Metabolic Syndrome as a Factor Affecting Systemic Inflammation in Patients with Chronic Obstructive Pulmonary Disease

  • R. Rubinsztajn
  • T. PrzybyłowskiEmail author
  • M. Maskey-Warzęchowska
  • M. Paplińska-Goryca
  • P. Nejman-Gryz
  • K. Karwat
  • R. Chazan
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1021)


Chronic obstructive pulmonary disease (COPD) is a systemic disease which may be associated with other comorbidities. The aim of the study was to estimate the incidence of metabolic syndrome (MS) in COPD patients and to assess its impact on systemic inflammation and lung function. MS was diagnosed in accordance with the recommendations of the Polish Forum for the Prevention of Cardiovascular Diseases. The study group consisted of 267 patients with stable COPD in all stages of severity. All patients underwent spirometry with bronchial reversibility testing and 6 min walk test (6MWT). The following blood tests were evaluated: lipid profile, glucose and C-reactive protein as well as serum concentration of IL-6, leptin, adiponectin, and endothelin. MS was diagnosed in 93 patients (35.8%). No differences were observed in the incidence of MS in relation to airflow limitation severity (mild; moderate; severe and very severe: 38.9; 36.3; 35.2 and 25.0%, respectively). FEV1 (% predicted), FVC (% predicted), 6MWT distance (6MWD), age, and the number of pack-years were similar in patients with and without MS. MS was more frequent in males than females (38.7 vs. 28.4%, p > 0.05). Serum concentrations of IL-6, endothelin, leptin, and CRP were higher in the MS group, contrary to adiponectin concentration which was lower (p < 0.01). MS was more frequent in male COPD patients, but there were no differences in its frequency between patients with different severity of airflow limitation. We conclude that MS, as a comorbidity, occurs in all COPD stages and affects systemic inflammation. MS incidence does not depend on COPD severity.


Adiponectin Bronchial reversibility test Comorbidities Endothelin Interleukin 6 Lung disease Spirometry 



The study was performed as the part of National Center for Research and Development project ‘Chronic obstructive pulmonary disease (COPD) – systemic disease; the biggest threat of twenty-first century’ (NR 13 0034 06/2009).

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.


  1. Akpinar EE, Akpinar S, Ertek S, Sayin E, Gülhan M (2012) Systemic inflammation and metabolic syndrome in stable COPD patients. Tuberk Toraks 60:230–237CrossRefPubMedGoogle Scholar
  2. Alberti KG, Zimmet PZ (1998) Definition, diagnosis and classifi cation of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus: provisional report of WHO consultation. Diabet Med 1:539–553CrossRefGoogle Scholar
  3. ATS (2002) Guidelines for the six-minute walk test. Am J Respir Crit Care Med 166:111–117CrossRefGoogle Scholar
  4. Bacakoglu F, Atasever A, Ozhan MH, Gurgun C, Ozkilic H, Guzelant A (2003) Plasma and bronchoalveolar lavage fluid levels of endothelin-1 in patients with chronic obstructive pulmonary disease and pulmonary hypertension. Respiration 70:594–599CrossRefPubMedGoogle Scholar
  5. Bae YJ, Kim SH, Chung JH, Song SW, Kim KS, Kim MK, Kwon O, Choi MS, Sung MK (2013) Evaluation of adiposity-related biomarkers as metabolic syndrome indicators. Clin Nutr Res 2:91–99CrossRefPubMedPubMedCentralGoogle Scholar
  6. Barnes PJ, Celli BR (2009) Systemic manifestations and comorbidities of COPD. Eur Respir J 33:1165–1185CrossRefPubMedGoogle Scholar
  7. Choi JH, Park S, Shin YH, Kim MY, Lee YJ (2011) Sex differences in the relationship between metabolic syndrome and pulmonary function: the 2007 Korean National Health and nutrition examination survey. Endocr J 58:459–465CrossRefPubMedGoogle Scholar
  8. Corbaton-Anchuelo A, Martinez-Larrad MT, Fernandez-Perez C, Vega-Quiroga S, Ibarra-Rueda JM, Serrano-Rios M (2013) Metabolic syndrome, adiponectin, and cardiovascular risk in Spain (the Segovia study): impact of consensus societies criteria. Metab Syndr Relat Disord 11:309–318CrossRefPubMedGoogle Scholar
  9. Díez-Manglano J, Barquero-Romero J, Almagro P, Cabrera FJ, López García F, Montero L, Soriano JB, Working Group on COPD; Spanish Society of Internal Medicine (2014) COPD patients with and without metabolic syndrome: clinical and functional differences. Intern Emerg Med 4:419–425CrossRefGoogle Scholar
  10. Ferri C, Bellini C, Desideri G, Baldoncini R, Properzi G, Santucci A, De Mattia G (1997) Circulating endothelin 1 levels in obese patients with the metabolic syndrome. Exp Clin Endocrinol Diabetes 105(Suppl 2):38–40PubMedGoogle Scholar
  11. Funakoshi Y, Omori H, Mihara S, Marubayashi T, Katoh T (2010) Association between airflow obstruction and the metabolic syndrome or its components in Japanese men. Inter Med 49:2093–2099CrossRefGoogle Scholar
  12. Ghoorah K, De Soyza A, Kunadian V (2013) Increased cardiovascular risk in patients with chronic obstructive pulmonary disease and the potential mechanisms linking the two conditions: a review. Cardiol Rev 21:196–202CrossRefPubMedGoogle Scholar
  13. GOLD (2016) Global strategy for the diagnosis, management and prevention of COPD, global initiative for chronic obstructive lung disease. Accessed on 1 Feb 2017
  14. Guerra S, Sherrill DL, Bobadilla A, Martinez FD, Barbee RA (2002) The relation of body mass index to asthma, chronic bronchitis, and emphysema. Chest 122:1256–1263CrossRefPubMedGoogle Scholar
  15. Hu G, Qiao Q, Tuomilehto J, Balkau B, Borch-Johnsen K, Pyorala K (2004) Prevalence of the metabolic syndrome and its relation to all-cause and cardiovascular mortality in nondiabetic European men and women. Arch Intern Med 164:1066–1076CrossRefPubMedGoogle Scholar
  16. International Diabetes Federation (2006) IDF consensus worldwide definition of the metabolic syndrome. Accessed on 1 Feb 2017
  17. Karadag F, Kirdar S, Karul AB, Ceylan E (2008) The value of C-reactive protein as a marker of systemic inflammation in stable chronic obstructive pulmonary disease. Eur J Int Med 19:104–108CrossRefGoogle Scholar
  18. Lam KB, Jordan RE, Jiang CQ, Thomas GN, Miller MR, Zhang WS, Lam TH, Cheng KK, Adab P (2010) Airflow obstruction and metabolic syndrome: the Guangzhou Biobank cohort study. Eur Respir J 35:317–323CrossRefPubMedGoogle Scholar
  19. Leone N, Courbon D, Thomas F, Bean K, Jego B, Leynaert B, Guize L, Zureik M (2009) Lung function impairment and metabolic syndrome: the critical role of abdominal obesity. Am J Respir Crit Care Med 179:509–516CrossRefPubMedGoogle Scholar
  20. Mamcarz A, Podolec P, Kopeć G, Czarnecka D, Rynkiewicz A, Stańczyk J, Undas A, Godycki-Ćwirko M, Kozek E, Pająk A, Naruszewicz M, Opala G, Grzeszczak W, Windaket A (2009) Guidelines for metabolic syndrome diagnosis of polish forum for the prevention of cardiovascular diseases. Forum Profilaktyki 2:1–3Google Scholar
  21. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Crapo R, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J, ATS/ERS Task Force (2005) Standardisation of spirometry. Europ Respir J 26:319–338CrossRefGoogle Scholar
  22. Minas M, Kostikas K, Papaioannou AI, Mystridou P, Karetsi E, Georgoulias P, Liakos N, Pournaras S, Gourgoulianis KI (2011) The association of metabolic syndrome with adipose tissue hormones and insulin resistance in patients with COPD without co-morbidities. COPD 8:414–420CrossRefPubMedGoogle Scholar
  23. NCEP (2001) Executive summary of the third report of the National Cholesterol Education Program. Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA 285:2486–2497CrossRefGoogle Scholar
  24. Park YW, Zhu S, Palaniappan L, Heshka S, Carnethon MR, Heymsfield SB (2003) The metabolic syndrome: prevalence and associated risk factor findings in the US population from the third National Health and nutrition examination survey, 1988–1994. Arch Intern Med 163:427–436CrossRefPubMedPubMedCentralGoogle Scholar
  25. Poulain M, Doucet M, Drapeau V, Fournier G, Tremblay A, Poirier P, Maltais F (2008) Metabolic and inflammatory profile in obese patients with chronic obstructive pulmonary disease. Chron Respir Dis 5:35–41CrossRefPubMedGoogle Scholar
  26. Reichenberger F, Schauer J, Kellner K, Sack U, Stiehl P, Winkler J (2001) Different expression of endothelin in the bronchoalveolar lavage in patients with pulmonary diseases. Lung 179:163–174CrossRefPubMedGoogle Scholar
  27. Sato M, Shibata Y, Abe S, Inoue S, Igarashi A, Yamauchi K, Aida Y, Kishi H, Nunomiya K, Nakano H, Sato K, Watanabe T, Konta T, Ueno Y, Kato T, Kayama T, Kubota I (2013) Retrospective analysis of the relationship between decline in FEV(1) and abdominal circumference in male smokers: the Takahata study. Int J Med Sci 10:1–7CrossRefPubMedGoogle Scholar
  28. Stylianou C, Galli-Tsinopoulou A, Farmakiotis D, Rousso I, Karamouzis M, Koliakos G, Nousia-Arvanitakis S (2007) Ghrelin and leptin levels in obese adolescents. Relationship with body fat and insulin resistance. Hormones 6:295–303CrossRefPubMedGoogle Scholar
  29. van den Borst B, Gosker HR, Koster A, Yu B, Kritchevsky SB, Liu Y, Meibohm B, Rice TB, Shlipak M, Yende S, Harris TB (2012) The influence of abdominal visceral fat on inflammatory pathways and mortality risk in obstructive lung disease. Am J Clin Nutr 96:516–526CrossRefPubMedPubMedCentralGoogle Scholar
  30. van Manen JG, Bindels PJ, IJzermansn CJ, van der Zee JS, Bottema BJ, Schadé E (2001) Prevalence of comorbidity in patients with a chronic airway obstruction and controls over the age of 40. J Clin Epidemiol 54:287–293CrossRefPubMedGoogle Scholar
  31. Watz H, Waschki B, Kirsten A, Müller KC, Kretschmar G, Meyer T, Holz O, Magnussen H (2009) The metabolic syndrome in patients with chronic bronchitis and COPD: frequency and associated consequences for systemic inflammation and physical inactivity. Chest 136:P1039–P1046CrossRefGoogle Scholar
  32. Wehrmeister FC, Menezes AM, Muniz LC, Martinez-Mesa J, Domingues MR, Horta BL (2012) Waist circumference and pulmonary function: a systematic review and meta-analysis. Syst Rev 1:55CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • R. Rubinsztajn
    • 1
  • T. Przybyłowski
    • 1
    Email author
  • M. Maskey-Warzęchowska
    • 1
  • M. Paplińska-Goryca
    • 1
  • P. Nejman-Gryz
    • 1
  • K. Karwat
    • 1
  • R. Chazan
    • 1
  1. 1.Department of Internal Medicine, Pneumology and AllergologyWarsaw Medical UniversityWarsawPoland

Personalised recommendations