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. 2012 Feb 15;185(4):392-9.
doi: 10.1164/rccm.201109-1672OC. Epub 2011 Nov 17.

Metabolic syndrome biomarkers predict lung function impairment: a nested case-control study

Bushra Naveed  1 , Michael D Weiden, Sophia Kwon, Edward J Gracely, Ashley L Comfort, Natalia Ferrier, Kusali J Kasturiarachchi, Hillel W Cohen, Thomas K Aldrich, William N Rom, Kerry Kelly, David J Prezant, Anna Nolan
Affiliations

Metabolic syndrome biomarkers predict lung function impairment: a nested case-control study

Bushra Naveed et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Cross-sectional studies demonstrate an association between metabolic syndrome and impaired lung function.

Objectives: To define if metabolic syndrome biomarkers are risk factors for loss of lung function after irritant exposure.

Methods: A nested case-control study of Fire Department of New York personnel with normal pre-September 11th FEV(1) and who presented for subspecialty pulmonary evaluation before March 10, 2008. We correlated metabolic syndrome biomarkers obtained within 6 months of World Trade Center dust exposure with subsequent FEV(1). FEV(1) at subspecialty pulmonary evaluation within 6.5 years defined disease status; cases had FEV(1) less than lower limit of normal, whereas control subjects had FEV(1) greater than or equal to lower limit of normal.

Measurements and main results: Clinical data and serum sampled at the first monitoring examination within 6 months of September 11, 2001, assessed body mass index, heart rate, serum glucose, triglycerides and high-density lipoprotein (HDL), leptin, pancreatic polypeptide, and amylin. Cases and control subjects had significant differences in HDL less than 40 mg/dl with triglycerides greater than or equal to 150 mg/dl, heart rate greater than or equal to 66 bpm, and leptin greater than or equal to 10,300 pg/ml. Each increased the odds of abnormal FEV(1) at pulmonary evaluation by more than twofold, whereas amylin greater than or equal to 116 pg/ml decreased the odds by 84%, in a multibiomarker model adjusting for age, race, body mass index, and World Trade Center arrival time. This model had a sensitivity of 41%, a specificity of 86%, and a receiver operating characteristic area under the curve of 0.77.

Conclusions: Abnormal triglycerides and HDL and elevated heart rate and leptin are independent risk factors of greater susceptibility to lung function impairment after September 11, 2001, whereas elevated amylin is protective. Metabolic biomarkers are predictors of lung disease, and may be useful for assessing risk of impaired lung function in response to particulate inhalation.

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Figures

Figure 1.
Figure 1.
Study design. FDNY = Fire Department of New York; LLN = lower limit of normal as defined by NHANES III; NHANES = National Health and Nutrition Examination Survey; NYU = New York University; PFT = pulmonary function test; SPE = subspecialty pulmonary examination; WTC = World Trade Center.
Figure 2.
Figure 2.
Change in FEV1 (milliliter per year) significantly different between cases and control subjects only at medical monitoring examination (MME) to subspecialty pulmonary examination (SPE) time period. n = 237; * P < 0.0001. Slope was not statistically significant between cases and control subjects at pre–September 11th (n = 169) and between pre–September 11th to MME (n = 237). Results represented as box (median and interquartile range) and whiskers (10th–90th percentile). Significance determined by Mann-Whitney U test.
Figure 3.
Figure 3.
Receiver operator characteristic (ROC) reduced and final models. Final model ROC curve (solid black line) includes leptin greater than or equal to 10,300 pg/ml, amylin greater than or equal to 116 pg/ml, high-density lipoprotein less than 40, triglycerides greater than or equal to 150, and heart rate greater than or equal to 66 bpm, adjusted for age at September 11th, body mass index at subspecialty pulmonary examination, race, and World Trade Center arrival time. Individual components (dotted lines) are crude models with the single predictor indicated, adjusted for age at September 11th, body mass index at subspecialty pulmonary examination, race, and World Trade Center arrival time. AUC = area under the curve.
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