Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD)

Managing malnutrition in COPD: A review

In the UK approximately 1.2 million people have COPD with around 25-40% being underweight and 35% have a severely low fat-free mass index. Measuring their body mass index is recommended and Health care professionals should endeavour to ensure that COPD patients are achieving their nutritional requirements. A narrative review summarizes evidence from 28 original articles identified through a systematic searches of databases, grey literature and hand searches covering 15 years, focusing on two themes, on the impact of malnutrition on COPD, and the management of malnutrition in COPD. Malnutrition causes negative effects on exercise and muscle function and lung function as well as increasing exacerbations, mortality and cost. Management options include nutritional supplementation which may increase weight and muscle function. Nutritional education has short-term improvements. Malnutrition affects multiple aspects of COPD, but treatment is of benefit. Clinical practice should include nutrition management.

Chronic Obstructive Pulmonary Disease: A 2019 Evidence Analysis Center Evidence-Based Practice Guideline

Chronic obstructive pulmonary disease (COPD) is a progressive lung disorder in which patients are at high risk for both pulmonary and systemic complications of their disease. Medical nutrition therapy by a registered dietitian nutritionist can be an integral component of lifestyle treatment targeted at maintaining and improving outcomes, such as lung function, mortality, and quality of life. The Academy of Nutrition and Dietetics (Academy) convened an expert workgroup to conduct a systematic review to update the COPD Evidence-Based Nutrition Practice Guideline. This publication outlines the Academy's Evidence Analysis Library methods used to complete the systematic review and guideline and examines the recommendations and supporting evidence. A total of 14 recommendations were developed based on evidence from eight conclusions. Using the Nutrition Care Process as a framework for practice, recommendations rated as strong included assessing and monitoring and evaluating body weight and medical nutrition therapy by a registered dietitian nutritionist. Weak recommendations included predicting resting and total energy expenditure. All other recommendations were rated as fair. These included individualizing the calorie prescription and macronutrient composition of the diet; assessing and monitoring and evaluating energy intake, serum 25-hydroxyvitamin D levels, and frequency of exacerbations; and determining need for vitamin D supplementation. Fewer than one-third of the systematic review's conclusions could be used to support the recommendations due to conflicting results or limited or no evidence available. The Evidence Analysis Library 2019 COPD Evidence-Based Nutrition Practice Guideline is a valuable resource for registered dietitian nutritionists and other health care professionals caring for those with COPD.

Assessment of 7 trace elements in serum of patients with nontuberculous mycobacterial lung disease

Nontuberculous mycobacterial (NTM) lung diseases are an emerging cause of pulmonary infection, becoming more common in the clinical setting as incidence of NTM lung diseases steadily increases worldwide. Trace elements are essential micronutrients and are known to play many important roles in infectious diseases. We investigated the concentrations of trace elements in patients with NTM lung disease and compared these values to patients with pulmonary tuberculosis and healthy controls. A case-control study was conducted to evaluate the serum trace element concentrations in 95 patients with NTM lung disease, 97 patients with pulmonary tuberculosis, and 99 healthy control subjects. The serum concentrations of 7 trace elements (cobalt, copper, chromium, manganese, molybdenum, selenium, and zinc) were measured using inductively coupled plasma-mass spectrometry. We also analyzed demographic data, clinical outcomes, and other biochemical parameters. The median serum concentrations of copper and molybdenum were higher in patients with NTM lung disease (109 vs. 91 μg/dL, p < 0.001 and 1.70 vs. 0.96 μg/L, p < 0.001). In contrast, the median serum concentrations of selenium and zinc were significantly lower in patients with NTM lung disease than in healthy controls (105 vs. 115 μg/L, p < 0.001 and 94 vs. 102 μg/dL, p < 0.001). Compared to patients with pulmonary tuberculosis, the serum concentrations of molybdenum and zinc were higher in patients with NTM lung disease, while cobalt and copper concentrations were lower (p < 0.001). Correlations among trace element concentrations were observed (copper and zinc, r = -0.367; cobalt and molybdenum, r = -0.360; selenium and zinc, r = 0.335; and manganese and zinc, r = 0.327, respectively). None of the 7 trace elements were associated with treatment outcomes. Patients with NTM lung disease showed different serum trace element concentrations. Our study indicates that altered trace element status is associated with mycobacterial disease. Further study investigating the clinical significance of individual trace elements and their association with nutritional status in patients with NTM lung disease would be required.

Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease

Low energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.

Estimating the severity distribution of disease in South Korea using EQ-5D-3L: a cross-sectional study

Background

There is a paucity of data on the distribution of disease severity. In this study, we estimated disease severity distributions in South Korea using two EQ-5D-3L population surveys.

Methods

A total of 110 health states for 35 diseases with 2–5 severity levels (e.g., mild, moderate, severe) were included in this study. A general population of 360 participants from the areas surrounding Seoul and Gyunggi evaluated these health states using EQ-5D-3L via face-to-face interviews and a paper questionnaire. The EQ-5D indices were used to measure the severity levels of health states and used as the cutoff points for the disease severity distributions. Finally, these cutoff points were applied to disease prevalence data with EQ-5D-3L, which were obtained from the Korean National Health and Nutrition Examination Surveys (KNHNES) and Korean Community Health Survey, in order to estimate the disease severity distributions.

Results

The severity distributions of 8 diseases were estimated, including asthma, angina, stroke, chronic obstructive pulmonary disease, major depressive disorder, musculoskeletal problems in the legs, anemia, and allergic rhinitis and conjunctivitis. For example, the EQ-5D indices for chronic obstructive pulmonary disease severity were 0.929, 0.742, and 0.620, and the cut-off points were 0.835 (between mild and moderate) and 0.681 (between moderate and severe). Using these cutoff points, the distributions of chronic obstructive pulmonary disease severity were 66.5 % (mild), 23.3 % (moderate), and 10.1 % (severe) according to KNHNES.

Conclusions

The estimated severity distributions in this study can be used as a valid calculation of the disease burden in the general population.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2904-5) contains supplementary material, which is available to authorized users.

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

Cachexia and muscle wasting are well recognized as common and partly reversible features of chronic obstructive pulmonary disease (COPD), adversely affecting disease progression and prognosis. This argues for integration of weight and muscle maintenance in patient care. In this review, recent insights are presented in the diagnosis of muscle wasting in COPD, the pathophysiology of muscle wasting, and putative mechanisms involved in a disturbed energy balance as cachexia driver. We discuss the therapeutic implications of these new insights for optimizing and personalizing management of COPD-induced cachexia.

Effect of 6-minute walk test on neuromuscular properties of patients with chronic obstructive pulmonary disease

OBJECTIVE

The objective of this study was to evaluate the neuromechanical properties of the knee extensor muscles before and after the 6-minute walk test (6MWT) in chronic obstructive pulmonary disease (COPD) patients and control subjects.

MATERIALS AND METHODS

COPD patients from the Department of Pulmonology of the Hospital de Clinicas de Porto Alegre and age- and sex-matched control volunteers without COPD were included in this study. Body composition and lower limb strength assessed by maximal voluntary isometric contraction (MVIC) of the knee extensors) were assessed before and after the 6MWT. The total reaction time (TRT), premotor time (PMT) and motor time (MT) were assessed using surface electromyography of the rectus femoris and vastus lateralis knee extensor muscles.

RESULTS

Eighteen patients COPD patients (10 men, FEV₁ 36 ± 12% of predicted) and 8 control subjects (5 men, FEV₁ 82 ± 7% of predicted) were included. COPD patients had lower muscle strength before (21.77 ± 7.86 kg) and after the 6MWT (11.16 ± 4.70 kg) compared with control subjects (33.50 ± 14.01 kg before; 29.25 ± 16.66 kg after). After the 6MWT, COPD patients showed a significant reduction in the MVIC and a significant increase in the TRT and PMT, which did not occur in control subjects. The reaction time parameters were higher in COPD patients after the 6MWT compared with control subjects. The TRT (r = -0.535, P < 0.005) and PMT (r = -0.549, P < 0.005) were inversely correlated with the MVIC after the 6MWT.

CONCLUSIONS

Neuromuscular changes associated with upper motor neuron activation contribute to MVIC impairment in COPD patients after performing a functional test.

Plasma orexin-A and ghrelin levels in patients with chronic obstructive pulmonary disease: Interaction with nutritional status and body composition

Orexin-A and ghrelin are two important polypeptides that stimulate food intake, however, there is a lack of sufficient information concerning their plasma levels in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the association between plasma orexin-A and ghrelin levels with food consumption and body composition in patients with stable phase COPD. In total, 40 patients (age, 44–80 years; male, 31; female 9) who were in the stable phase of COPD were included in the study. Blood samples for plasma orexin-A and ghrelin analysis were collected after 8–12 h of fasting; certain anthropometric measurements were obtained and a 24-h dietary recall was recorded. The mean plasma orexin-A levels in the male and female patients were 1.3±0.37 and 1.4±0.13 ng/ml, respectively, while the mean plasma ghrelin levels were 25.9±7.31 and 27.3±8.54 ng/ml, respectively. No significant correlation was observed between the body mass index and plasma orexin-A and ghrelin levels or between the plasma ghrelin levels and dietary nutrient intake (P>0.05). The plasma orexin-A levels were demonstrated to be higher in patients with a higher dietary total fibre intake (r=0.303, P=0.022). A similar correlation was observed between plasma orexin-A levels and dietary intake of soluble (r=0.033, P=0.029) and insoluble (r=0.335, P=0.024) fibre, as well as between the daily consumption of calcium and the levels of plasma orexin-A (r=0.065, P=0.046). Therefore, the results of the present study indicated that a positive correlation existed between dietary nutrient intake and plasma orexin-A levels in patients with COPD.