Malnutrition In Chronic Obstructive Pulmonary Disease Research Articles

Nutrition status and obesity paradox in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the main causes of increasing morbidity and mortality worldwide, and therefore is becoming a major public health problem. The aim of this research was to summarize the data of observational and clinical studies concerning the influence of nutritional status (both malnutrition and obesity) on the COPD course and outcomes. Material and methods. The databases PubMed, RSCI, MEDLINE, EMBASE were used for the period from January 2008 to February 2021, with a total of 582 works viewed. Searches included the keywords: nutritional status, obesity paradox, chronic obstructive pulmonary disease. Results. In the pathogenesis of malnutrition in COPD, such phenomena as excessively enhanced metabolism, loss of appetite and dietary imbalance are most often described. It is proposed to pay great attention to preventing muscle loss in the correction of these phenomena. More than a third of COPD patients has obesity, which is associated according to some reports with a low quality of life, an increased frequency of hospitalizations for exacerbations, but also with better survival. The issue of the obesity paradox in COPD is increasingly discussed in scientific literature. Many authors emphasize that basic scientific research will help to understand the mechanisms of obesity and COPD relationship, as well as timely adjust the rehabilitation program, improving the quality of patients' life. Conclusion. Nutritional status is the important factor in COPD outcomes. Maintaining muscle mass is a priority in COPD patients, including those with obesity. The proposed dietary therapy should take into account the food intake according to the needs of patients, the correct proportion of macronutrients and the level of the body mass index.

'Mind the gap': the importance of managing malnutrition in chronic obstructive pulmonary disease.

Malnutrition is linked to poor outcomes in patients with chronic obstructive pulmonary disease (COPD), and reduced fat free mass and low BMI are independent risk factors for increased mortality. However, weight loss is not inevitable and can be prevented or reversed so screening for malnutrition is essential. The latest guidelines for managing malnutrition in COPD recommend first-line nutritional support. In particular, patients with a BMI <20 kg/m2 should be prescribed oral nutritional supplements (ONS), which have been shown to significantly improve outcomes. However, this guidance is often not implemented locally, increasing the likelihood of malnutrition, hospital admission and increased healthcare costs. Ready-prepared, low-volume, high-protein, high-energy drinks can improve compliance with ONS, particularly in people who are unable to tolerate high volumes. ONS therefore play an important role in managing malnutrition in COPD, helping to reduce its physiological and economic effects.

Chronic obstructive pulmonary disease and malnutrition in developing countries.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disorder characterized by progressive, poorly reversible airflow limitation. In addition to its pulmonary manifestations, COPD is also associated with several systemic expressions including anemia, osteoporosis, coronary artery disease, and malnutrition. In COPD, malnutrition is a consequence of reduced nutritional intake and muscle loss, further compounded by systemic inflammation. In the developing world, malnutrition is a significant problem by itself, even without any systemic illness. It is likely that the occurrence and consequence of malnutrition in COPD may be even more profound in developing countries. In this review, we discuss the relationship between malnutrition and COPD and their overall impact in the developing world. COPD is highly prevalent in developing countries with an estimated 15-43 million patients suffering from COPD. The pooled prevalence of malnutrition in COPD was found to be 47.6% [95% confidence interval (CI), 23.5-71.5%] with the prevalence being higher in acute exacerbations of COPD compared to stable COPD. There is a need for generating good quality evidence from the developing world regarding the prevalence of malnutrition in COPD, the role of nutritional supplementation and its impact on exercise capacity, and overall health-related quality of life in patients with COPD.

P260 Oral nutritional supplements in chronic obstructive pulmonary disease (COPD): a systematic review and meta-analysis

Oral nutritional supplements (ONS) are often used to treat malnutrition in COPD, but the latest Cochrane review in COPD concluded that nutrition support, mainly involving ONS, did not improve anthropometry and other functional outcomes.1 The latest NICE guidelines for the management of COPD recommend the use of ONS but state it is based on grade D evidence2 despite previous reviews suggesting otherwise.3 This review aimed to clarify the evidence base for ONS use in COPD. A systematic review identified 11 randomised controlled trials using ONS vs control (189 vs 185). Meta-analysis was performed of nutritional intake, weight, mid-arm muscle circumference (MAMC) and handgrip strength (HGS) (Comprehensive Meta-analysis v2). Quality of life, exercise capacity and respiratory outcomes were also examined. In contrast to previous Cochrane reviews, examining only data at the end of intervention,1 this review examined the changes induced by ONS. Significantly improved energy intake was reported in six out of seven studies of which four were meta-analysable (+262 SE 104 kcal/d, p=0.012, random effect model, four RCT). Meta-analysis found ONS significantly improved body weight (+1.85 kg SE 0.25 kg, p&lt;0.001 (malnourished) and +1.31 kg SE 0.34 kg, p&lt;0.001 (nourished), 11 studies) and had a tendency to improve MAMC (+0.21 kg SE 0.19 kg, p=0.277, fixed effect model; I²=0; 2 studies). Improved HGS was found in three of four studies, two significant in their own right with meta-analysis favouring ONS (+2.14 kg SE 1.1 kg, p=0.054, random effect model (+8.3% improvement)). No improvements were reported in FEV₁ (eight studies) however, respiratory muscle strength appeared more responsive to ONS with PI max improved in three out of five studies (NS), PE max significantly improved in two out of four studies and sternomastoid strength significantly improved in one study. Exercise tolerance (six out of seven studies), dyspnoea and general well-being (three out of five studies) and quality of life (two out of two studies) were significantly improved with ONS although meta-analysis of these outcomes was not possible. ONS result in significant improvements in nutritional intake and body weight and a tendency for improvements in several functional outcomes. This would support an increased level of evidence for ONS in the NICE COPD guidelines.

Clinical and inflammatory factors associated with body mass index in elderly patients with chronic obstructive pulmonary disease

Body mass index (BMI) is closely associated with mortality in chronic obstructive pulmonary disease (COPD). Systemic inflammation has been suggested as one of the mechanisms of malnutrition in COPD. This study investigated the relationships of clinical variables and inflammatory biomarkers with BMI in COPD in an aging population. Baseline levels of serum biomarkers were determined for 69 patients with stable male COPD. Multivariate logistic regression was used to evaluate associations between clinical variables, including emphysema scores, and biomarkers with BMI. Twenty eight patients were categorized as low BMI (<20 kg/m2). BMI was inversely correlated with serum α1-antitrypsin (α1-AT) concentration and emphysema scores, and was positively correlated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). Multivariate logistic regression analysis showed that α1-AT was independently associated with BMI. Low BMI was associated with the severity of emphysema and systemic inflammation reflected by elevated α1-AT level.

The relationships of serum prealbumin levels with parameters that indicate severity of disease and emphysema pattern in patients with stable chronic obstructive pulmonary disease.

Malnutrition, which is a complication frequently observed in chronic obstructive pulmonary disease (COPD) and negatively affects prognosis, has become a parameter that must be monitored. Even though various methods are applied to assess malnutrition, biochemical parameters, especially serum prealbumin levels, are useful. The relationships between serum prealbumin levels, which we used as an indicator of malnutrition, with the severity of disease and the parameters predicting emphysema in stable COPD patients with no additional health problems were determined in this prospective study. One hundred stable COPD patients were evaluated prospectively. Serum prealbumin levels had a negative correlation with the total number of hospitalizations due to acute exacerbation, total hospitalization time, and average number of annual hospitalizations, whereas it showed a positive correlation with FEV1 and FEV1/FVC% values. Serum prealbumin levels were positively correlated with the length of the line connecting the costophrenic sinus to the dome of the diaphragm, which is used to assess the presence of emphysema and was negatively correlated with retrosternal distance. Also, in COPD patients with low prealbumin levels, while the FEV1 and FEV1/FVC% values and the length of the line connecting the costophrenic sinus to the diaphragm dome significantly decreased, the retrosternal distance dramatically increased compared to COPD patients with normal prealbumin levels. Serum prealbumin levels were convenient for monitoring malnutrition in COPD, were correlated with spirometric and anamnestic data indicating the severity of COPD, and were useful in distinguishing the subtype of COPD due to its decrease in the presence of emphysema.

EPOC y malnutrición

Weight loss and malnutrition related mainly to lean mass loss can develop in advanced stages of chronic obstructive pulmonary disease (COPD) and are a clear indication of phenotypic heterogeneity. The presence of weight loss and malnutrition is associated with a worse prognosis, independently of forced expiratory volume in 1 second (FEV 1). The most widely accepted thresholds for risk are 21 for the body mass index (BMI) and 17 and 14 for men and women, respectively, for the fat-free mass index (FFMI). The coexistence of both defines a situation of greater nutritional risk (cachexia). Nevertheless, a reduction in FFMI is an independent risk factor, although not superior to a low BMI. Therefore, although obtaining FFMI by bioelectric impedanciometry is reliable and relatively easy, we recommend the use of this procedure only in patients with COPD and low weight (BMI < 21), together with more specific nutritional evaluation. Currently, longitudinal studies providing data on the behavior of BMI within the natural course of the disease are lacking. Moreover, there is no solid scientific evidence that confirms the main mechanisms of malnutrition in COPD. This lack of evidence explains the difficulty of the therapeutic management of these patients, which has not advanced in the last few decades. Nevertheless, current evidence suggests that initiating individually-tailored nutritional treatment combined with pulmonary rehabilitation programs (exercise) is reasonable in patients with cachexia. Further studies are required to provide greater insight into the physiopathology and the role of other therapeutic options (hormones, antiinflammatory drugs) in malnutrition in patients with COPD.

Relationship between serum ghrelin and nutrition status in patients with chronic obstructive pulmonary disease

Objective To investigate the correlation between the serum ghrelin levels and nutrition state in the patients with chronic obstructive pulmonary disease(COPD) ,as well as to explore the role of ghxelin in the nutri-tion metabolism. Methods Fifty-three COPD patients were observed, thirty-one of them were with malnutrition (group A), twenty-two COPD patients with normal nutrition status(group B), and twenty were healthy controls.Serum ghrelin, and nutritional parameters such as body mass index(BMI), ideal body weitht( % IBW), mid-upper arm cricumference(MAC), serum albumin(ALB), total lymphocyte counts(LYM) were determined. The correlation between ghrelin and nutritional parameters was analysed. Resuits The level of serum ghrelin in group A were sig-nificantly higher than those in group B and in healthy controls. And the serum ghrelin showed a negative correlation with BMI, % IBW, MAC, but there was no correlation between serum ghrelin level, ALB and LYM. Conclusion Ghrelin participated in the nutrition metabolism in patients with COPD, it would become much higher because of malnutrition in COPD. Key words: Pulmonary disease; Somatotropin-releasing hormone, chronic obstructive

The pulmonary cachexia syndrome: aspects of energy balance.

The present paper reviews current knowledge of the pulmonary cachexia syndrome with reference to chronic obstructive pulmonary disease (COPD). Aspects of incidence, aetiology and management are discussed. Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD. Both fat mass and fat-free mass become depleted. Loss of fat-free mass is the more important and appears to be due to a depression of protein synthesis. Weight loss is an independent prognostic indicator of mortality, and is associated with increased morbidity and decreased health-related quality of life. The aetiology of malnutrition in COPD is not well understood. Reduced food intake does not seem to be the primary cause. Resting energy expenditure (REE) is elevated in a proportion of patients and probably contributes to negative energy balance. Measurement of actual REE is helpful when considering the adequacy of nutritional supplementation. The underlying reason for a hypermetabolic state is not known. Although weight-losing COPD patients are not catabolic, nutritional supplementation alone does not appear to reverse the loss of fat-free mass. Strategies involving nutritional supplementation in combination with a second intervention are being explored, and there are some encouraging results using anabolic hormones.

Hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD): influence of severity of COPD on nutritional status

In 90 patients with hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD), noninvasive anthropometric and biochemical nutritional indices were measured to assess the prevalence and features of malnutrition in COPD and to analyze the relationship between nutritional depletion and the severity of the disease. A significant inverse relationship was found between PaCO2 and body weight; a parallel decrease of both somatic proteins and body-energy stores of fat appears to be paired with decreasing body weight. Deterioration of nutritional status occurred in the COPD patients considered despite seemingly adequate calorie and protein intakes, although in patients with more severe impairment of pulmonary gas exchange, calorie intake was significantly lower compared with basal energy expenditure. In the course of hypercapnic-hypoxemic COPD malnutrition is common, it is related to the severity of the disease as judged by the need for hospitalization and degree of impairment of gas exchange, and it may be present despite apparently adequate nutrient intake.