Body composition and resting energy expenditure in elderly male patients with chronic obstructive pulmonary disease

Sergi, Giuseppe; Coin, Alessandra; Marín, Sara; Vianello, Andrea; Manzan, Alessandro; Peruzza, Silvia; Inelmen, Eminè Meral; Busetto, Luca; Mulone, Silvana; Enzi, Giuliano

doi:10.1016/j.rmed.2006.03.008

Cited by 95 publications

(73 citation statements)

References 29 publications

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“…Sarcopenia (physiological muscle loss) may contribute to bone mass loss, but its role may be confused with that of nonphysiological conditions such as nutritional disorders (Sergi et al 2006). Our subjects revealed a prevalence of sarcopenia in about 50% of both men and women, but our results -like those of other authors (Walsh et al, 2006) identified no independent effect of sarcopenia (expressed by ASMM as an independent variable) on total femoral BMD.…”

Section: Discussionsupporting

confidence: 54%

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

et al. 2007

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Objectives: The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds. Subjects and methods: Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.575.3 years and 136 men aged 73.975.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry. Results: The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI o22 (OR ¼ 12) and a protein intake o65.7 g/day (OR ¼ 3.7). Women carried some risk already in the BMI 25-30 class (OR ¼ 5), and a much greater risk in the BMI o22 class (OR ¼ 26). Albumin o40 g/l also emerged as an independent risk factor (OR ¼ 2.6). Conclusions: BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values o22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Agerelated sarcopenia does not seem to be involved in bone mass loss.

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Section: Discussionsupporting

confidence: 54%

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

et al. 2007

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“…It was postulated that due to airways obstruction, the work of breathing was increased, 24 h a day, 7 days a week. Whether work of breathing explains the results or not, hypermetabolism has been noted, for example, by SERGI et al [19], where resting energy expenditure was found to be 10% higher in COPD patients than in normal subjects of a similar age, height and weight. The oxygen cost of exercise has also been found to be higher than in normal subjects [20].…”

Section: Energy Imbalancementioning

confidence: 90%

Possible mechanisms underlying the development of cachexia in COPD

Pd¹

2008

Eur Respir J

231

173

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About 25% of patients with chronic obstructive pulmonary disease (COPD) will develop cachexia (fat-free body mass index ,17 kg?m -2 (males) or ,14 kg?m -2 (females)). This is associated with ,50% reduction in median survival. The pathogenetic mechanism has been variously suggested to result from the following: 1) energy imbalance; 2) disuse atrophy; 3) tissue hypoxia from arterial hypoxaemia; 4) systemic inflammation; and 5) anabolic hormonal insufficiency. Genetic polymorphisms implicate inflammatory cytokines, especially interleukin (IL)-1b, but IL-6 and tumour necrosis factor (TNF)-a do not show polymorphisms in these patients. Early reports of elevated TNF-a levels suggested a role for inflammation, but recent studies have not shown elevated levels of either IL-6 or TNF-a. Therapeutic trials of nutritional support, hormonal supplementation, anti-TNF-a immunotherapy, ghrelin and antioxidants have been conducted, but only a few have shown any benefits in muscle structure and function.Considerably more mechanistic knowledge is needed before therapeutic recommendations can be made. At this time, it is not possible to attribute cachexia in COPD unequivocally to inflammation or any other cause, and much more research is needed.To date, studies have been predominantly cross-sectional, with measurements made only after cachexia has developed. Future research should target prospective observation, studying patients as cachexia progresses, since once cachexia is established, inflammatory cytokine levels may not be abnormal.

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“…The underlying mechanisms are unclear, but multiple factors have been implicated, including increased REE (4,20), elevated systemic inflammation (5), derangement of anabolic hormone metabolism (21,22), and muscle disuse atrophy. Sergi and colleagues found that REE was 10% higher in patients with COPD than in normal subjects similar in age, height, and weight (20). Similarly, Schols and colleagues found that REE, when adjusted for fat-free mass, was higher in patients with COPD who lost weight compared with those whose weight remained stable (23).…”

Section: Discussionmentioning

confidence: 99%

Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

Kim

Kretschman

Sternberg

et al. 2012

Am J Respir Crit Care Med

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Rationale: Lung volume reduction surgery (LVRS) is associated with weight gain in some patients, but the group that gains weight after LVRS and the mechanisms underlying this phenomenon have not been well characterized. Objectives: To describe the weight change profiles of LVRS patients enrolled in the National Emphysema Treatment Trial (NETT) and to correlate alterations in lung physiological parameters with changes in weight. . We compared BMI groups and LVRS and medical groups within each BMI stratum with respect to baseline characteristics and percent change in BMI (%DBMI) from baseline. We examined patients with (DBMI > 5%) and without (DBMI , 5%) significant weight gain at 6 months and assessed changes in lung function and ventilatory efficiency (V E/V CO 2 ). Measurements and Main Results: The percent change in BMI was greater in the LVRS arm than in the medical arm in the underweight and normal weight groups at all follow-up time points, and at 12 and 24 months in the overweight group. In the LVRS group, patients with DBMI > 5% at 6 months had greater improvements in FEV 1 (11.53 6 9.31 vs. 6.58 6 8.68%; P , 0.0001), FVC (17.51 6 15.20 vs. 7.55 6 14.88%; P , 0.0001), residual volume (-66.20 6 40.26 vs. -47.06 6 39.87%; P , 0.0001), 6-minute walk distance (38.70 6 69.57 vs. 7.57 6 73.37 m; P , 0.0001), maximal expiratory pressures (12.73 6 49.08 vs. 3.54 6 32.22; P ¼ 0.0205), and V E/V CO 2 (-1.58 6 6.20 vs. 0.22 6 8.20; P ¼ 0.0306) at 6 months than patients with DBMI , 5% at 6 months. Conclusions: LVRS leads to weight gain in nonobese patients, which is associated with improvement in lung function, exercise capacity, respiratory muscle strength, and ventilatory efficiency. These physiological changes may be partially responsible for weight gain in patients who undergo LVRS.

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Body composition and resting energy expenditure in elderly male patients with chronic obstructive pulmonary disease

Abstract: Elderly patients with stable COPD develop an increased REE. This hypermetabolism seems to be independent of the severity of the pulmonary obstruction and to influence the patient's physical performance.

Cited by 95 publications

References 29 publications

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

Possible mechanisms underlying the development of cachexia in COPD

Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

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