The Effects of Refeeding on Peripheral and Respiratory Muscle Function in Malnourished Chronic Obstructive Pulmonary Disease Patients

Whittaker, J. S.; Ryan, C. Frank; Buckley, Philip; Road, Jeremy

doi:10.1164/ajrccm/142.2.283

Cited by 149 publications

(75 citation statements)

References 6 publications

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“…1). Although this study suggested that diaphragm adaptation was of considerably less importance than previously suggested, it did not exclude its occurrence, as our results could have been obtained despite adaptation in other factors (for example diaphragm geometry, malnutrition [16], steroid use [17] or blood gas disturbances [18,19]) had reduced diaphragm strength. To further investigate whether adaptation occurs, we used another length-dependent property of muscle, specifically the fact that muscle shortening has a disproportionately detrimental effect on the tension (or pressure) elicited by low-frequency stimuli [20,21].…”

contrasting

confidence: 77%

The diaphragm in chronic obstructive pulmonary disease: how useful is it?

Polkey

Moxham

1997

Eur J Clin Investigation

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The respiratory muscle pump should be considered an essential organ, and the diaphragm is normally the most important inspiratory muscle in man [1], accounting for approximately 70% of resting ventilation. Diaphragm dysfunction would reasonably be expected to impose limits on ventilatory performance and, in the extreme case of neuromuscular disease, this is easily demonstrated [2,3]. Probably the most common potential cause of diaphragm dysfunction in clinical medicine is that associated with chronic obstructive pulmonary disease (COPD). In COPD, the pressure-generating capacity of the diaphragm is affected by several factors, of which the most important is hyperinflation.When lung volume is increased acutely, the force that can be generated by the diaphragm (assessed as transdiaphragmatic pressure, P id ) is reduced [4]. Since the mid-nineteenth century, abnormal rib cage movement, attributed to diaphragm dysfunction, has been recognized as a clinical feature of advanced emphysema [5][6][7]. However, more recently, studies in emphysematous

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contrasting

confidence: 77%

The diaphragm in chronic obstructive pulmonary disease: how useful is it?

Polkey

Moxham

1997

Eur J Clin Investigation

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“…Consequently, nutritional support has been advocated as a useful part of the care of COPD patients with low BMI. A number of nutritional intervention studies with pulmonary function, exercise capacity or weight increase as outcome have been performed [4][5][6][7]. However, a recent meta-analysis reviewed the effect of these studies and concluded that the studies did not document a beneficial effect of nutritional support in patients with COPD [8].…”

mentioning

confidence: 99%

Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study

Prescott¹,

Almdal²,

Mikkelsen³

et al. 2002

European Respiratory Journal

232

159

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An association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) has been found in a number of studies. The prevalence and prognostic importance of weight change in unselected subjects with COPD was examined.Subjects with COPD, defined as forced expiratory volume in one second/forced vital capacityv0.7 in the Copenhagen City Heart Study and who attended two examinations 5 yrs apart, were followed for 14 yrs for COPD-related and all-cause mortality.The proportion of subjects who lost w1 unit BMI (y3.8 kg) between the two examinations was significantly associated with level of COPD, reaching y30% in subjects with severe COPD. After adjusting for age, smoking habits, baseline BMI and lung function, weight loss was associated with higher mortality in both persons with and without COPD (rate ratio (RR) for weight loss w3 BMI units 1.71 (95% confidence interval (CI): 1.32-2.23) and 1.63 (95% CI 1.38-1.92), respectively). Weight gain was associated with increased mortality, but not significantly so in subjects with COPD. Risk of COPD-related death increased with weight loss (RR 2.14 (95% CI 1.18-3.89)), but not with weight gain (RR 0.95 (95% CI 0.43-2.08)). In subjects without COPD or with mild-to-moderate COPD, the effect of weight change was the same irrespective of initial weight. In subjects with severe COPD, there was a significant risk ratio modification (p=0.045) between effect of baseline BMI and weight change: in the normal-to-underweight (BMIv25), best survival was seen in those who gained weight, whereas for the overweight and obese (BMIo25), best survival was seen in stable weight.A high proportion of subjects with chronic obstructive pulmonary disease experienced a significant weight loss, which was associated with increased mortality. The results support further intervention studies that aim at avoiding weight loss in normal-tounderweight chronic obstructive pulmonary disease patients. In patients with chronic obstructive pulmonary disease (COPD), a number of observational studies have shown that a low body mass index (BMI) is associated with a poor prognosis independent of the degree of ventilatory impairment [1][2][3]. Consequently, nutritional support has been advocated as a useful part of the care of COPD patients with low BMI. A number of nutritional intervention studies with pulmonary function, exercise capacity or weight increase as outcome have been performed [4][5][6][7]. However, a recent meta-analysis reviewed the effect of these studies and concluded that the studies did not document a beneficial effect of nutritional support in patients with COPD [8]. So far, no controlled intervention study with mortality as outcome has tested the effect of nutritional support in these patients.A different way of addressing this question is in an epidemiological setting to study mortality rates of subjects with COPD and relate these to changes in body weight. In a previous study, the present authors have shown that low BMI was an inde...

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“…For instance, following EN, hospitalized patients with COPD experienced improved maximal expiratory and inspiratory pressures. 45 Researchers identified improved immune function after EN was provided to other populations, such as elderly hospitalized patients and hospitalized patients with critical illness. 4,[46][47] Similarly, a meta-analysis identified functional benefits after EN for patients in the community with primary diagnoses including COPD, cystic fibrosis, GI disease, HIV, and cancer.…”

Section: Improved Outcomes Resulting From Enmentioning

confidence: 99%

Disease‐Related Malnutrition and Enteral Nutrition Therapy

2010

Nut in Clin Prac

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The Effects of Refeeding on Peripheral and Respiratory Muscle Function in Malnourished Chronic Obstructive Pulmonary Disease Patients

Cited by 149 publications

References 6 publications

The diaphragm in chronic obstructive pulmonary disease: how useful is it?

The diaphragm in chronic obstructive pulmonary disease: how useful is it?

Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study

Disease‐Related Malnutrition and Enteral Nutrition Therapy

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