Department of Research and Development, Ciro, Horn, The Netherlands.
NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Obes Facts. 2023;16(5):435-446. doi: 10.1159/000531196. Epub 2023 May 25.
INTRODUCTION: One of the most prominent extrapulmonary manifestations in patients with chronic respiratory disease is changes in body weight and composition. However, the frequency and functional consequences of low appendicular lean mass (ALM) or sarcopenic obesity (SO) in patients with asthma are largely unknown. Therefore, the aim of the current study was to assess the frequency and functional consequences of low appendicular lean mass index (ALMI) and SO in patients with asthma. METHODS: A retrospectively analyzed cross-sectional study was conducted in 687 patients with asthma (60% female, 58 ± 13 years, FEV1 76 ± 25% pred) referred for comprehensive pulmonary rehabilitation (PR). Body composition, pulmonary function, exercise capacity, quadriceps muscle function, and quality of life were assessed. Patients were classified as presenting low ALMI according to the 10th percentiles of age-sex-body mass index (BMI)-specific reference values and as having SO according to the diagnostic procedure proposed by the 2022 ESPEN/EASO consensus. In addition, clinical outcomes between patients with normal and low ALMI or with and without SO were compared. RESULTS: The frequency of patients classified as low ALMI was 19%, whereas 45% of the patients were obese. Among the obese patients, 29% had SO. In patients with normal weight, those with low ALMI were younger and had worse pulmonary function, exercise capacity and quadriceps muscle function than those with normal ALMI (all p < 0.05). Overweight patients with low ALMI presented poorer pulmonary function and quadriceps muscle function (both strength and total work capacity). In obese class I patients, those with low ALMI showed lower quadriceps strength and maximal oxygen uptake acquired during cardiopulmonary exercise testing. Both male and female patients with SO showed lower quadriceps muscle function and reduced maximal exercise capacity compared to non-SO asthma patients. CONCLUSION: Approximately one in five asthma patients presented low ALM when age-sex-BMI-specific ALMI cutoffs were applied. Obesity is common among patients with asthma referred for PR. Among the obese patients, a significant proportion presented SO. Low ALM and SO were associated with worse functional outcomes.
简介：在慢性呼吸系统疾病患者中，最突出的肺外表现之一是体重和身体成分的变化。然而，哮喘患者四肢瘦体重（ALM）或肌少症性肥胖（SO）的频率和功能后果在很大程度上尚不清楚。因此，本研究旨在评估哮喘患者四肢瘦体重指数（ALMI）和 SO 的频率及其功能后果。
方法：对 687 例接受综合肺康复（PR）的哮喘患者（60%为女性，58±13 岁，FEV1 为预计值的 76±25%）进行回顾性分析。评估了身体成分、肺功能、运动能力、股四头肌功能和生活质量。根据年龄、性别、体重指数（BMI）特异性参考值的第 10 百分位数将患者分类为低 ALMI，并根据 2022 年 ESPEN/EASO 共识提出的诊断程序将患者分类为 SO。此外，还比较了 ALMI 正常和低 ALMI 患者以及有无 SO 患者之间的临床结局。
结果：低 ALMI 患者的频率为 19%，而肥胖患者的频率为 45%。在肥胖患者中，29%存在 SO。在体重正常的患者中，低 ALMI 患者比 ALMI 正常的患者更年轻，且肺功能、运动能力和股四头肌功能更差（均 p < 0.05）。超重且低 ALMI 的患者肺功能和股四头肌功能（包括力量和总工作能力）更差。在肥胖 I 级患者中，低 ALMI 患者的股四头肌力量和心肺运动试验中最大摄氧量较低。与非 SO 哮喘患者相比，男性和女性 SO 患者的股四头肌功能和最大运动能力均降低。
结论：当应用年龄、性别、BMI 特异性 ALMI 截断值时，约五分之一的哮喘患者存在低 ALM。肥胖在接受 PR 的哮喘患者中很常见。在肥胖患者中，很大一部分存在 SO。低 ALM 和 SO 与较差的功能结局相关。
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