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

Fiaccadori, Enrico; Canale, S. Del; Coffrini, E.; Vitali, P; Antonucci, C; Cacciani, Giancarlo; Mazzola, Isabella C.; Guariglia, A

doi:10.1093/ajcn/48.3.680

Cited by 50 publications

(25 citation statements)

References 18 publications

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“…This observation is in line with previous data showing that nutritional depletion preferentially affects peripheral but not respiratory muscle function (Engelen et al, 1994). We did not observe a correlation between hypercapnia and nutritional status (Fiaccadori et al, 1988), probably because all patients were under NPPV that aimed to lower PaCO 2 . Consequently, mean PaCO 2 was as low as 45 mmHg.…”

Section: Discussionsupporting

confidence: 93%

“…In COPD, many studies have investigated the relationship between nutritional status and respiratory indices, with different results (Openbrier et al, 1983;Fiaccadori et al, 1988;Sridhar et al, 1994;;Engelen et al, 1994Engelen et al, , 1999Mannix et al, 1999;Godoy et al, 2000;Cano et al, 2002). To our knowledge, TLC, ITGV and sR aw obtained by body plethysmography have not yet been analysed for their relationship to nutritional status in different end-stage pulmonary diseases.…”

Section: Discussionmentioning

confidence: 99%

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Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

et al. 2007

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Objective: While malnutrition, especially fat-free mass index (FFMI), is a predictor for mortality in chronic obstructive pulmonary disease (COPD), less information on prevalence and mechanisms is available in patients with chronic respiratory failure (CRF) due to restrictive thoracic diseases (RTD). Design and setting: Cross-sectional study of patients consecutively admitted to an in-patient primary pulmonary centre. Subjects: One hundred and thirty-two patients (30% RTD; 70% COPD) with CRF and intermittent non-invasive positive pressure ventilation. Interventions: Malnutrition was quantified by bioelectrical impedance analysis or body mass index (BMI), and its relationship to laboratory, lung function, inspiratory muscle and blood gas parameters and 6-min walking distance (6-MWD) was assessed. Results: Malnutrition in terms of BMIo20 kg/m 2 occurred in 16.1% of patients with COPD but none of those with RTD. FFMIo17.4 (o15.0 in female patients) kg/m 2 was found in 35.4 and 30.7%, respectively. FFMI was correlated with airway obstruction (sR aw , r ¼ À0.50; FEV 1 /VC, r ¼ À0.28; Pp0.01 each) and lung hyperinflation (intrathoracic gas volume, r ¼ À0.41; total lung capacity (TLC), r ¼ À0.50; Pp0.001 each) in COPD, and with lung restriction in RTD (TLC, r ¼ 0.40; P ¼ 0.011). Furthermore, malnourished patients showed a higher inspiratory load (P 0.1 ) and reduced 6-MWD in both groups. In COPD, only hyperinflation and P 0.1 were independently related to FFMI. Conclusions: Malnutrition as indicated by low FFMI was similarly prevalent in patients with CRF and COPD or RTD, but inadequately represented by BMI. The correlations between lung function impairments specific for the disease and FFMI emphasized the link between malnutrition and respiratory mechanical load irrespective of its aetiology.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

et al. 2007

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“…The clinical importance of weight loss, particularly loss of FFM, has been demonstrated in its adverse effects on physical performance and on respiratory muscle function (Fiaccadori et al, 1988). Furthermore, weight loss and a low body mass are unfavourable prognostic factors for survival (Schols et al, 1995).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of an elevated resting energy expenditure in patients with chronic obstructive pulmonary disease in relation to body composition and lung function

et al. 1998

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Objective: This study describes the prevalence and characteristics of an elevated resting energy expenditure (REE) in patients with chronic obstructive pulmonary disease (COPD). Design and setting: Patients were consecutively admitted to an in-patient pulmonary rehabilitation centre. Subjects: The study group consisted of 172 (123<) clinically stable patients with COPD, age mean (s.d. ) 64 (10) y). Interventions: REE was assessed by indirect calorimetry (ventilated hood) and adjusted for the in¯uence of fatfree mass (FFM; measured by bioelectrical impedance analysis) using the linear regression equations of REE on FFM generated in 92 healthy age-matched subjects (58<, age 67 (8) y) for men and women separately. The predicted REE adjusted for FFM (REEFFM) was obtained by using the FFM of each individual patient in the linear regression equation of REE on FFM generated in the healthy control group. Results: 26% of the patients were hypermetabolic (de®ned as REE b 110% REEFFM), characterized by a lower age (60 (10) vs 65 (9) y) and a lower total lung capacity (TLC; 122 (27) vs 139 (28)%pred) compared to normometabolic patients (P`0.001). The prevalence of FFM-depletion was equal among normo-and hypermetabolic patients: 36% vs 33% respectively. Depleted patients expressed however a signi®cantly higher residual volume/TLC ratio and a lower maximal inspiratory mouth pressure independently of hypermetabolism (P`0.05). In contrast, on base of the Harris & Benedict (HB) prediction equations, which do not take body composition into account, 54% of the patients were hypermetabolic (REE b 110% REEHB), characterized by a higher age and a lower body mass and FFM (P`0.05). Conclusions: Hypermetabolism commonly occurs in COPD, characterized by less hyperin¯ation at rest, in contrast to the suggested contribution of an elevated oxygen cost of breathing (OCB) to hypermetabolism in COPD. The higher hyperin¯ation at rest in FFM-depleted patients independently of hypermetabolism suggests a higher OCB during activities, contributing to the elevated total daily energy expenditure previously reported in COPD. The HB-equations overestimate the prevalence of hypermetabolism and link hypermetabolism incorrectly to aging and depletion.

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“…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].…”

mentioning

confidence: 99%

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

Shoup¹,

Dalsky²,

Warner³

et al. 1997

Eur Respir J

175

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

Cited by 50 publications

References 18 publications

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

Prevalence of an elevated resting energy expenditure in patients with chronic obstructive pulmonary disease in relation to body composition and lung function

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

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