Effects of acupuncture on nutritional state of patients with stable chronic obstructive pulmonary disease (COPD): re-analysis of COPD acupuncture trial, a randomized controlled trial

Masao Suzuki,Michiaki Mishima,Tadamichi Mitsuma,Kazuo Endo,Susumu Sato,Motonari Fukui,Tetsuhiro Shiota,Toyohiro Hirai,Naoto Ishizaki,Shigeo Muro,Tomoko Suzuki

doi:10.1186/s12906-018-2341-3

Abstract

BackgroundThere are an increasing number of evidences that chronic obstructive pulmonary disease (COPD) is a systemic illness and that bodyweight loss is its prominent manifestation. We focused on the nutritional outcomes to find out the effectiveness of acupuncture on nutritional state of COPD patients and on their prognosis in our previous interventional study.MethodsThe present study is re-analysis of our previous interventional study, COPD Acupuncture Trial (CAT) published in 2012. Data from CAT was re-analyzed in terms of nutritional status, inflammatory biomarkers, and prognostic index. Nutritional states were evaluated by the measurements of body weight, body composition, and muscle strength, and the nutritional hematological examination results (retinol-binding protein (RBP), prealbumin (PA), transferrin (Tf), and hemoglobin (Hb) in serum), and inflammation biomarkers such as carboxyhemoglobin (COHb), High sensitivity C-reactive protein (Hs-CRP), Tumor Necrosis Factor-alpha (TNF-α), Interleukin 6 (IL-6), and Serum Amyloid A (SAA) were measured. The BODE index was measured in terms of prognosis. These measurements were compared between the real acupuncture group (RAG) and the placebo acupuncture group (PAG). All data are presented as mean (SD) or mean (95% CI). The difference between baseline and final volumes was compared using analysis of covariance (ANCOVA). Moreover, correlations between nutritional hematological examination scores and inflammation biomarker parameters were assessed using Spearman’s rank correlation coefficient.ResultsAfter 12 weeks, the change in body weight was significantly greater in the RAG compared with the PAG (mean [SD] difference from baseline: 2.5 [0.4] in RAG vs − 0.5 [1.4] in PAG; mean difference between the groups: 3.00, 95% CI, 2.00 to 4.00 with ANCOVA). Patients in RAG also had improvements in the results of nutritional hematological examination (RBP, PA, Tf, Hb), Inflammation biomarkers (TNF-α, IL-6, SAA, Hs-CRP, COHb) and the BODE index.ConclusionThis study demonstrated some clear evidences that acupuncture can be a useful adjunctive therapy to improve nutritional state of COPD patients.Trial registrationUMIN Clinical Trials Registry (UMIN000001277). Retrospectively registered.

Highlights

There are an increasing number of evidences that chronic obstructive pulmonary disease (COPD) is a systemic illness and that bodyweight loss is its prominent manifestation
Gan et al performed a systematic review of these studies and found that circulating leukocytes, fibrinogen, serum C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) levels were higher in COPD patients than in control subjects [8]
We previously demonstrated that dyspnea and exercise capacity evaluated with Borg scale scores and the 6-min walking distance (6MWD) were markedly improved with acupuncture in a prospective, randomized controlled trial in COPD patients who were receiving standard medication [9]

Summary

Introduction

There are an increasing number of evidences that chronic obstructive pulmonary disease (COPD) is a systemic illness and that bodyweight loss is its prominent manifestation. We focused on the nutritional outcomes to find out the effectiveness of acupuncture on nutritional state of COPD patients and on their prognosis in our previous interventional study. Low body mass index (BMI) is closely associated with mortality in COPD [1]; Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD [2]; Weight loss may be the result of an increased imbalance in energy expenditure caused by inadequate intake of nutrient. Previous studies have suggested that underweight patients show higher metabolic rate (negative energy balance) [3], lower antioxidant capacity of skeletal muscles [4], and increased systemic inflammation [5], which may be causing weight loss and morbidity. Previous studies have shown that patients with COPD exhibit low-grade systemic inflammation which is often associated with significant extra-pulmonary effects, such as cardiovascular abnormalities and skeletal muscle dysfunctions [7]. Gan et al performed a systematic review of these studies and found that circulating leukocytes, fibrinogen, serum C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) levels were higher in COPD patients than in control subjects [8]

Methods

Results

Discussion

Conclusion