Nutritional Indicators are Correlated with the Radiological Severity Score in Patients with <i>Mycobacterium avium</i> Complex Pulmonary Disease: A Cross-sectional Study

Abstract

Objective Body weight loss in patients with Mycobacterium avium complex (MAC) pulmonary disease can be fatal. The administration of nutritional supplements should be an important component in the treatment of this disease. Objective data regarding the association between the nutritional status and disease severity have not been reported. This cross-sectional study aimed to compare the nutritional status and radiological severity scores in MAC pulmonary disease patients. Methods We retrospectively reviewed the records of 40 patients who were admitted to our institution for the treatment of MAC pulmonary disease between July 2008 and July 2010. Nutritional indices, including the ideal body weight ratio, triceps skinfold, mid-upper arm muscle circumference, and percentage of predicted resting energy expenditure, were compared with the radiological severity scores. Quantitative values of the extent of nodules, infiltration shadows, cavities, and bronchiectasis on the computed tomography scans were used to evaluate the radiological severity scores. Results The patients suffered from a significantly decreased percentage of ideal body weight, body fat and muscle mass. The average radiological score was 17.6±8.4 points. The percentage of ideal body weight (p< 0.001), percentage of triceps skinfold (p<0.001) and percentage of mid-upper arm muscle circumference (p< 0.002) were negatively correlated with the radiological scores, while the percentage of the predicted resting energy expenditure (p<0.001) was positively correlated with the scores. Conclusion A poor nutritional status is common in patients with progressive MAC pulmonary disease, which supports the hypothesis that aggressive nutritional interventions are indicated in the treatment of this disease.

The impact of adjuvant surgical treatment of nontuberculous mycobacterial pulmonary disease on prognosis and outcome

“…Preoperative chest CT images of all patients were acquired within a month before surgery and evaluated by two pulmonologists blinded to the clinical data. To assess radiological severity, we used the National Institute for Health and Care Excellence scoring method (NICE score) [22]. The NICE score was calculated as below.…”

Nontuberculous mycobacterial pulmonary disease: an integrated approach beyond antibiotics

“…Typical characteristics of patients with NTM-PD are low body mass index (BMI) and history of weight loss [30][31][32]. Such features are among those that make the clinician suspect a NTM infection and are so typical of middle-aged women that a specific phenotype called "Lady Windermere syndrome" has been identified [33].…”

“…Physical deconditioning is frequent in patients with COPD as well as bronchiectasis [ 49 ]; however, the presence of sarcopenia and the evaluation of muscle mass in patients with NTM-PD have only been marginally evaluated. M orimoto et al [ 30 ] described decreased muscle mass in patients with MAC-PD and found that the percentage of triceps skinfold and mid-upper arm muscle circumference were negatively correlated with the severity of radiological scores.…”

Lady Windermere syndrome

“…47 Nutritional deficiencies may also contribute to the development of LWS since malnutrition is associated with increased risk of M. tuberculosis infection and with worse outcomes in NTM infections. 51,52 Several genetic factors and subtle immune phenotypes are more common in patients with LWS than in the general population. Most notably, 36.5% of patients with pulmonary NTM had one CFTR mutations compared to 15.6% of individuals in the control population.…”