Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD. M. A.P. Vermeeren, A.M.W.J. Schols, E.F.M. Wouters. ERS Journals Ltd 1997. ABSTRACT: In this study, we investigated the influence of an acute disease exacerbation on the nutritional and metabolic status of patients with chronic obstructive pulmonary disease (COPD).The study group consisted of 23 patients acutely admitted to the hospital for standardized medical treatment. Dietary intake (dietary records and diet history), resting energy expenditure (ventilated hood), body composition (bioelectrical impedance spectroscopy) and disease symptoms (visual analogue scale) were assessed on admission, daily throughout the hospitalization period, at discharge and 3 months thereafter in stable clinical condition.Dietary intake, since aggravation of disease symptoms, prior to admission, (5,640±2,671 kJ) was significantly lower than habitual intake (7,863±2,005 kJ). The balance between dietary intake with measured resting energy expenditure and estimated diet-induced thermogenesis was severely impaired during the first 3 days of hospitalization, stabilizing thereafter to 145±24% at discharge. Resting energy expenditure decreased from 6,812±900 kJ (123±11%) on admission to 6,196±795 kJ (113±14%) at discharge (p<0.001). During treatment, no significant shift in water compartments, fat-free mass and body weight was seen. Follow-up data were obtained from 10 out of 23 patients. Three months after admission, dietary intake was not significantly different from usual dietary intake (8,512±2,290 and 8,415±2,600 kJ, respectively), resting energy expenditure was similar to the value at discharge, and a significant body weight gain was seen.We conclude that an acute exacerbation of chronic obstructive pulmonary disease is accompanied by an impaired energy balance due to a decreased dietary intake and an increased resting energy expenditure. Eur Respir J 1997; 10: 2264-2269 [4]. Dysfunction of the respiratory muscles is furthermore related to the patient's sensation of dyspnoea [6].Weight loss results from an imbalance between dietary intake and energy expenditure. In the majority of COPD patients, weight loss appears to develop gradually, while they are in an otherwise stable clinical condition. Previous studies using diet histories found a normal to elevated dietary intake in COPD patients when compared to normal values [7,8]. A within-group comparison, however, showed a significantly lower dietary intake in weight-losing than in weight-stable patients, both in absolute terms and when expressed as percentage of measured resting energy expenditure (REE) [8]. Several studies have shown an increased REE, in addition to a relatively decreased dietary intake, in clinically stable COPD patients, the cause of which is unclear [9,10].Retrospective data suggest that, in a sub-group of patients, weight loss follows a stepwise pattern related to acute disease exacerbations. However, limited data are available on dietary intake and energy metabolism in...
