Targeted medical nutrition for cachexia in chronic obstructive pulmonary disease: a randomized, controlled trial

Abstract

BackgroundCachectic patients with chronic obstructive pulmonary disease (COPD) may benefit from nutritional support. This double‐blind, randomized, controlled trial evaluated the safety and efficacy of targeted medical nutrition (TMN) vs. an isocaloric comparator in pre‐cachectic and cachectic patients with COPD.MethodsPatients aged ≥50 years with moderate‐to‐severe COPD and involuntary weight loss or low body mass index (16–18 kg/m2) were randomized 1:1 to receive TMN (~230 kcal; 2 g omega‐3 fatty acids; 10 μg 25‐hydroxy‐vitamin D3) or isocaloric comparator twice daily for 12 weeks (ClinicalTrials.gov Identifier: NCT02442908). Primary safety endpoints comprised adverse events and changes in vital signs, laboratory parameters, and concomitant medications. Secondary efficacy endpoints included changes in weight, body composition, exercise tolerance, metabolic biomarkers, and systemic inflammation.ResultsForty‐five patients were randomized to receive TMN (n = 22; mean 69.2 years) or isocaloric comparator (n = 23; mean 69.7 years). TMN was well tolerated. Adverse events were similar in number and type in both groups. Compliance to both products was good (TMN, 79%; comparator, 77%). Both groups gained weight, but the TMN group gained comparatively more fat mass (P = 0.0013). Reductions in systolic blood pressure (P = 0.0418) and secondary endpoints of triglycerides (P = 0.0217) and exercise‐induced fatigue (P = 0.0223) and dyspnoea (P = 0.0382), and increases in high‐density lipoprotein cholesterol (P = 0.0254), were observed in the TMN vs. the comparator group by week 12.ConclusionsTargeted medical nutrition containing high‐dose omega‐3 fatty acids, vitamin D, and high‐quality protein is well tolerated with a good safety profile and has positive effects on blood pressure and blood lipids and on exercise‐induced fatigue and dyspnoea. Therefore, this TMN could be clinically beneficial in the nutritional and metabolic support of pre‐cachectic and cachectic patients with COPD.

Aspiration pneumonia induces muscle atrophy in the respiratory, skeletal, and swallowing systems

“…Taken together, the mechanisms of muscle atrophy in this model may include hypoxia, and possibly malnutrition and immobility in addition to chronic inflammation. Medical nutrition for patients with chronic obstructive pulmonary disease and physical activity has been suggested to be clinically beneficial for muscle atrophy . Therefore, nutritional support and exercise training may have potential as therapeutic interventions for aspiration pneumonia to prevent and/or to improve muscle atrophy.…”

Skeletal muscle wasting in chronic heart failure

“…66 Low levels of testosterone or vitamin D were not prognostic for muscle mass and function in middle-aged and elderly men, while low insulin-like growth factor 1 (IGF-1) levels were found to predict alterations in gait speed in men aged ≥70 years. 72 In a Korean study, high serum vitamin D levels in mid-life and late-life were linked to reduced odds of various adverse effects on body composition, particularly in osteosarcopenic obesity, stressing the importance of maintaining adequate levels of vitamin D. 73 Vitamin D supplementation has also proven beneficial in improvement of muscle weakness in prostate cancer patients. 68 However, testosterone deprivation therapy due to prostate cancer selectively impairs lower-limb muscle function, primarily affecting muscles that support body weight, mediate the forward movement the body during walking, and mediate balance.…”

Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care

“…Next to low muscle mass, a high prevalence of deficiencies in vitamin D, vitamin B 12 and iron in hospitalised COPD are reported 46. Calder and colleagues47 investigated 3 months of multimodal nutritional intervention including high-quality protein, vitamin D and n−3 fatty acids versus an isocaloric control, and showed positive effects on blood pressure, blood lipids and on exercise-induced fatigue. A Dutch trial48 investigated the efficacy of a similar multimodal nutritional intervention as adjunct to 4 months of high-intensity exercise training.…”