Frequency and functional translation of low muscle mass in overweight and obese patients with COPD

Abstract

Background Cut offs for fat-free mass index (FFMI) and appendicular skeletal muscle mass index (ASMI) are available for diagnosing low muscle mass in patients with COPD. This study aimed to investigate: (1) the frequency of low muscle mass (FFMI and ASMI) applying different cut-offs and (2) the functional translation (clinical impact) of low muscle mass, in patients with COPD stratified into BMI categories. Methods Patients with COPD were assessed regarding body composition, exercise capacity, quadriceps muscle strength, symptoms of anxiety and depression, dyspnea and quality of life upon referral to pulmonary rehabilitation. The proportion of patients with low muscle mass was compared among BMI categories. Clinical outcomes between patients with normal and low muscle mass within each BMI category were compared. Results 469 patients with COPD were included for analyses. The frequency of patients classified as low FFMI varied significantly according to the choice of cut-off (32 to 54%; P < 0.05), whereas the frequency of patients with low ASMI was 62%. When applying age-gender-BMI-specific cut-offs, 254 patients (54%) were classified as low FFMI. The choice of the cut-off affected the frequency of patients with low muscle mass in all BMI categories. Overweight and obese patients with low muscle mass were more frequently males and presented worse pulmonary function, exercise capacity and muscle strength compared with overweight and obese patients with normal muscle mass. Conclusions Approximately half of the overweight and obese patients with COPD have low muscle mass when applying age-gender-BMI-specific cut-offs. Low muscle mass is associated with worse functional outcomes in overweight and obese COPD patients.

Abdominal obesity in COPD is associated with specific metabolic and functional phenotypes

“…Future studies should focus on interventions specifically targeting further improvement in muscle function in AO-COPD patients. While various definitions of sarcopenia are used in the literature, a recent analysis has validated an age-sex-BMI specific cutoff in COPD patients [ 44 ]. With studies often focusing on the combination of sarcopenia and obesity [ 1 , 10 , 11 ], it would be of interest to examine this combined effect in our free-living COPD outpatients.…”

Association between body composition, sarcopenia and pulmonary function in chronic obstructive pulmonary disease

“…Maddocks et al found no difference in predicted FEV 1 % between subjects with low and normal FFMI. On the other hand, Machado et al showed that subjects with low FFMI had lower predicted FEV 1 % [ 18 ]. No evidence has been reported about the impact of SMMI or ASMMI on pulmonary function.…”

Epidemiology and outcome of pressure injuries in critically ill patients with chronic obstructive pulmonary disease: A propensity score adjusted analysis

“…COPD is a chronic inflammatory lung disease which is considered a systemic disease 15 . Multi-morbidity including hormonal, metabolic and musculoskeletal derangements are common [16][17][18] . In the context of critical illness, COPD represents an independent risk factor for unfavourable outcomes including increased length of ICU stay, prolonged ventilator weaning, muscle wasting and interrupted skin integrity 19 , ICU readmission, and death 14,20,21 .…”