title: Obesity in adults is associated with reduced lung function in metabolic syndrome and diabetes: the Strong Heart Study.
abstract: OBJECTIVE
  The purposes of this study were to investigate whether reduced lung function is associated with metabolic syndrome (MS) and diabetes (DM) in American Indians (AIs) and to determine whether lower pulmonary function presents before the development of DM or MS.
  
  
  METHODS
  The Strong Heart Study (SHS) is a multicenter, prospective study of cardiovascular disease (CVD) and its risk factors among AI adults. The present analysis used lung function assessment by standard spirometry at the SHS second examination (1993-1995) in 2,396 adults free of overt lung disease or CVD, with or without DM or MS. Among MS-free/DM-free participants, the development of MS/DM at the SHS third examination (1996-1999) was investigated.
  
  
  RESULTS
  Significantly lower pulmonary function was observed for AIs with MS or DM. Impaired pulmonary function was associated with MS and DM after adjustment for age, sex, abdominal obesity, current smoking status, physical activity index, hypertension, and SHS field center. Both forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were negatively associated with insulin resistance or DM severity and with serum markers of inflammation (P < 0.05). FVC and FEV1-to-FVC ratio both predicted DM in unadjusted analyses but not when adjusted for covariates, including waist circumference. In the adjusted model, abdominal obesity predicted both MS and DM.
  
  
  CONCLUSIONS
  Reduced lung function is independently associated with MS and with DM, and impaired lung function presents before the development of MS or DM; these associations may result from the effects of obesity and inflammation.
authors.affiliation: College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. fawn-yeh@ouhsc.edu
authors.forename: Fawn
authors.initials: F
authors.lastname: Yeh
authors.forename: Anne E
authors.initials: AE
authors.lastname: Dixon
authors.forename: Susan
authors.initials: S
authors.lastname: Marion
authors.forename: Carl
authors.initials: C
authors.lastname: Schaefer
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Lyle G
authors.initials: LG
authors.lastname: Best
authors.forename: Darren
authors.initials: D
authors.lastname: Calhoun
authors.forename: Everett R
authors.initials: ER
authors.lastname: Rhoades
authors.forename: Elisa T
authors.initials: ET
authors.lastname: Lee
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007198:Indians, North American; D016014:Linear Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000503:physiopathology*; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012307:Risk Factors