Nutritional and metabolic modulation in chronic obstructive pulmonary disease management

Abstract

Nutritional and metabolic modulation in chronic obstructive pulmonary disease management. A.M.W.J. Schols. #ERS Journals Ltd 2003. ABSTRACT: In this paper the perspective for nutritional modulation of systemic impairment in patients with chronic obstructive pulmonary disease (COPD) is discussed. Progressive weight loss is characterised by disease-specific elevated energy requirements unbalanced by dietary intake. Weight gain per se can be achieved by caloric supplementation while future studies may prove efficacy of amino acid modulation to stimulate protein synthesis and enhance muscle anabolism.Disproportionate muscle wasting resembles the cachexia syndrome as described in other chronic wasting diseases (cancer, chronic heart failure, acquired immunodeficiency syndrome (AIDS)). There is yet no adequate nutritional strategy available to treat cachexia in COPD. Muscle substrate metabolism has hardly been investigated, but the few data available point towards a decreased fat oxidative capacity that may show similarities with the "metabolic syndrome" as described in type II diabetes and obesity and could theoretically benefit from polyunsaturated fatty acid modulation.To adequately target the different therapeutic options, clearly more clinical (intervention) studies are needed in chronic obstructive pulmonary disease patients that are adequately characterised by local and systemic impairment and in which molecular and metabolic markers are linked to functional outcome. Nutritional screening and therapy is nowadays considered as an essential component of integrated chronic obstructive pulmonary disease (COPD) management. In particular systemic manifestations of COPD are potential targets for intervention. The present paper aims to present current insight into the efficacy of dietary supplementation to reverse weight loss and muscle wasting in COPD as well as to discuss the perspective for nutritional modulation of altered muscle metabolism. In addition the question will be addressed to what extent these systemic manifestations in COPD should be regarded as disease specific, or represent generalised phenomena of chronic disease. Modulation of energy balance Loss of body weight and fat massThe association between underweight and increased mortality risk has been well established in numerous retrospective studies ranging from selected COPD patients to populationbased samples [1][2][3]. Two prospective studies even showed in COPD patients with a body mass index below 25 kg?m -2 that weight gain was associated with decreased mortality risk [2,4]. It is not fully understood why COPD patients become underweight but weight loss and specifically loss of fat mass, is generally the result of a negative energy balance and appears to be more prevalent in patients with emphysema [5]. In contrast to an adaptive decreased energy metabolism during (semi) starvation, increased resting energy requirements have been observed in some of the COPD patients, linked to low-grade systemic inflammation [6,7]. Studies in other chronic wastin...

Effects of Lung Volume Reduction Surgery for Emphysema on Glycolipidic Hormones*

“…Ghrelin, which is released by the gastric fundus, stimulates appetite, reduces energy expenditure, enhances glucose utilization, and prevents fat consumption, thus restoring body weight and composition, both FFM and FM. 21,22 Several studies [1][2][3][4][5][6][7][8][9] have confirmed that emphysema can significantly affect glycolipidic hormones and metabolism. Insulin resistance and impaired glucose tolerance, with increased levels of insulin and HOMA-IR, but normal fasting glycemia, have been demonstrated in hypoxic patients.…”

“…ulmonary emphysema causes significant systemic alterations including progressive tissue depletion, both fat mass (FM) and fat-free mass (FFM), [1][2][3][4] mainly due to persistent inflammation, chronic hypoxemia, and impaired respiratory dynamics. The so-called respiratory cachexia is associated with the elevation of inflammatory cytokine levels and the reduction of anabolic hormone levels.…”

“…These alterations, together with a shift from oxidative to glycolytic metabolism in peripheral skeletal muscles, secondary to the increased resting energy expenditure, favor a prevalent lipid substrate utilization and protein wasting. [1][2][3][4][5][6][7][8][9] Compared to maximal medical therapy and standard respiratory rehabilitation (RR), lung volume reduction surgery (LVRS) has been shown to be effective in improving respiratory function, exercise tolerance, quality of life, nutritional status, resting energy expenditure, and substrate oxidation pattern in properly selected patients. 10 -13 To date, little information is available regarding the effects of LVRS on glycolipidic hormone levels.…”

The effects of creatine supplementation on thermoregulation and physical (cognitive) performance: a review and future prospects

“…There have been numerous strategies designed to attenuate muscle atrophy such as the use of nutritional supplements, recombinant human growth hormone, anabolic steroids and appetite stimulants (Burdet et al 1997;Creutzberg et al 2003;Schols 2003;Steiner et al 2003;Weisberg et al 2002). Positive effects of these applications have been reported including weight gain and improvements in quality of life, however none of the aforementioned strategies have reported improvements in whole body exercise performance.…”

Possible mechanisms underlying the development of cachexia in COPD

“…Another factor is that cachexia itself leads to anorexia [22], and this must create a vicious circle, such that the more weight lost, the less food is taken in. Aggressive nutritional augmentation and appetite stimulation have not solved the problem [10,23,24], casting some doubt on the centrality of this mechanism. CREUTZBERG et al [25] found that poor responders to nutritional therapy were somewhat older, had less appetite and evidence of more inflammation.…”