OBJECTIVE Insulin resistance (IR) may be a risk factor for lung disease, but objective evidence is limited. We sought to define the relationship of longitudinal IR with radiographic imaging outcomes and examiner-identified incident lung disease in the Framingham Offspring Study. RESEARCH DESIGN AND METHODS Participants without baseline lung disease underwent repeated measurements of fasting insulin and glucose levels over an average period of 13.6 years, from which time-weighted average HOMA-IR was calculated. Each participant then underwent a cardiac gated whole-lung computed tomography scan, which was analyzed for the presence of emphysema, interstitial lung abnormalities (ILAs), and quantitative airway features. Incident lung disease was determined by a study examiner. The relationship of HOMA-IR to these outcomes was estimated in models adjusted for demographics, BMI, and lifetime smoking. RESULTS A total of 875 participants with longitudinal IR data and outcomes were identified. Their mean age was 51.5 years, and BMI was 26.7 kg/m2. HOMA-IR was temporally unstable, with a within-person SD approximately two-thirds of the between-person SD. In adjusted models, a 1 SD increase in log(HOMA-IR) z score was associated with higher odds of qualitative emphysema (odds ratio [OR] 1.33; 95% CI 1.04–1.70), ILAs (OR 1.35; 95% CI 1.05–1.74), and modest increases in airway wall thickness and wall area percentage. These radiographic findings were corroborated by a positive association of HOMA-IR with incident lung disease. CONCLUSIONS IR is associated with radiographic lung abnormalities and incident lung disease. Deeper phenotyping is necessary to define mechanisms of IR-associated lung injury.

中文翻译：

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胰岛素抵抗与放射学肺部异常和新发肺病的关系： Framingham 后代研究


目的 胰岛素抵抗 （IR） 可能是肺部疾病的危险因素，但客观证据有限。在 Framingham Offspring 研究中，我们试图定义纵向 IR 与放射学成像结果和检查者确定的肺病事件之间的关系。研究设计和方法 没有基线肺病的参与者在平均 13.6 年的时间里重复测量空腹胰岛素和葡萄糖水平，从中计算出时间加权平均 HOMA-IR。然后，每个参与者都接受了心脏门控全肺计算机断层扫描，分析了肺气肿、间质性肺异常 （ILA） 和定量气道特征的存在。新发肺病由研究检查员确定。HOMA-IR 与这些结果的关系是在根据人口统计学、 BMI 和终生吸烟进行调整的模型中估计的。结果 共确定了 875 名具有纵向 IR 数据和结果的参与者。他们的平均年龄为 51.5 岁，BMI 为 26.7 kg/m2。HOMA-IR 在时间上不稳定，人内 SD 约占人间 SD 的三分之二。在调整后的模型中，log（HOMA-IR） z 评分增加 1 SD 与定性肺气肿的几率较高相关 （比值比 [OR] 1.33;95% CI 1.04-1.70）、ILA （OR 1.35;95% CI 1.05-1.74），以及气道壁厚和壁面积百分比的适度增加。HOMA-IR 与新发肺病的正相关证实了这些影像学检查结果。结论 IR 与影像学肺部异常和新发肺病相关。更深入的表型分析对于确定 IR 相关肺损伤的机制是必要的。