Typ-2-Diabetes ist bei schwerer Adipositas mit einer Verringerung der kardiorespiratorischen Fitness – jedoch nicht der Lungenfunktion – assoziiert

Zusammenfassung

Ziel Sowohl schwere Formen der Adipositas als auch des Typ-2-Diabetes (T2DM) gehen mit einer verringerten Lungenfunktion und einer schlechteren kardiorespiratorischen Fitness einher. Wir untersuchten, ob das zusätzliche Vorliegen einer T2DM-Erkrankung die bereits beeinträchtigte Lungenfunktion und kardiorespiratorische Fitness bei Personen mit schwerer Adipositas weiter limitiert.

Methoden In dieser Querschnittsstudie wurde die Lungenfunktion (Einsekundenkapazität FEV₁; Vitalkapazität, VC) bei 65 Probanden mit schwerer Adipositas und T2DM (T2DM-Gruppe) und 65 schwer adipösen Personen ohne T2DM (Nicht-T2DM-Gruppe), die paarweise nach Geschlecht, Alter, Körpermasse und -größe zugeordent wurden, bestimmt. Bei 30 dieser gematchten Paare wurde die kardiorespiratorische Fitness (maximale Leistung, W_peak, maximale Sauerstoffaufnahme, V O_2peak) im Fahrrad-Stufentest ermittelt.

Ergebnisse Zwischen der T2DM- und der Nicht-T2DM-Gruppe bestanden keine Unterschiede bezüglich FEV₁ und VC (alle p ≥ 0,110), wohingegen W_peak und V O_2peak –sowohl absolut als auch relativ zur Körpermasse – in der T2DM-Gruppe signifikant niedriger waren, als in der nicht-T2DM-Gruppe (alle p ≤ 0,030). Objektive Marker der Ausbelastung d. h. die maximale Herzfrequenz und der respiratorische Quotient, unterschieden sich zwischen beiden Gruppen nicht (beide p ≥ 0,245).

Schlussfolgerung Das Vorliegen einer T2DM-Erkrankung bei Personen mit schwerer Adipositas ist mit einer geringeren kardiorespiratorischen Fitness assoziiert, geht jedoch nicht mit einer weiteren Einschränkung der Lungenfunktion einher, im Vergleich zu Personen mit schwerer Adipositas, jedoch ohne T2DM. Obwohl die zugrunde liegenden Mechanismen noch nicht vollständig bekannt sind, verdeutlichen diese Befunde das Zusammenspiel von kardiorespiratorischer Fitness und dem Metabolismus, auch bei Personen mit schwerer Adipositas.

Abstract

Aims Both severe obesity and type 2 diabetes (T2DM) are associated with reduced pulmonary function and reduced cardiorespiratory fitness. We investigated whether T2DM further aggravates the impaired pulmonary function and cardiorespiratory fitness in subjects with severe obesity.

Methods In this cross-sectional study pulmonary function (forced expiratory volume within 1 s, FEV1; vital capacity, VC) was assessed in 65 severely obese subjects with T2DM (T2DM group) and 65 severely obese subjects without T2DM (non-T2DM group), pairwise matched for sex, age, weight, and height. In 30 of the matched pairs, cardiorespiratory fitness was assessed by an incremental bicycle test (peak workload, W_peak, oxygen uptake, V O_{2, peak}).

Results FEV1 and VC did not differ between the T2DM and non-T2DM group (all p≥ 0.110), whereas W_peak and V O_{2, peak} – absolute values as well as relative to body mass – were significantly lower in subjects with T2DM compared to those without T2DM (all p≤ 0.030). Objective markers of maximal exertion, i. e., maximal heart rate and respiratory exchange ratio, did not differ between the 2 groups (both p≥ 0.245).

Conclusions The presence of T2DM in subjects with severe obesity is associated with lower cardiorespiratory fitness but with no further reduction in pulmonary function compared to subjects with severe obesity but without T2DM. While the cause-effect relationship of this association is not yet clear, these findings highlight the interplay between cardiorespiratory fitness and metabolic health, even in subjects with severe obesity.

Schlüsselwörter

Sauerstoffaufnahme - Herzfrequenz - Ergospirometrie - Spirometrie - BMI - Glukose

Key words

oxygen uptake - heart rate - ergospirometry - spirometry - bmi - glucose

• Referenzen

• 1 Hulens M, Vansant G, Lysens R. et al. Exercise capacity in lean versus obese women. Scand J Med Sci Sports 2001; 11: 305-309
• 2 Sabia S, Shipley M, Elbaz A. et al. Why does lung function predict mortality? Results from the Whitehall II Cohort Study. Am J Epidemiol 2010; 172: 1415-1423
• 3 Schünemann HJ, Dorn J, Grant BJ. et al. Pulmonary function is a long-term predictor of mortality in the general population: 29-year follow-up of the Buffalo Health Study. Chest 2000; 118: 656-664
• 4 Kodama S, Saito K, Tanaka S. et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA 2009; 301: 2024-2035
• 5 Lee S, Kuk JL, Katzmarzyk PT. et al. Cardiorespiratory fitness attenuates metabolic risk independent of abdominal subcutaneous and visceral fat in men. Diabetes Care 2005; 284: 895-901
• 6 McClean KM, Kee F, Young IS. et al. Obesity and the lung: 1. Epidemiology. Thorax 2008; 63: 649-654
• 7 Brazzale DJ, Pretto JJ, Schachter LM. Optimizing respiratory function assessments to elucidate the impact of obesity on respiratory health. Respirol Carlton Vic 2015; 20: 715-721
• 8 Holloway GP, Thrush AB, Heigenhauser GJF. et al. Skeletal muscle mitochondrial FAT/CD36 content and palmitate oxidation are not decreased in obese women. Am J Physiol Endocrinol Metab 2007; 292: E1782-E1789
• 9 Larsen S, Stride N, Hey-Mogensen M. et al. Increased mitochondrial substrate sensitivity in skeletal muscle of patients with type 2 diabetes. Diabetologia 2011; 54: 1427-1436
• 10 Kelley DE, He J, Menshikova EV. et al. Dysfunction of mitochondria in human skeletal muscle in type 2 diabetes. Diabetes 2002; 51: 2944-2950
• 11 Lecube A, Sampol G, Muñoz X. et al. Type 2 diabetes impairs pulmonary function in morbidly obese women: a case-control study. Diabetologia 2010; 53: 1210-1216
• 12 Kim HK, Kim CH, Jung YJ. et al. Association of restrictive ventilatory dysfunction with insulin resistance and type 2 diabetes in koreans. Exp Clin Endocrinol Diabetes 2011; 119: 47-52
• 13 Yeh HC, Punjabi NM, Wang NY. et al. Cross-sectional and prospective study of lung function in adults with type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study. Diabetes Care 2008; 31: 741-746
• 14 Brandenburg SL, Reusch JE, Bauer TA. et al. Effects of exercise training on oxygen uptake kinetic responses in women with type 2 diabetes. Diabetes Care 1999; 22: 1640-1646
• 15 Fang ZY, Sharman J, Prins JB. et al. Determinants of exercise capacity in patients with type 2 diabetes. Diabetes Care 2005; 28: 1643-1648
• 16 Regensteiner JG, Bauer TA, Reusch JEB. et al. Cardiac dysfunction during exercise in uncomplicated type 2 diabetes. Med Sci Sports Exerc 2009; 41: 977-984
• 17 Chen Y, Rennie D, Cormier YF. et al. Waist circumference is associated with pulmonary function in normal-weight, overweight, and obese subjects. Am J Clin Nutr 2007; 85: 35-39
• 18 Murugan AT, Sharma G. Obesity and respiratory diseases. Chron Respir Dis 2008; 5: 233-242
• 19 Weynand B, Jonckheere A, Frans A. et al. Diabetes mellitus induces a thickening of the pulmonary basal lamina. Respir Int Rev Thorac Dis 1999; 66: 14-19
• 20 Fogarty AW, Jones S, Britton JR. et al. Systemic inflammation and decline in lung function in a general population: a prospective study. Thorax 2007; 62: 515-520
• 21 Thyagarajan B, Jacobs DR, Apostol GG. et al. Plasma fibrinogen and lung function: the CARDIA Study. Int J Epidemiol 2006; 35: 1001-1008
• 22 Phielix E, Meex R, Moonen-Kornips E. et al. Exercise training increases mitochondrial content and ex vivo mitochondrial function similarly in patients with type 2 diabetes and in control individuals. Diabetologia 2010; 53: 1714-1721
• 23 Mogensen M, Sahlin K, Fernström M. et al. Mitochondrial respiration is decreased in skeletal muscle of patients with type 2 diabetes. Diabetes 2007; 56: 1592-1599
• 24 Poirier P, Garneau C, Bogaty P. et al. Impact of left ventricular diastolic dysfunction on maximal treadmill performance in normotensive subjects with well-controlled type 2 diabetes mellitus. Am J Cardiol 2000; 85: 473-477
• 25 Teixeira TFS, Alves RDM, Moreira APB. et al. Main characteristics of metabolically obese normal weight and metabolically healthy obese phenotypes. Nutr Rev 2015; 73: 175-190
• 26 Ferrer R, Pardina E, Rossell J. et al. Morbidly “healthy” obese are not metabolically healthy but less metabolically imbalanced than those with type 2 diabetes or dyslipidemia. Obes Surg 2015; 25: 1380-1391
• 27 Wilms B, Ernst B, Thurnheer M. et al. Correction factors for the calculation of metabolic equivalents (MET) in overweight to extremely obese subjects. Int J Obes 2014; 38: 1383-1387
• 28 Waldburger R, Wilms B, Ernst B. et al. Cardio-respiratory fitness is independently associated with cardio-metabolic risk markers in severely obese women. Exp Clin Endocrinol Diabetes 2014; 122: 190-194
• 29 Matthews DR, Hosker JP, Rudenski AS. et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-419
• 30 Quanjer PH, Tammeling GJ, Cotes JE. et al. Lung volumes and forced ventilatory flows. Report working party standardization of lung function tests, european community for steel and coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 1993; 16: 5-40
• 31 Quanjer PH, Stanojevic S, Cole TJ. et al. Multi-ethnic reference values for spirometry for the 3–95-yr age range: the global lung function 2012 equations. Eur Respir J 2012; 40: 1324-1343
• 32 Vestbo J, Hurd SS, Agustí AG. et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187: 347-365
• 33 Jouven X, Empana JP, Schwartz PJ. et al. Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 2005; 352: 1951-1958
• 34 Wasserman K, Hansen J, Sue D. et al. Principles of exercise testing and interpretation. 4th ed. Philadelphia, USA: Lippincott Williams & Wilkins;
• 35 Solomon TPJ, Malin SK, Karstoft K. et al. Association between cardiorespiratory fitness and the determinants of glycemic control across the entire glucose tolerance continuum. Diabetes Care 2015; 38: 921-929
• 36 Bakkman L, Fernström M, Loogna P. et al. Reduced respiratory capacity in muscle mitochondria of obese subjects. Obes Facts 2010; 3: 371-375
• 37 Jackson AS, Sui X, Hébert JR. et al. Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med 2009; 169: 1781-1787
• 38 Isomaa B, Forsén B, Lahti K. et al. A family history of diabetes is associated with reduced physical fitness in the prevalence, prediction and prevention of diabetes (PPP)-botnia study. Diabetologia 2010; 53: 1709-1713
• 39 Barrett-Connor E, Frette C. NIDDM, impaired glucose tolerance, and pulmonary function in older adults. The Rancho Bernardo Study. Diabetes Care 1996; 19: 1441-1444
• 40 Lecube A, Sampol G, Muñoz X. et al. Insulin resistance is related to impaired lung function in morbidly obese women: a case-control study. Diabetes Metab Res Rev 2010; 26: 639-645
• 41 Oosthuyse T, Bosch AN. The effect of the menstrual cycle on exercise metabolism: implications for exercise performance in eumenorrhoeic women. Sports Med Auckl NZ 2010; 40: 207-227
• 42 Frank I, Briggs R, Spengler CM. Respiratory muscles, exercise performance, and health in overweight and obese subjects. Med Sci Sports Exerc 2011; 43: 714-727
• 43 Chennaoui M, Arnal PJ, Sauvet F. et al. Sleep and exercise: a reciprocal issue?. Sleep Med Rev 2015; 20: 59-72
• 44 Guette M, Gondin J, Martin A. et al. Plantar flexion torque as a function of time of day. Int J Sports Med 2006; 27: 171-177