COPD, 12:82–89, 2015 ISSN: 1541-2555 print / 1541-2563 online Copyright © Informa Healthcare USA, Inc. DOI: 10.3109/15412555.2014.908835
Association between Sarcopenia and Metabolic Syndrome in Chronic Obstructive Pulmonary Disease: The Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011 COPD Downloaded from informahealthcare.com by University of Washington on 02/11/15 For personal use only.
Jae Ho Chung,1 Hee-Jin Hwang,2 Chang Hoon Han,3 Bong Soo Son,4 Do Hyung Kim,4 and Moo Suk Park5,6 1
Division of Pulmonology, Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong Univerisity College of Medicine, Incheon, Korea
Longevity Medical Center & Department of Family Medicine, International St. Mary’s Hospital, Catholic Kwandong Univerisity College of Medicine, Incheon, Korea
Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Koyang, Korea
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Korea
Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
The Institute of Chest Diseases, Yonsei University College of Medicine, Seoul, Korea
Abstract Aim: It is not clear whether the restrictive or obstructive pattern of spirometry is associated with metabolic syndrome. We investigated the associations between restrictive and obstructive spirometric patterns and metabolic risk factors using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Additionally, we investigated whether sarcopenia is associated with metabolic syndrome in patients with chronic obstructive pulmonary disease (COPD). Methods: Using data from KNHANES between 2008 and 2011, we enrolled 8,145 subjects (normal lung function: 6,077, obstructive spirometric pattern: 1,039, restrictive pattern: 1,029) aged ≥40 years who underwent anthropometric measurement, laboratory tests, spirometry and estimation of appendicular muscle mass. Sarcopenia was deﬁned as an appendicular skeletal muscle mass divided by body weight squared 30 min at a time more than ﬁve times per week for moderate exercise; >20 min at a time for strenuous exercise) or when the subject walked >30 min at a time more than ﬁve times per week. Daily energy and nutrient intake were assessed using the 24-h recall method, which provides reliable and valid nutrient information and has been used worldwide (16). Daily intake of total energy, fat, carbohydrate, and protein were calculated based on the food items consumed. A venous blood sample was collected from each subject after a 12-h fast. The sample was centrifuged and refrigerated at the examination site and then transported in an icebox to a central laboratory on the same
COPD Downloaded from informahealthcare.com by University of Washington on 02/11/15 For personal use only.
Chung et al.
day. Plasma glucose, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG) levels were measured using an auto-analyzer (Hitachi automatic analyzer 7600 Hitachi, Tokyo, Japan). Fasting insulin levels were measured by immunoradiometric assay using a 1470 WIZARD gamma counter (PerkinElmer Oy, Turku, Finland). Insulin resistance status was calculated using homeostatic model assessment-insulin resistance (HOMA-IR) using the following formula:
(ORs) for restrictive lung disease in metabolic syndrome and for sarcopenia in patients with COPD. The logistic regression model was adjusted for age, BMI, smoking, alcohol, personal income, physical activity, education, and carbohydrate intake. Statistical analyses were conducted using the Statistical Package for the Social Sciences for Windows, version 20.0 (SPSS Inc., Chicago, IL, USA).
HOMA-IR = (fasting insulin [μIU/mL] × fasting blood glucose [mM/L])/22.5
Metabolic syndrome was deﬁned according to The National Cholesterol Education Program’s Adult Treatment Panel III revised guidelines (17). This deﬁnition was satisﬁed if a subject met three or more of the following ﬁve criteria: (1) abdominal waist circumference ≥90 cm in males or ≥80 cm in females, (2) serum TG ≥150 mg/dL (1.7 mmol/L), (3) serum HDL-C