Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands; Department of Research and Education, CIRO, Horn, The Netherlands.
J Am Med Dir Assoc. 2017 Jun 1;18(6):533-538. doi: 10.1016/j.jamda.2016.12.081. Epub 2017 Feb 22.
It is well established that low muscle mass affects physical performance in chronic obstructive pulmonary disease (COPD). We hypothesize that combined low muscle mass and abdominal obesity may also adversely influence the cardiometabolic risk profile in COPD, even in those with normal weight. The cardiometabolic risk profile and the responsiveness to 4 months high-intensity exercise training was assessed in normal-weight patients with COPD with low muscle mass stratified by abdominal obesity.
This is a cross-sectional study including 81 clinically stable patients with COPD (age 62.5 ± 8.2 years; 50.6% males; forced expiratory volume in 1 second 55.1 ± 19.5 percentage predicted) with fat-free mass index <25th percentile eligible for outpatient pulmonary rehabilitation. Body composition, blood biomarkers, blood pressure, physical activity level, dietary intake, and physical performance were assessed at baseline and in a subgroup after 4 months of exercise training.
Mean body mass index was 22.7 ± 2.7 kg/m, and 75% of patients had abdominal obesity. Abdominally obese patients had higher glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), branched chain amino acids and a higher prevalence of metabolic syndrome compared with those without abdominal obesity. Exercise training improved cycling endurance time and quadriceps strength, but did not yield a clinically meaningful improvement of the cardiometabolic risk profile. Triglycerides showed a significant decrease, while the HOMA-IR increased.
Abdominal obesity is highly prevalent in normal-weight patients with COPD with low muscle mass who showed an increased cardiometabolic risk compared with patients without abdominal obesity. This cardiometabolic risk profile was not altered after 4 months of exercise training.
众所周知，肌肉量低会影响慢性阻塞性肺疾病（COPD）患者的身体机能。我们假设，即使在体重正常的患者中，肌肉量低合并腹型肥胖也可能对 COPD 的心脏代谢风险状况产生不利影响。本研究旨在评估体重正常的 COPD 患者中，肌肉量低且腹型肥胖患者的心脏代谢风险状况，并观察其对 4 个月高强度运动训练的反应。
这是一项横断面研究，共纳入 81 例临床稳定的 COPD 患者（年龄 62.5 ± 8.2 岁；50.6%为男性；1 秒用力呼气容积占预计值百分比为 55.1 ± 19.5%），这些患者的去脂体重指数＜第 25 百分位数，适合接受门诊肺康复治疗。在基线和运动训练 4 个月后，对所有患者进行身体成分、血液生物标志物、血压、身体活动水平、饮食摄入和身体机能评估。
患者的平均 BMI 为 22.7 ± 2.7kg/m2，75%的患者存在腹型肥胖。与无腹型肥胖的患者相比，腹型肥胖患者的血糖、胰岛素、胰岛素抵抗评估的稳态模型（HOMA-IR）、支链氨基酸水平更高，且代谢综合征的患病率更高。运动训练可改善患者的踏车耐力时间和股四头肌力量，但对心脏代谢风险状况无明显改善作用。运动训练后，患者的甘油三酯水平显著降低，而 HOMA-IR 水平升高。
体重正常的 COPD 患者中，肌肉量低合并腹型肥胖的患者非常普遍，与无腹型肥胖的患者相比，其心脏代谢风险更高。4 个月的运动训练并不能改变这一心脏代谢风险状况。
