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

Abstract

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.

Genome-Wide Association Analysis of Body Mass in Chronic Obstructive Pulmonary Disease

“…Although variation also exists regarding the threshold used to define low FFMI, the prevalence of low FFMI in COPD is estimated to be between 20-50% in most studies (4,(8)(9)(10). In subjects with COPD, low FFMI has been associated with increased mortality (8,11), more advanced GOLD stage (11), and reduced peripheral muscle strength and exercise capacity (10,12,13).…”

Nutrition and Acute Lung Injury in Critical Care: Focus on Nutrition Care Process

“…Low fat-free mass index is correlated with airway obstruction, lung hyperinflation, and higher inspiratory load (Budweiser et al 2008). Even a short period of suboptimal nutrition results in decreased respiratory muscle strength, though hypocaloric feeding for the obese patient may be beneficial (Frankenfield et al 2003;McClave et al 2009).…”

Comparison of PG-SGA, SGA and body-composition measurement in detecting malnutrition among newly diagnosed lung cancer patients in stage IIIB/IV and benign conditions

“…Now, some studies used subjective assessment tools [e.g. the subjective global assessment (SGA), the scored patientgenerated (PG-SGA) and the Mini-Nutritional Assessment] [10][11][12][13][14] in diagnosing malnutrition in lung cancer patients and lung benign diseases [15][16][17][18]. They found subjective assessment tools have higher sensitivity and specificity than objective anthropometric and biochemical measurements.…”