Weight loss is a factor that affects prognosis in patients with chronic obstructive pulmonary disease (COPD) independent of lung function. One of the major factors for weight loss is energy malnutrition. There have been no reports on the factors related to energy malnutrition in COPD patients. This retrospective observational study aimed to investigate these factors. We included 163 male subjects with COPD. Respiratory quotient (RQ), an index of energy malnutrition, was calculated by expiratory gas analysis using an indirect calorimeter. RQ < 0.85 was defined as the energy-malnutrition group and RQ ≥ 0.85 as the no energy-malnutrition group. Factors related to energy malnutrition were examined by multivariate and decision-tree analysis. We finally analyzed data from 56 selected subjects (median age: 74 years, BMI: 22.5 kg/m2). Energy malnutrition was observed in 43%. The independent factors associated with energy malnutrition were tidal volume (VT) (OR 0.99; 95% CI 0.985–0.998; p = 0.015) and Th12 erector spinae muscle cross-sectional area SMI (Th12ESMSMI) (OR 0.71; 95% CI 0.535–0.946; p = 0.019). In decision-tree profiling of energy malnutrition, VT was extracted as the first distinguishable factor, and Th12ESMSMI as the second. In ROC analysis, VT < 647 mL (AUC, 0.72) or Th12ESMSMI < 10.1 (AUC, 0.70) was the cutoff value for energy malnutrition. Energy malnutrition may be an early warning sign of nutritional disorders.
Abstract.[Purpose] The aim of this cross-sectional study was to test whether the body mass index (BMI), airway obstruction, dyspnea, and exercise capacity (BODE) index is superior to the global initiative for chronic obstructive lung disease (GOLD) classification for physical ability, and to ascertain the usefulness of the BODE index in chronic obstructive pulmonary disease (COPD) patients. [Methods] We studied 48 patients with stable COPD (mean [±SD] age: 76.2±7.0 years). We measured BMI, modified medical research council (mMRC) dyspnea score, pulmonary function, muscle strength, timed up-and-go test (TUG), 6 minute walk distance (6MWD), and St. George's respiratory questionnaire (SGRQ). Comparisons of each measurement item in the BODE index quartile groups 1-2 and 3-4 were conducted for patients in GOLD Stages II and III.[Results] The mean total score for the BODE index was 3.9±2.9. The characteristics that showed a significant difference between the two groups were mMRC, %FVC, muscle strength, TUG and 6MWD. [Conclusions] This study showed that the GOLD classification assesses milder symptoms than the BODE index. The BODE index is as useful as the GOLD classification for physical ability, and also indicates comprehensive measures for COPD patients.
The physical characteristics were compared among chronic obstructive pulmonary disease (COPD) patients with different 6-minute walking distances (6MWD). The subjects were 76 patients with stable COPD. The 6MWD, body mass index (BMI), respiratory function test, lower limb muscle strength, grip strength, respiratory muscle strength, balance function, walking ability, Nagasaki University Respiratory ADL Questionnaire (NRADL), and St George's Respiratory Questionnaire (SGRQ) were evaluated. The patients were divided into 3 groups based on the 6MWD, and each measurement item was investigated. Significant differences were noted in the %forced vital capacity (%FVC), forced expiratory volume in one second (%FEV), knee extension muscle strength, grip strength, respiratory muscle strength, single leg standing time, TUG, CS-30, time required to walk a specific distance at the maximum walking speed, NRADL, and SGRQ. The 6MWD reflected the respiratory function, muscle strength, physical ability, ADL, and health-related QOL.
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