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1 Division of Internal Medicine, Leopoldo Parodi-Delfino Hospital, Azienda Sanitaria Locale Roma G, Colleferro (Rome), Italy.
2 Division of Geriatrics, University Campus Biomedico of Rome, Italy.
3 AfaR (Associazione Fatebenefratelli per la Ricerca), Rome, Italy.
4 Department of Aging Science, University La Sapienza, Rome, Italy.
Address correspondence to Filippo L. Fimognari, MD, Centro per la Salute dell'Anziano (CeSA), University Campus Biomedico of Rome, Via dei Compositori 130, 00128, Rome, Italy. E-mail: filippo.fimognari{at}virgilio.it
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 
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).
Conclusion. 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.
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