2011 Nov;13(11):672-5.
The "obesity paradox" is defined as an inverse association of good health, survival and obesity. Usually in healthy persons the more obese you are the more metabolic complications you have; however, thin patients with chronic obstructive pulmonary disease (COPD) have more cardiovascular complications and a higher mortality rate.
To explore whether atherosclerosis and peripheral artery disease (PAD) contribute to the higher morbidity and mortality of patients with COPD.
This prospective study included 87 patients with chronic COPD who were treated in the pulmonary outpatient clinic; all signed a consent form before enrollment. We documented their lung function (FEV1%), body mass index (BMI) and ankle brachial index (ABI). The primary endpoints were to find an association between atherosclerosis and BMI in patients with COPD, and between atherosclerosis and severity of lung disease.
Average ABI was 1.01 +/- 0.20, BMI was 29.33 +/- 7.48 kg/m2, and the abdominal circumference was 107.34 +/- 18.87 cm. A positive correlation was found between BMI and ABI (P=0.001) and between abdominal circumference and ABI (P=0.000). Patients with peripheral artery disease were older (73.6 +/- 11.5 vs. 68.1 +/- 11.6 years old, P= 0.04), were thinner (average BMI 25.5 +/- 6.2 vs. 31.06 +/- 7.3, P= 0.001), and had a lower abdominal circumference (97.7 +/- 18.3 vs. 111.7 +/- 17.5 cm, P=0.001). No such difference was observed for years of smoking. Male PAD patients with COPD had a lower BMI (25.2 +/- 5.6 vs. 29.9 +/- 7.4, P = 0.016), and their abdominal circumference was smaller (96.1 +/- 18.0 vs. 110.2 +/- 16.5 cm, P=0.004). Female PAD patients with COPD had a lower BMI (26.3 +/- 8.2 vs. 33.1 +/- 7.0, P=0.045), but their abdominal circumference was not different from females without PAD (102.0 +/- 19.7 vs. 114.0 +/- 19.4 cm, P=0.162). Patients with PAD had a worse lung disease (FEV1% 34 +/- 8% vs. 45 +/- 16%, P=0.01). During the 1 year of follow-up five patients died: two PAD patients due to acute myocardial infarction and three non-PAD patients died from pulmonary insufficiency (two patients) and pulmonary emboli (one patient).
We found that COPD patients with PAD were older and thinner and had a lower abdominal circumference and a more progressive lung disease. Extensive atherosclerosis in patients with COPD may partly explain the "obesity paradox" observed in patients with COPD.
“肥胖悖论”被定义为健康状况良好、生存率与肥胖之间的负相关关系。通常在健康人群中，肥胖程度越高，代谢并发症就越多；然而，患有慢性阻塞性肺疾病（COPD）的消瘦患者心血管并发症更多，死亡率更高。
探讨动脉粥样硬化和外周动脉疾病（PAD）是否导致COPD患者更高的发病率和死亡率。
这项前瞻性研究纳入了87名在肺科门诊接受治疗的慢性COPD患者；所有患者在入组前均签署了知情同意书。我们记录了他们的肺功能（FEV1%）、体重指数（BMI）和踝臂指数（ABI）。主要终点是找出COPD患者中动脉粥样硬化与BMI之间以及动脉粥样硬化与肺部疾病严重程度之间的关联。
平均ABI为1.01±0.20，BMI为29.33±7.48kg/m²，腹围为107.34±18.87cm。发现BMI与ABI之间（P=0.001）以及腹围与ABI之间（P=0.000）存在正相关。患有外周动脉疾病的患者年龄更大（73.6±11.5岁对68.1±11.6岁，P=0.04），更瘦（平均BMI 25.5±6.2对31.06±7.3，P=0.001），腹围更低（97.7±18.3对111.7±17.5cm，P=0.001）。在吸烟年限方面未观察到此类差异。患有COPD的男性PAD患者BMI更低（25.2±5.6对29.9±7.4，P=0.016），腹围更小（96.1±18.0对110.2±16.5cm，P=0.004）。患有COPD的女性PAD患者BMI更低（26.3±8.2对33.1±7.0，P=0.045），但其腹围与无PAD的女性无差异（102.0±19.7对114.0±19.4cm，P=0.162）。患有PAD的患者肺部疾病更严重（FEV1% 34±8%对45±16%，P=0.01）。在1年的随访期间，5名患者死亡：2名PAD患者死于急性心肌梗死，3名非PAD患者死于肺功能不全（2名患者）和肺栓塞（1名患者）。
我们发现患有PAD的COPD患者年龄更大、更瘦，腹围更低，肺部疾病进展更严重。COPD患者中广泛的动脉粥样硬化可能部分解释了在COPD患者中观察到的“肥胖悖论”。
