Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease

Vermeeren, M.A.P.; Wouters, E.F.M.; Nelissen, L.H.; Lier, Alies van; Hofman, Zandrie; Schols, A.M.W.J.

doi:10.1093/ajcn/73.2.295

Cited by 67 publications

(46 citation statements)

References 17 publications

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“…The VCO 2 increase can worsen the condition of patients in respiratory failure, but its effect on stable patients is small, of little clinical importance. It is important to point out that a more recently published study did not find any difference in exercise performance and that, although high dietary carbohydrate did determine an increase in the respiratory quotient, dyspnea was significantly higher when the patients received a highfat diet (43) .…”

Section: Studies In Nutritional Supplementationmentioning

confidence: 78%

Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

Ferreira

2003

J. Pneumologia

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Section: Studies In Nutritional Supplementationmentioning

confidence: 78%

Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

Ferreira

2003

J. Pneumologia

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“…Earlier studies indeed showed adverse effects of a carbohydrate-rich energy overload on carbon dioxide production and exercise capacity [10], but these results were not confirmed when using a normal energy load [11]. In fact even positive effects of a carbohydrate-rich supplement relative to a fat-rich supplement on lung function and dyspnoea sensation were reported [12].…”

Section: Loss Of Body Weight and Fat Massmentioning

confidence: 94%

Nutritional and metabolic modulation in chronic obstructive pulmonary disease management

Schols¹

2003

European Respiratory Journal

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Nutritional and metabolic modulation in chronic obstructive pulmonary disease management. A.M.W.J. Schols. #ERS Journals Ltd 2003. ABSTRACT: In this paper the perspective for nutritional modulation of systemic impairment in patients with chronic obstructive pulmonary disease (COPD) is discussed. Progressive weight loss is characterised by disease-specific elevated energy requirements unbalanced by dietary intake. Weight gain per se can be achieved by caloric supplementation while future studies may prove efficacy of amino acid modulation to stimulate protein synthesis and enhance muscle anabolism.Disproportionate muscle wasting resembles the cachexia syndrome as described in other chronic wasting diseases (cancer, chronic heart failure, acquired immunodeficiency syndrome (AIDS)). There is yet no adequate nutritional strategy available to treat cachexia in COPD. Muscle substrate metabolism has hardly been investigated, but the few data available point towards a decreased fat oxidative capacity that may show similarities with the "metabolic syndrome" as described in type II diabetes and obesity and could theoretically benefit from polyunsaturated fatty acid modulation.To adequately target the different therapeutic options, clearly more clinical (intervention) studies are needed in chronic obstructive pulmonary disease patients that are adequately characterised by local and systemic impairment and in which molecular and metabolic markers are linked to functional outcome. Nutritional screening and therapy is nowadays considered as an essential component of integrated chronic obstructive pulmonary disease (COPD) management. In particular systemic manifestations of COPD are potential targets for intervention. The present paper aims to present current insight into the efficacy of dietary supplementation to reverse weight loss and muscle wasting in COPD as well as to discuss the perspective for nutritional modulation of altered muscle metabolism. In addition the question will be addressed to what extent these systemic manifestations in COPD should be regarded as disease specific, or represent generalised phenomena of chronic disease. Modulation of energy balance Loss of body weight and fat massThe association between underweight and increased mortality risk has been well established in numerous retrospective studies ranging from selected COPD patients to populationbased samples [1][2][3]. Two prospective studies even showed in COPD patients with a body mass index below 25 kg?m -2 that weight gain was associated with decreased mortality risk [2,4]. It is not fully understood why COPD patients become underweight but weight loss and specifically loss of fat mass, is generally the result of a negative energy balance and appears to be more prevalent in patients with emphysema [5]. In contrast to an adaptive decreased energy metabolism during (semi) starvation, increased resting energy requirements have been observed in some of the COPD patients, linked to low-grade systemic inflammation [6,7]. Studies in other chronic wastin...

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“…Vermeeren and coworkers (22) examined the differences between a fat-rich versus carbohydrate-rich diet on exercise performance in COPD. They hypothesized that a fat-rich diet would be better tolerated than a carbohydrate-rich diet due to a lower Respiratory Quotient and thus lower CO 2 production.…”

Section: Nutritional Interventionsmentioning

confidence: 99%

Nutritional Aspects of Chronic Obstructive Pulmonary Disease

King¹,

Cordova²,

Scharf³

2008

Proceedings of the American Thoracic Society

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It is clear that being underweight is a poor prognostic sign in chronic obstructive pulmonary disease (COPD). It is also clear that undernutrition is at least in part associated with the severity of airflow obstruction. While both weight and body mass index are useful screening tools in the initial nutritional evaluation, fat-free mass (FFM) may be a better marker of undernutrition in patients with COPD. The causes of cachexia in patients with COPD are multifactorial and include decreased oral intake, the effect of increased work of breathing due to abnormal respiratory mechanics, and the effect of chronic systemic inflammation. Active nutritional supplementation in undernourished patients with COPD can lead to weight gain and improvements in respiratory muscle function and exercise performance. However, long-term effects of nutritional supplementation are not clear. In addition, the optimal type of nutritional supplementation needs to be explored further. The role of novel forms of treatment, such as androgens or appetite stimulants designed to increase FFM, also needs to be further studied. Thus, in the absence of definitive data, it cannot be said that long-term weight gain, either using enhanced caloric intake, with or without anabolic steroids or appetite stimulants, offers survival or other benefits to patients with COPD. However, there are indications from singlecenter trials that this is an avenue well worth exploring.

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Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease

Abstract: An energy load up to 2092 kJ had no adverse immediate effect in COPD patients compared with placebo. The subjects who consumed the fat-rich supplement experienced more shortness of breath than did the subjects who consumed the carbohydrate-rich supplement.

Cited by 67 publications

References 17 publications

Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

Nutritional and metabolic modulation in chronic obstructive pulmonary disease management

Nutritional Aspects of Chronic Obstructive Pulmonary Disease

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