Anorexia in chronic obstructive pulmonary disease — Association to cachexia and hormonal derangement

Koehler, Friedrich; Doehner, Wolfram; Hoernig, Soeren; Witt, Christian; Anker, Stefan D.; Morser, John

doi:10.1016/j.ijcard.2006.07.088

Cited by 77 publications

(36 citation statements)

References 31 publications

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“…Serum levels of TNF-a are higher in cachectic patients with COPD compared with noncachectic patients with COPD and healthy control subjects (24,25), and elevations in IL-1 and IL-6 may also play a role in the development of cachexia (26,27). Reductions in circulating levels of testosterone, growth hormone, insulin-like growth factor, and leptin have also been found in cachectic patients with COPD (21,22,25).…”

Section: Discussionmentioning

confidence: 99%

“…The underlying mechanisms are unclear, but multiple factors have been implicated, including increased REE (4,20), elevated systemic inflammation (5), derangement of anabolic hormone metabolism (21,22), and muscle disuse atrophy. Sergi and colleagues found that REE was 10% higher in patients with COPD than in normal subjects similar in age, height, and weight (20).…”

Section: Discussionmentioning

confidence: 99%

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Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

Kim

Kretschman

Sternberg

et al. 2012

Am J Respir Crit Care Med

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Rationale: Lung volume reduction surgery (LVRS) is associated with weight gain in some patients, but the group that gains weight after LVRS and the mechanisms underlying this phenomenon have not been well characterized. Objectives: To describe the weight change profiles of LVRS patients enrolled in the National Emphysema Treatment Trial (NETT) and to correlate alterations in lung physiological parameters with changes in weight. . We compared BMI groups and LVRS and medical groups within each BMI stratum with respect to baseline characteristics and percent change in BMI (%DBMI) from baseline. We examined patients with (DBMI > 5%) and without (DBMI , 5%) significant weight gain at 6 months and assessed changes in lung function and ventilatory efficiency (V E/V CO 2 ). Measurements and Main Results: The percent change in BMI was greater in the LVRS arm than in the medical arm in the underweight and normal weight groups at all follow-up time points, and at 12 and 24 months in the overweight group. In the LVRS group, patients with DBMI > 5% at 6 months had greater improvements in FEV 1 (11.53 6 9.31 vs. 6.58 6 8.68%; P , 0.0001), FVC (17.51 6 15.20 vs. 7.55 6 14.88%; P , 0.0001), residual volume (-66.20 6 40.26 vs. -47.06 6 39.87%; P , 0.0001), 6-minute walk distance (38.70 6 69.57 vs. 7.57 6 73.37 m; P , 0.0001), maximal expiratory pressures (12.73 6 49.08 vs. 3.54 6 32.22; P ¼ 0.0205), and V E/V CO 2 (-1.58 6 6.20 vs. 0.22 6 8.20; P ¼ 0.0306) at 6 months than patients with DBMI , 5% at 6 months. Conclusions: LVRS leads to weight gain in nonobese patients, which is associated with improvement in lung function, exercise capacity, respiratory muscle strength, and ventilatory efficiency. These physiological changes may be partially responsible for weight gain in patients who undergo LVRS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

Kim

Kretschman

Sternberg

et al. 2012

Am J Respir Crit Care Med

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“…Therefore, nitrogen supply should not be calculated as the total nitrogen content that is the sum of EAs plus NEAs, but mainly the adequacy of EAs intake. Many pathological conditions increase dramatically nitrogen daily needs, coronary heart disease, 23 chronic obstructive pulmonary disease, 24 wound healing, 25 and traumatized and critically ill patients, 26 so that nitrogen intake is impossible to be matched by normal diets.…”

Section: Discussionmentioning

confidence: 99%

A Novel Amino Acids Oral Supplementation in Hemodialysis Patients: a Pilot Study

et al. 2011

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Background: Protein malnutrition and lowering serum albumin is frequent in hemodialysis patients. A special amino acid formulation has recently been used with favorable effects in elderly people but no data exist in renal patients. Aim: To assess the effects of this novel amino acid formulation in stable hemodialysis patients with reduced albumin levels. Methods: Thirty stable hemodialysis patients with serum albumin levels <3.5 g/dL, normalized protein nitrogen appearance (nPNA) <1.1 g/kg/d, and body mass index (BMI) >20 kg/m 2 were selected: 15 patients were randomized to oral amino acid supplementation (4 g thrice a day) for 3 months and 15 patients comparable for age, gender, and dialysis durations formed the control group. Biochemistry and bioimpedentiometry parameters were measured at baseline and at the end of treatment. Results: No difference was observed between study group and control group at baseline. At the end of the study period, no change occurred in the studied parameters in the control group, whereas increase in serum albumin (3.1 ± 0.3 vs. 3.6 ± 0.2 g/dL, p < 0.001) and in total proteins (5.7 ± 0.4 vs. 6.4 ±0.7 g/dL, p < 0.001) occurred in the study group. Hemoglobin rose from 10.7 ± 0.9 to 11.7 ± 0.8 g/dL (p < 0.05) at the same erythropoiesis-stimulating agent (ESA) dosage. C-Reactive protein (CRP) levels decreased in the study group (8.7 ± 7.3 vs. 3.8 ± 3.1 mg/L, p < 0.01). Increase of body weight and of equilibrated protein catabolic rate (ePCR) was observed in the study group. Conclusions: Oral amino acids supplementation was able to improve albumin and total protein in hypoalbuminemia hemodialysis patients. This effect was associated with reduction of CRP levels that is with lowering of pro-inflammatory status and anemia improvement.

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“…These hormones are testosterone, growth hormone and insulin-like growth factor. Observational studies in cachectic COPD patients have found diminished circulating levels of these hormones [48,49]. These hormones may be a rational choice for factors contributing to cachexia but, as stated above, this does not mean that observed associations prove cause and effect.…”

Section: Hormonal Insufficiencymentioning

confidence: 98%

“…While it is likely that nobody would argue against this, the improvement provided by dietary modification has been somewhat inconsistent. Even when appetite stimulants are used, the net result has been modest [49]. Whether attention to diet would be more effective earlier in the course of disease, before cachexia had developed, remains to be tested.…”

Section: Pathogenetic Insights From Therapeutic Interventionsmentioning

confidence: 99%

Possible mechanisms underlying the development of cachexia in COPD

Pd¹

2008

European Respiratory Journal

229

173

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About 25% of patients with chronic obstructive pulmonary disease (COPD) will develop cachexia (fat-free body mass index ,17 kg?m -2 (males) or ,14 kg?m -2 (females)). This is associated with ,50% reduction in median survival. The pathogenetic mechanism has been variously suggested to result from the following: 1) energy imbalance; 2) disuse atrophy; 3) tissue hypoxia from arterial hypoxaemia; 4) systemic inflammation; and 5) anabolic hormonal insufficiency. Genetic polymorphisms implicate inflammatory cytokines, especially interleukin (IL)-1b, but IL-6 and tumour necrosis factor (TNF)-a do not show polymorphisms in these patients. Early reports of elevated TNF-a levels suggested a role for inflammation, but recent studies have not shown elevated levels of either IL-6 or TNF-a. Therapeutic trials of nutritional support, hormonal supplementation, anti-TNF-a immunotherapy, ghrelin and antioxidants have been conducted, but only a few have shown any benefits in muscle structure and function.Considerably more mechanistic knowledge is needed before therapeutic recommendations can be made. At this time, it is not possible to attribute cachexia in COPD unequivocally to inflammation or any other cause, and much more research is needed.To date, studies have been predominantly cross-sectional, with measurements made only after cachexia has developed. Future research should target prospective observation, studying patients as cachexia progresses, since once cachexia is established, inflammatory cytokine levels may not be abnormal.

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Anorexia in chronic obstructive pulmonary disease — Association to cachexia and hormonal derangement

Cited by 77 publications

References 31 publications

Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

Weight Gain after Lung Reduction Surgery Is Related to Improved Lung Function and Ventilatory Efficiency

A Novel Amino Acids Oral Supplementation in Hemodialysis Patients: a Pilot Study

Possible mechanisms underlying the development of cachexia in COPD

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