asthma and obesity
DESCRIPTION
ASTHMA and OBESITY. Ömer KALAYCI, MD Hacettepe Universit School of Medicine Pediatric Allergy and Asthma Unit. When the world was a simpler place The rich were fat, the poor were thin and The wise people thought about how to feed the hungry. Now, in many places around the world - PowerPoint PPT PresentationTRANSCRIPT
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ASTHMA and OBESITY
Ömer KALAYCI, MD
Hacettepe Universit School of Medicine
Pediatric Allergy and Asthma Unit
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When the world was a simpler place
The rich were fat, the poor were thin and
The wise people thought about how to feed the hungry.
Now, in many places around the world
The rich are thin, th epoor are fat and
The wise people are thinking about how to deal with obesity.
Economist, 13 Aralık 2003
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OBESITY
Accumulation of fat to a degree to endanger health
WHO 2006
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ClassificationBMI(kg/m²)
wight/ height2
Ayırım noktası
Lean <18.50
Severe <16.00
Moderate 16.00 - 16.99
Mild 17.00 - 18.49
Normal range 18.50 - 24.99
Overweight ≥25.00
Pre-obese 25.00 - 29.99
Obese ≥30.00
Obese class I 30.00 - 34-99
Obese class II 35.00 - 39.99
Obese class III ≥40.00
WHO 2006
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OBESITY FIGURES
• Year 2005 – 1.6 billion adults (age 15+) overweight– AT least 400 million adult obese– < 5 age 20 million children overweight
• By 2015 – 2.3 billion adults overweight– > 700 million obese.
WHO 2006
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ASTHMA AND OBESITY
• Epidemiology
• Physiology
• Immunological-inflammatory
• Experimental
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EPIDEMIOLOGY
• Does obesity increase the risk of asthma?
• Does obesity influence the course of asthma?
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EPIDEMIOLOGY CROSSSECTIONAL STUDIES
• Obesity in asthmatics – obesity in controls
• High in asthma / no difference between groups• Difference in women / No gender related difference
REsults are not consistentCannot define cause-effect relationship
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EPIDEMIOLOGY PROSPECTIVE STUDIES
Overweight, Obesity, and Incident AsthmaA Meta-analysis of Prospective Epidemiologic StudiesAm J Respir Crit Care Med Vol 175. pp 661–666, 2007
• Adults• Primary outcome measure: asthma devlopment• BMI measurement• AT least 1 year follow-up• AT least 70% follow-up • Classification according to standard BMI ranges
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Çalışma Nüfus n İzlem (yıl)
OR
Camargo 99 Nurse
Male
Female
0
85,911
4
2.7 (2.3-3.1)
Chen 02 Canada national
Male
Female
9,149 2
1.0
1.9 (1.1-3.4)
Ford 04 NHANES
Male
Female
9,546 10
1.5 (0.9-2.6)
1.4 (1.0-1.9)
Gunnbjrn 04 ECRHS
Male
Female
16,191 7,9
2.1 (1.4-3.2)
1.6 (1.1-2.1)
Huovinen 03 Finnland twin
Male
Female
9,671 9
3.5 (1.6-7.7)
2.3 (0.9-6.1)
Nystad 04 Norway
Male
Female
135,405 21
1.8 (1.4-2.3)
2.0 (1.7-2.4)
Nomieu 03 French
Male
Female
0
67,229
3
2.2 (1.4-3.2)
Total 333,102 8.1 2
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1 year point incidence
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60
65
70
75
80
85
Baseline 8 week diet 6 month 1 year
Diet n=19 Control n=19
EPIDEMIOLOGYWeight loss
% F
EV
1
Stenius-Aarniala, B. et al. BMJ 2000;320:827-832
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8
10
12
14
1618
20
22
24
Baseline 8 weeks diet 6 months 1 year
Diyet n=19 Kontrol n=19
Dy
sp
ne
a v
isu
al s
ca
le
Stenius-Aarniala, B. et al. BMJ 2000;320:827-832
EPIDEMIOLOGYWeight loss
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0,0
0,5
1,0
1,5
2,0
2,5
Baseline 8 week diet 6 month 1 year
Bro
nk
od
ilato
r u
se Diyet n=19
Kontrol n=19
Stenius-Aarniala, B. et al. BMJ 2000;320:827-832
EPİDEMİYOLOJİKilo verme
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EPIDEMIOLOGY
STUDIES• Cross-sectional• Prospective• Weight loss
RESULTS• Obesity increases the risk of
asthma• Obesity impairs asthma control
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FİZYOLOJİ
ERV and FRC decrease fast and shallow breathingTidal vıolume decrease loss of bronchodil effect
Shore and Fredberg JACI 2005;115:925-7
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FİZYOLOJİ
Beuther, Weiss, Sutherland AJRCCM 2006;174:112–119
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-0,15
-0,10
-0,05
0,00
0,05
0,10
0,15
18.5 – 25.0 25.0 – 30.0 > 30.0
BMI kg/m2
Gaw
L s
-1 c
m H
2O-1
PHYSIOLOGYPulmonary functions
n=139 E
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0
2
4
6
810
12
14
16
18
10 1 100
FE
V1
(% d
ecre
ase)
ObesNon-obesObeseNon-obese
Metacholin μmol
Obese n= 23 BMI: 37.3 (30-63) kg/m2
Non-obese n= 25 BMI: 23.1 (21-28) kg/m2
Salome, Munoz, King AJRCCM ATS 2005 A562
PHYSIOLOGYAirway hyperreactivity
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0,0
0,5
1,0
1,5
2,0
BMI annual change
-1.5 - -0.2 -0.2 - 0 0 – 0.2 0.2 – 0.4 0.4 – 1.9
OR
airw
ay h
yper
reac
tivity
PHYSIOLOGYAirway hyperreactivity
A A Litonjua, D Sparrow, J C Celedon, D DeMolles and S T Weiss. Thorax 2002;57;581-585
BHR developing group (4 years) n=61Control, n= 244
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PHYSIOLOGY
OBESITY
• Decreased lung volumes
• Alterations in airway smooth muscle
• Data on airway hyperreactivity are inconsistent
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Normal immunefunctions
Optimum nutrition
İmmune aktivation Inflamattory
Over nutrition
İmmune suppression
Malnutrition
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OBESITYINFLAMMATORY MEDIATORS
• TNF-α• IL-6• IL-1• IL-8• MCP• IL-10• TGF-β• LEPTİN • CRP• ADİPONEKTİN: decreased
increased
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LEPTİN
• Adipocytes• Blunts appetite• Increases energy
expenditure• Correaltes with BMI.
• T cell– increased proliferation– increased activation
• Monocyte– increased activation
Anjiogenesis– increase
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0,00
5,00
10,00
15,00
20,00
25,00
30,00
Before treatment
Aftertreatment
ASTHMAn=23
Controln=20
Ser
um le
ptin
ng/
ml
INFLAMMATIONASTIMLI ÇOCUKLARDA SERUM LEPTİN DÜZEYİ
Gürkan F et al., Ann Allergy Asthma Immunol. 2004;93:277-80.
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Asthma
N=102
Control
N=33
GEnder
Girl
Boy
37
65
14
19
AGe
Girl
Boy
6.0±3.5
5.4±3.0
6.3 ±3.7
6.1±3.5
6.8±3.0
5.7±3.8
>0.05
BMI
Girl
Boy
17.5±2.9
16.9±2.8
17.9±2.9
17.0±3.0
17.0±3.0
17.0±2.9
>0.05
Leptin (ng/ml)
Girl
Boy
3.5 (2.1-7.2)
4.7 (2.7-7.2)
3.1 (2.0-7.5)
2.3 (1.3-4.7)
2.7 (2.2-12.2)
1.5 (1.1-3.2)
0.008
>0.05
0.003
Guler N, Kirerleri E, Ones U, Tamay Z, Salmayenli N, Darendeliler F. J Allergy Clin Immunol. 2004;114:254-9.
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Wellen KE and Hotamisligil GS. J. Clin. Invest. 2003;112:1785-1788
OBESITY INFLAMMATION
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0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Saline 0,3 1 3 10 30
Saline-PBS
Leptin-PBS
Saline -OVA
Leptin-Ova
Pen
h
Methacholine mg/ml
Shore S. et al., JACI 2005;115:103-109
EXPERIMENTAL
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0
10
20
30
40
50
60
70
IL-1
3 p
g/m
l
0
2
4
6
8
10
12
14
IL-4
pg
/ml
0
1
2
3
4
5
6
7
8
9
IL-5
pg
/ml
PBS OVA
Salin
Leptin
Shore S. Et al., JACI 2005;115:103-109
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OTHER FACTORS
• Sex hormones - estrogen
• Genetic markers
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ASTHMA AND OBESITY
• Epidemiology
• Physiology
• Immunological-inflammatory
• Experimental
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CLINICAL RESULTSObesity is associated with alterations in
pulmonary physiology.
Specifity of clinical findings may be low.
OBESE ASTHMATICS SHOULD LOSE WEIGHT