Abstract
Background: In the current obesogenic society, muscle wasting in COPD patients may coexist with abdominal obesity (AO). This could increase cardiovascular risk. It is furthermore unknown if pulmonary rehabilitation (PR) influences cardiometabolic health in this COPD phenotype.
Aims and objectives: To assess the cardiometabolic risk profile in clinically stable lean COPD patients with AO and to study reversibility by PR.
Methods: The study was conducted within the NUTRAIN-trial consisting of 81 clinically stable COPD patients (age: 62±8 years, BMI: 22.7±2.7kg/m2) with fat free mass index <25th percentile participating in out-patient PR. AO was assessed using dual energy X-ray absorptiometry. Glucose, insulin, amino acids and lipid profile were analyzed in fasting blood.
Results: The majority of patients (75%) had AO. FEV1 (55±20%predicted) and transfer factor for carbon monoxide (TLCO) % predicted (49±15) were not different between groups but patients with AO had lower intrathoracic gas volume (ITGV) % predicted (137±29 vs 161±32, p=0.002). Metabolic syndrome was more prevalent in patients with AO (47% vs 7%, p=0.004) and patients with AO had higher HOMA-IR (1.88 (1.28-2.82) vs 1.05 (0.67-1.78), p=0.005). They also had higher branched chain amino acids (469 (421-507) vs 415 (377-468) µm/L) which correlated with HOMA-IR (ρ=0.492, p<0.001). After PR, triglycerides decreased (p<0.001) while HOMA-IR increased (p=0.036) and lipids (HDL and LDL cholesterol) remained the same.
Conclusions: The elevated cardiometabolic risk and its poor response to PR suggests metabolic inflexibility in emphysematous COPD patients with combined low muscle mass and AO.
- Copyright ©the authors 2016