INTRODUCTION Chronic obstructive pulmonary disease is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airow limitation that is due to airway and / or alveolar abnormalities usually caused 1by signicant exposure to noxious particles or gases . The term chronic systemic inammatory syndrome is proposed to take account of inammatory nature of COPD and its co morbid conditions such as MetS Metabolic syndrome has . multiple risk factors that arise from insulin resistance accompanying abnormal adipose deposition and function. It is a risk factor for coronary heart disease, diabetes, fatty liver, and several cancers. Obesity is seen in approximately 18% of patients with COPD and is far more common in early stages 2(stage-I and II) . 3,4Several studies from North America have shown a prevalence of metabolic syndrome in COPD patients in a 5range 29-58%. Tanni et al reported MetS in 36% of COPD patients. Indian data on the prevalence of MetS or its 6components in COPD are sparse. Dave et al reported MetS in 42% COPD cases. The aim of this study was to investigate the prevalence MetS in stable COPD patients. METHODS This prospective study was conducted in 67 COPD patients attending the Department of Tuberculosis and Respiratory Diseases, G.S.V.M. Medical College, Kanpur from April- 2017 to March -2018. INCLUSION CRITERIA: Ÿ Stable COPD Patients. EXCLUSION CRITERIA: Ÿ Other respiratory diseases such as pulmonary tuberc ulosis, bronchial asthma, interstitial lung diseases, obstructive sleep apnea and lung cancer. Ÿ Known case of Ischemic heart disease and chronic renal failure. Ÿ Unstable COPD patients with acute exacerbation. Patients attending hospital with cough and breathlessness were evaluated for COPD as per GOLD-2017. All routine blood investigations including complete lipid prole and plasma glucose estimation (FBS & OGTT) were done. Spirometry with reversibility was performed. Metabolic syndrome is dened as per New International 7Diabetes Federation IDF denition (IDF) : Ÿ Central obesity (dened as waist circumference >90 cm for men and >80 cm for women, with ethnicity specic values for other groups) Ÿ Plus any two of the following four factors: Ÿ Raised TG level: >150 mg/dl (1.7 mmol/L), or specic treatment for this lipid abnormality. Ÿ Reduced HDL cholesterol: <40 mg/dl in males and < 50 mg/dl in females, or specic treatment for this lipid abnormality. Ÿ Raised blood pressure: systolic BP ≥130 or diastolic BP 85 mm Hg, or treatment of previously diagnosed hypertension. Ÿ Raised fasting plasma glucose (FPG) ≥100 mg/dl (5.6 mmol/L), or previously diagnosed type 2 diabetes. Ÿ If above 5.6 mmol/L or 100 mg/dL, Oral Glucose Tolerance Test is strongly recommended but is not necessary to dene presence of the syndrome. STATISTICAL ANALYSIS Statistical analyses were performed using SPSS 22.0 software package and instat graphpad software. Variables were analyzed using student's t test and p value less than 0.05 was considered signicant. RESULTS Total 67 patients were included for nal analysis after exclu sion criteria. Mean age of male was 58.67 ± 9.87 years while mean age of female was 57.23 ± 10.40 years. Overall percentage of obese, overweight, normal weight and underweight were 31.3%, 23.9%, 29.8% and 14.9% respectively. 50% female and 22.2% male were obese. Mean 2BMI of male was 24.33±6.64 kg/m and mean BMI of study 2population was 26.22±7.22 kg/m . The mean waist circumference of male was 86.91±13.31 cm while in female it was 87.18±14.51 cm. Most parameters of lipid prole were deranged in study population. Among all parameters of lipid prole, raised triglyceride was found in majority of patients (69.4%) followed A STUDY TO INVESTIGATE THE PREVALENCE OF METABOLIC SYNDROME IN STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS Original Research Paper Dr Sachin Kumar Gupta (Senior resident) Dept Of Respiratory Medicine, IRD, SMS Medical College, Jaipur X 3GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Respiratory Medicine BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is associated with several extra- pulmonary systemic manifestations including metabolic syndrome. Metabolic syndrome is an aggregate of inter-related cardio-metabolic risk factors, comprising glucose intolerance, abdominal obesity, dyslipidemia and hypertension, which are associated with an increased risk of cardiovascular disease and type-2 diabetes. The objective of study was to assess prevalence of metabolic syndrome among COPD patients. METHODS: This cross-sectional study was conducted from April 2017 to March 2018. Total 67 COPD patients were classied according to GOLD guideline. International Diabetes Federation (IDF) guideline was used for metabolic syndrome(MetS). RESULTS: Prevalence of MetS was 29.85%, highest (47.06%) in GOLD stage-II, followed by stage-I (40%). CONCLUSIONS: The presence of metabolic syndrome is common in patients with COPD and all COPD patients should be considered for its screening. ABSTRACT KEYWORDS : Chronic Obstructive Pulmonary Disease, Metabolic Syndrome VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Dr Aashish Kumar Singh* (Assoc Prof) Dept Of Respiratory Medicine, IRD, SMS Medical College, Jaipur *Corresponding Author 4 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Prevalence of Metabolic Syndrome in our study was 29.85%. Metabolic syndrome was most common in GOLD stage-II (47.06%). (Table-2) Table-2 DISCUSSION Prevalence of metabolic syndrome in our study was 29.85% (40.91%in female and 24.44% in male). Metabolic syndrome was most common in GOLD stage-II (47.06%) followed by stage-I (40%) followed by stage-III (25.71%) and it was only 810% in stage- IV. Henrik Watz et al reported metabolic syndrome in 47.5% patients with highest (53%) in stage- II, 50% in stage-I, 44% in stage-IV and 37% in stage-III. Jesús 9Díez-Manglano et al found the overall prevalence of metabolic syndrome in COPD patients was 42.9%, being more 10frequent in female (59.5%). Marquis et al found frequency of Metabolic syndrome in patients with COPD was 21% and the frequency decreases to about 10% at GOLD stages III and IV. There was no evidence that the relation between airow obstruction and metabolic syndrome varied with smoking. Maximum patients of metabolic syndrome (45.5%) were in stage-I & II combined and only 22.2% of patients were in stage- III & IV combined in our study. However, no signicant variation was found in triglyceride levels, HDL levels, raised BP and raised FBS among various stages of COPD. It means that all parameters except central obesity were present in population and they were not affected by different GOLD stages. 2Mean BMI of males in our study was 24.33 ± 6.64 kg/m while 2in case of females it was 30.07 ± 6.95 kg/m . Overall mean BMI 2of study population was 26.22 ± 7.22 kg/m ,similar to Emel 11 12BULCUN et al and Z.Yasar et al . CONCLUSION Metabolic Syndrome is more common in COPD patients leading to signicant morbidity and mortality. Thus, it is essential to focus on a comprehensive way of management of COPD and its comorbidities rather than primarily treating the pulmonary symptoms. REFERENCES : 1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD 2017 global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease, 2017 report. 2. Steuten LM, Creutzberg EC, Vrijhoef HJ, Wouters EF. COPD as a multico mponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care. Pri Care Resp J. 2006 Apr 1;15(2):84-91. 3. Park SK, Larson JL. Metabolic syndrome and associated factors in people with chronic obstructive pulmonary disease. West J Nursing Res. 2014 May;36(5):620-42. 4. Poulain M, Doucet M, Drapeau V, Fournier G, Tremblay A, Poirier P, et al. Metabolic and inammatory prole in obese patients with chronic obstructive pulmonary disease. Chronic Resp Dis. 2008 Feb;5(1):35-41. 5. Tanni SE, Zamuner AT, Coelho LS, Vale SA, Godoy I, Paiva SA. Are metabolic syndrome and its components associated with 5-year mortality in chronic obstructive pupmonary disease patients?. Metab Syndrome Related Disord. 2015 Feb 1;13(1):52-4. 6. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL, Held LS, et al. Chronic obstructive pulmonary disease: current burden and future projections. Euro Res J. 2006 Feb 1;27(2):397-412. 7. Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: a global public health problem and a new denition. J atheroscler thrombosis. 2005;12(6):295-300. 8. Henrik Watz, Benjamin Waschki, Anne Kirsten, Kai-Christian Mu¨ller; Gunther Kretschmar, Thorsten Meyer, Olaf Holz, HelgoMagnussen. The Metabolic Syndrome in Patients With Chronic Bronchitis and COPD. 2009 CHEST; 136 (4):1039 9. Jesús Díez Manglano, José Barquero-Romero, Pedro Almagro, F. Javier Cabrera , Francisco López García, Lorena Montero, Joan B. Soriano. COPD patients with and without metabolic syndrome: clinical and functional differences. Internal and Emergncy Medicine. 2013;1-27 10. Karine Marquis, François Maltais, Véronique Duguay, Anne-Marie Bezeau, Picrre Le Blanc, Jcan Jobin, Paul Poirier. The Metabolic Syndrome in Patients With Chronic Obstructive Pulmonary Disease. Journal of Cardiopulmonary Rehabilitation. 2005;25:226-232 11. Emel Bulcun, Aydanur Ekici, Mehmet Ekici. Metabolic syndrome and chronic diseases in patients with chronic obstructive pulmonary disease. İzmir Göğüs Hospital journal.2015; 29:1-10 12. Z.Yasar, M. Buyuksirin, F.D. Ucsular, A.Kargi, F.Erdem, F. Talay, O.K. Kurt. Is an elevated neutrophil-to-lymphocyte ratio a predictor of metabolic syndrome in patientswith chronic obstructive pulmonary disease? European Review for Medical and Pharmacological Sciences. 2015;19:956-962 VOLUME-9, ISSUE-2, FEBRUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Table-1 : Comparision of various parameters between MetS and non-MetS COPD patients. Parameter COPD with metabolic syndrome (n=20) COPD without metabolic syndrome (n=47) Name of test (student t test) p value Signicant/ Non-signicant Waist circumference 101 ± 11.17 81.30 ± 10.86 2.0047 0.329 Not signicant TG 202.26 ± 97.72 140.86 ± 94.81 2.0287 0.41 Not signicant HDL 50.26 ± 12.12 54.77 ± 12.76 2.0094 0.592 Not signicant Fasting blood sugar 133.22 ± 21.06 99.39 ± 20.06 2.0223 0.381 Not signicant Systolic BP 148.09 ± 29.31 126.41 ± 15.34 2.0527 0.0001 Signicant by LDL (63.2%) and total cholesterol (63.2%). In female HDL was decreased in majority (58.3%) followed by LDL (36.8%) and total cholesterol (36.8%). Raised Fasting Blood Sugar (FBS) was more in female (54.5%) than males (31.1%). Overall 38.8% patients had raised FBS or on antidiabetic drugs previously. (Table-1) GOLD STAGE TOTAL PATIENTS METABOLIC SYNDROME TOTAL I 5 MALE 3 1 2(40%) FEMALE 2 1 II 17 MALE 14 6 8(47.06%) FEMALE 3 2 III 35 MALE 22 4 9(25.71%) 1(10%) FEMALE 13 5 IV 10 MALE 6 0 FEMALE 4 1 TOTAL 67(100%) 20(29.85%)