Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial
Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial
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DOI：
10.1111/cea.12004
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发表时间：
2013-01-01
影响因子：
6.1
通讯作者：
Wood, L. G.
中科院分区：
文献类型：
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作者：
Scott, H. A.;Gibson, P. G.;Wood, L. G.
背景肥胖和哮喘是相关疾病；然而，两者之间的联系机制尚不清楚。很少有研究研究减肥对肥胖症患者炎症和临床结果的影响。目的比较饮食限制、运动或饮食限制与运动联合减肥对超重和肥胖成人哮喘患者气道炎症和临床结局的影响。方法46例受试者(54.3%女性，平均体重指数(+/-SD)33.7+/-3.5 kg/m2)随机接受为期10周的饮食、运动或饮食运动联合干预。采用双能X线骨密度仪，填写Juniper哮喘控制问卷和Juniper哮喘生活质量问卷，测定炎症标志物、膳食摄入量和体力活动。该试验在澳大利亚临床试验注册中心注册：ACTRN12611000235909。结果保留率为82.6%。饮食、运动和综合干预后平均+/-SD减重率分别为8.5+/-4.2%、1.8+/-2.6%和8.3+/-4.9%。饮食干预后哮喘控制改善(均数+/-SD；-0.001+/-0.5，P=0.040)，生活质量改善[智商中位数(智商)0.90(0.4，1.3)，P=0.002]、运动干预[0.49(0.03，0.78)，P=0.037]和综合干预[0.5(0.1，1.0)，P=0.007]。510%的体重减轻导致58%的受试者哮喘控制得到临床上重要的改善，83%的受试者生活质量得到改善。女性女性脂肪组织减少与中性粒细胞炎症减少相关[β系数(95%CI)；1.75(0.02，3.48)，P=0.047]，而男性饮食饱和脂肪减少与中性粒细胞炎症减少相关(r=0.775，P=0.041)。运动干预后痰嗜酸粒细胞明显减少[中位数(IQR)；-1.3%(-2.0%，-1.0%，P=0.028]。结论和临床意义本研究建议将减重目标定为510%，以协助超重和肥胖成人哮喘的临床治疗。肥胖症的表型可能涉及先天和过敏性炎症途径。
Background Obesity and asthma are associated conditions; however, the mechanisms linking the two remain unclear. Few studies have examined the effects of weight loss on inflammation and clinical outcomes in obeseasthma. Objective To compare the effects of weight loss achieved by dietary restriction, exercise or combined dietary restriction and exercise on airway inflammation and clinical outcomes in overweight and obese adults with asthma. Methods Participants (n = 46; 54.3% female, body mass index (mean +/- SD) 33.7 +/- 3.5 kg/m2) were randomized to complete a 10-week dietary, exercise or combined dietary and exercise intervention. Dual-energy x-ray absorptiometry was performed, the Juniper Asthma Control Questionnaire and Juniper Asthma Quality of Life Questionnaire completed and inflammatory markers, dietary intake and physical activity measured. The trial was registered with the Australian Clinical Trials Registry: ACTRN12611000235909. Results Retention was 82.6%. Mean +/- SD weight loss was 8.5 +/- 4.2%, 1.8 +/- 2.6% and 8.3 +/- 4.9% after the dietary, exercise and combined interventions respectively. Asthma control improved after the dietary (mean +/- SD; -0.6 +/- 0.5, P = 0.001) and combined interventions (-0.5 +/- 0.7, P = 0.040), whereas quality of life improved after the dietary [median (IQR); 0.9 (0.4, 1.3), P = 0.002], exercise [0.49 (0.03, 0.78), P = 0.037] and combined [0.5 (0.1, 1.0), P = 0.007] interventions. A 510% weight loss resulted in clinically important improvements to asthma control in 58%, and quality of life in 83%, of subjects. Gynoid adipose tissue reduction was associated with reduced neutrophilic airway inflammation in women [beta-coefficient (95% CI); 1.75 (0.02, 3.48), P = 0.047], whereas a reduction in dietary saturated fat was associated with reduced neutrophilic airway inflammation in males (r = 0.775, P = 0.041). The exercise intervention resulted in a significant reduction to sputum eosinophils [median (IQR); -1.3 (-2.0, -1.0)%, P = 0.028]. Conclusion and clinical relevance This study suggests a weight-loss goal of 510% be recommended to assist in the clinical management of overweight and obese adults with asthma. The obeseasthma phenotype may involve both innate and allergic inflammatory pathways.