title: The association between metabolic syndrome and restrictive ventilatory dysfunction in older persons.
abstract: BACKGROUND
  The restrictive, but not the obstructive respiratory dysfunction, is associated with an increased risk of developing type 2 diabetes mellitus. Our aim was to verify in an elderly nondiabetic population whether a restrictive respiratory pattern was associated with a higher prevalence of metabolic syndrome and increased insulin resistance than were obstructive and normal respiratory patterns.
  
  
  METHODS
  We performed a cross-sectional study of 159 consecutive nondiabetic elderly persons attending two social centers. According to their spirometric pattern, volunteers were classified into the following categories: normal spirometry, obstructive (forced expiratory volume in 1 second/forced vital capacity<0.70), and restrictive pattern (forced vital capacity<80% predicted, forced expiratory volume in 1 second/forced vital capacity>or=0.70). Independent correlates of the metabolic syndrome were identified.
  
  
  RESULTS
  The prevalence of metabolic syndrome was higher in restrictive (56%) than in both normal (21.4%, p=.001) and obstructive volunteers (12.9%, p=.001). Insulin resistance, as assessed by the log transformation of the HOmeostasis Model Assessment (HOMA), was higher in restrictive than in obstructive and normal volunteers (1+/-0.6 vs 0.3+/-0.6 and 0.5+/-0.5, p<.001). Restriction was an independent correlate of metabolic syndrome, also after adjustment for waist circumference and body mass index (odds ratio=3.23, 95% confidence interval, 1.23-8.48; p=.01).
  
  
  CONCLUSIONS
  Restrictive, but not obstructive respiratory pattern, is associated with metabolic syndrome and insulin resistance, and does not only reflect a limitation of ventilation due to visceral obesity. Metabolic abnormalities likely mediate cardiovascular risk in patients with restrictive respiratory impairment.
authors.affiliation: Division of Internal Medicine, Leopoldo Parodi-Delfino Hospital, and University Campus Biomedico of Rome, Via dei Compositori 130, 00128, Rome, Italy. filippo.fimognari@virgilio.it
authors.forename: Filippo Luca
authors.initials: FL
authors.lastname: Fimognari
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pasqualetti
authors.forename: Leo
authors.initials: L
authors.lastname: Moro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Franco
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Piccirillo
authors.forename: Ruggero
authors.initials: R
authors.lastname: Pastorelli
authors.forename: Paolo Maria
authors.initials: PM
authors.lastname: Rossini
authors.forename: Raffaele Antonelli
authors.initials: RA
authors.lastname: Incalzi
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology*; D012120:Respiration Disorders / Q000150:complications*; D012129:Respiratory Function Tests