Body composition and health-related quality of life in patients with obstructive airways disease

Abstract

This study evaluated the effects of body weight and lean mass abnormalities on health-related quality of life (HRQL) in obstructive airways disease.Body weight, lean mass (using dual-energy X-ray absorptiometry), and HRQL (using the St George's Respiratory Questionnaire (SGRQ)) were measured in 50 patients. Low lean mass was defined as a lean mass index (lean mass/height 2 ) below the fifth percentile of a control population. Dyspnoea was measured by the baseline dyspnoea index.The mean (SD) age was 69±9 yrs; the forced expiratory volume in one second (FEV1) was 39±19% of predicted. Patients had 2.4±4.1 kg less lean mass than predicted. Increased dyspnoea was the most influential predictor of poor HRQL. Compared to normal-weight patients, those who were underweight had significantly greater impairment in activity, impact, and total SGRQ scores, while those who were overweight had greater impairment in impact and total SGRQ scores. Low lean mass was associated with greater impairment in symptoms, activity and impact subscores and the total SGRQ score. When dyspnoea was added to the model as a covariate, neither weight nor lean mass remained significantly related to HRQL.Thus, although body weight and lean mass abnormalities influence health-related quality of life, their effects appear to be mediated through increased levels of dyspnoea. Eur Respir J 1997; 10: 1576-1580 A significantly reduced body weight, which is common in individuals with advanced chronic obstructive pulmonary disease (COPD) [1,2], is related to decreased exercise performance [3,4] and increased mortality [5,6]. In addition, analyses using bioimpedance techniques have demonstrated reductions in fat-free mass in normal-weight and underweight patients [7]. Decreased fat-free mass may be a predictor of poor exercise performance independently of body weight [3].Although the effect of nutritional status on exercise performance is established, little attention has been given to its effect on health-related quality of life (HRQL). To evaluate this, we measured two nutritional parameters, body weight and total body lean mass determined by dual-energy X-ray absorptiometry, in 50 patients with symptomatic obstructive lung disease. These two variables were then compared with HRQL measured by the St George's Respiratory Questionnaire (SGRQ). MethodsThe study was approved by the Medical Center's Institutional Review Board and informed consent was obtained from all subjects before participation in the study. All testing was performed in the Osteoporosis Center, which is in close proximity to the University of Connecticut Health Center.Adults with obstructive lung disease who were symptomatic with dyspnoea despite medical therapy, were recruited for the study. All had moderate-to-severe airways obstruction following bronchodilator inhalation and were clinically stable at the time of the study. Most had previously completed an out-patient pulmonary rehabilitation programme and many were in a postrehabilitation exercise maintenance programme. Patient...

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