Metabolic consequences of obesity as an “outside in” mechanism of disease severity in asthma

Peters, Michael C.; Fahy, John V.

doi:10.1183/13993003.01132-2016

Cited by 28 publications

(19 citation statements)

References 12 publications

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“…First, visceral fat deposits, which are increased in abdominal adiposity, act as a reservoir for viral load promoting an inflammatory response. 23 24 Augmented visceral fat volume is also associated with an impaired viral shedding. 8 Second, an imbalance in proinflammatory and anti-inflammatory adipokines can cause increased respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19

et al. 2020

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BackgroundSeveral characteristics of the metabolic syndrome, such as obesity and hypertension, have emerged as risk factors for a poor clinical outcome in COVID-19. However, most reports lack data on the metabolic syndrome itself. This study investigated prospectively the relationship between respiratory deterioration and the presence of metabolic syndrome or abdominal adiposity in patients with COVID-19.MethodsA prospective observational cohort study analysing patients with respiratory symptoms who presented at a local emergency department in the Netherlands. The influence of abdominal adiposity—assessed by an increased waist–hip ratio—and metabolic syndrome on respiratory deterioration and the length of hospital stay were analysed with multivariable logistic regressions and Kaplan-Meier analyses.ResultsIn total, 166 patients were analysed, of whom 86 (52%) tested positive for COVID-19. The prevalence of metabolic syndrome did not differ between patients with COVID-19 with and without the need for intubation or level of supportive care (37.5% vs 48.4%, p=0.338). In contrast, abdominal adiposity is an independent risk factor for respiratory distress in COVID-19, adjusted for metabolic syndrome, age, gender and BMI (OR 1.11, 95% CI 1.02 to 1.20, p=0.014).ConclusionThis study shows that abdominal adiposity, and not the presence of metabolic syndrome, is associated with clinical deterioration in COVID-19. This prospective study provides further insight into the risk stratification of patients with COVID-19 based on a simple measurement as the waist and hip circumference.Trial registration numberNL8580.

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Section: Discussionmentioning

confidence: 99%

Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19

et al. 2020

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“…Within obese individuals, elevations in HbA1c may be explained by insulin resistance and metabolic syndrome (8). These conditions have been associated in cross-sectional studies with more severe or uncontrolled asthma (3)(4)(5)(6), and they form the evidence base for an emerging paradigm that proposes a mechanistic connection between metabolic dysfunction and asthma (2). This relationship has been described as an "outside in" process, whereby systemic comorbidities can modulate pulmonary diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Obese asthma has been described as a distinct phenotype that is more difficult-to-treat and associated with worsened outcomes (1). Metabolic dysfunction has been proposed as a possible explanation (2). Insulin resistance and metabolic syndrome, conditions more common in obesity, have been associated with increased asthma prevalence and morbidity (3)(4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Association Between Prediabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort

Brigham

Keet

et al. 2019

The Journal of Allergy and Clinical Immunology: In Practice

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Background: Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between pre-diabetes and diabetes, metabolic conditions more common in obesity, with asthma outcomes is not well-characterized. Objective: We sought to determine the association between pre-diabetes/diabetes and asthma exacerbations in an obese asthma cohort. Methods: A retrospective cohort of US adults with obese asthma, age 18-64, was created from a claims-based health services database spanning 2010-2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), pre-diabetes (5.7-6.4%), and diabetes (≥6.5%) ranges. Exacerbations, defined as asthma-related hospitalization, emergency department visit, or corticosteroid prescription ±14 days of an asthma-related outpatient visit, were ascertained. Associations were fit with zero-inflated negative binomial models, adjusted for age, sex, region, smoking, medication use, and comorbidities. Results: 5,722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully-adjusted model, compared to individuals with normal HbA1c, those

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“…Instead, the IL-6–high subgroup has clinical features of metabolic dysfunction, including systemic leukocytosis and high frequencies of obesity, hypertension, and diabetes mellitus ( 5 ). Thus, we do not consider that high plasma IL-6 concentrations result from spillover from airway IL-6 but instead result from obesity-associated systemic inflammation, which might drive proneness to exacerbation in these patients ( 6 ).…”

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confidence: 99%

Reply to Nannini and to Lipworth et al.

Peters

Fahy

Denlinger

2020

Am J Respir Crit Care Med

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Metabolic consequences of obesity as an “outside in” mechanism of disease severity in asthma

Cited by 28 publications

References 12 publications

Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19

Analyses of abdominal adiposity and metabolic syndrome as risk factors for respiratory distress in COVID-19

Association Between Prediabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort

Reply to Nannini and to Lipworth et al.

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