Abstract
There is a paucity of evidence to guide clinicians about appropriate management strategies for people with obesity and Chronic Obstructive Pulmonary Disease (COPD). We have recently published results from the first weight loss intervention in adults (>18 years) with obesity (body mass index; BMI ≥ 30 kg/m2) and COPD, using a low-calorie diet coupled with a partial meal replacement plan and resistance exercise training, which resulted in a 6.4% reduction in weight while maintaining skeletal muscle mass and improving health status. This sub-study aims to evaluate the intervention by (a) examining changes in dietary intake and nutritional biomarkers and (b) examining predictors of weight loss. Dietary intake was evaluated using four-day food diaries, and analysis of plasma fatty acids and plasma carotenoids as biomarkers of dietary fat intake and fruit and vegetable intake, respectively. Twenty-eight obese COPD subjects (n = 17 males, n = 11 females) with a mean (standard deviation; SD) age of 67.6 (6.3) years completed the 12-week weight loss intervention. Pre-intervention, mean (SD) BMI was 36.3 (4.6) kg/m2. Micronutrient intake improved from pre- to post-intervention, with the percentage of subjects meeting the Nutrient Reference Values increased for all micronutrients. Post-intervention, significant decreases in total (p = 0.009) and saturated fat intake (p = 0.037), and corresponding decreases in total (p = 0.007) and saturated plasma fatty acids (p = 0.003) were observed. There was a trend towards higher total carotenoids post-intervention (p = 0.078). Older age (p = 0.025), higher pre-intervention uncontrolled eating (p < 0.001) and plasma carotenoids (p = 0.009) predicted weight loss. This demonstrates the efficacy of a weight loss intervention in improving diet quality of obese COPD adults.
Highlights
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of mortality worldwide, and it is estimated that approximately 7.5% of Australians aged ≥40 years have disease that is significant enough to cause a daily symptom burden [1]
COPD has traditionally been associated with involuntary weight loss, malnutrition and muscle mass depletion [2], the prevalence of obesity (Body Mass Index, BMI ≥ 30 kg/m2 ) in COPD has been reported to be between 18–54% [3,4,5], and is becoming increasingly prevalent in the earlier stages of the disease (Global Initiative for Chronic Obstructive Lung Disease, GOLD stage I and II) [6,7,8,9]
This study demonstrates for the first time the feasibility and efficacy of a weight loss intervention in reducing energy intake, and improving eating behaviours and dietary quality, in regards to dietary fat and micronutrient intake, in people with obesity and COPD
Summary
Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of mortality worldwide, and it is estimated that approximately 7.5% of Australians aged ≥40 years have disease that is significant enough to cause a daily symptom burden [1]. Despite having less severe airflow limitations, people with obesity who have COPD are reported to experience greater exercise intolerance, fatigue and dyspnoea, and poorer health-related quality of life compared to their normal-weight counterparts [10]. These negative consequences of obesity, combined with the increasing prevalence of obesity in COPD, highlight the need for a suitable management approach [11]. Fruit and vegetables are recommended during weight loss, as they are low in energy while being high in micronutrients, such as carotenoids, and high in water and fibre, which contribute to satiety and result in the consumption of fewer calories [13]
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