Nutritional status and mortality in chronic obstructive pulmonary disease.

Abstract

The role of nutritional status in the prognosis of subjects with severe chronic obstructive pulmonary disease was studied in a cohort of Canadian men and women followed for 3 to 5 yr. A total of 348 subjects who were recruited for a study of negative pressure ventilation were evaluated for lung function and body weight, and a subset who entered hospital for the study (n=184) had baseline measures of diffusing capacity, maximal inspiratory and expiratory mouth pressure (PImax and PEmax), and blood gases. Predictors of survival were analyzed using Cox regression models. In the total cohort, low body mass index (BMI) and use of home oxygen were independently associated with reduced survival. In the hospitalized group, predictors of respiratory mortality were elevated PaCO2 and low BMI, PImax, and diffusing capacity. PaO2 (measured on oxygen therapy), FEV1, PEmax, age, smoking behavior, and gender were not associated with survival. The predictors of total mortality were similar, except that BMI was no longer significant. In conclusion, low body weight, a potentially modifiable factor, was associated with respiratory mortality, but whether it has a casual effect or is a marker of declining health can only be resolved through an intervention trial.

Fat-Free Mass Depletion Is Associated With Poor Exercise Capacity Irrespective of Dynamic Hyperinflation in COPD Patients

“…32 The results of this study are in line with those of previous reports showing that body weight depletion is related to a decreased exercise performance in COPD patients. [8][9][10][11][12] Our patients with low FFM showed a significant reduction in aerobic capacity both at peak of exercise and at AT. In our study, depleted and nondepleted patients did not differ in both resting spirometry and lung volume measurements and in operational volumes measured during maximal exercise.…”

“…7 Importantly, the reduction in FFM may also contribute to impairment of exercise capacity in these patients. Earlier studies [8][9][10] have reported a significant correlation between body weight and maximal exercise capacity in COPD patients. Notably, the FFM was found to be strictly related both to submaximal 11 and maximal 12 exercise performance in these patients.…”

Prevalence and consequences of nutritional depletion in lung transplant candidates

“…In end-stage lung diseases, lean body mass seems to be a better tool to assess nutritional depletion and monitoring this parameter in lung transplant candidates is recommended. If mortality is considered, the study confirms that nutritional status per se is of value to predict survival while awaiting LT [4,5,13,16,17]. In the postoperative course, nutritional depletion increases the risk of death, mainly in CF patients, as shown by different groups [5,6,13] but not by others [4].…”

“…m -2 [4,5,7,13]. In COPD patients, the prevalence of nutritional depletion increases with the degree of bronchial obstruction [8,10,14,16,17], the level of hypoxaemia [8,15] and the subtype of COPD, emphysema patients being more depleted [14]. Hypoxaemia per se modifies muscle mass through a sharp decline in protein synthesis so that oxygen supply can adapt to demand [18].…”

Muscle strength and functional mobility in relation to lean body mass in free-living frail elderly women

“…There is growing evidence that protein requirements in elderly individuals may in fact be higher (1.0 g/kg body weight/d) than current recommendations (0.86 g/kg body weight/d) (Campbell et al, 1994). The preservation of lean body mass in heavier subjects may also be a factor in the better survival of heavier COPD patients compared to those who are at what is generally accepted as normal body weight (Chailleux et al, 1992;Gray-Donald et al, 1996).…”