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Guðnadóttir SD, Gunnarsdóttir I, Hernandez UB, Ingadóttir ÁR. High risk of malnutrition among hospitalised coronavirus disease 2019 (COVID-19) patients is associated with mortality and other clinical outcomes. Clin Nutr ESPEN 2024; 61:1-7. [PMID: 38777420 DOI: 10.1016/j.clnesp.2024.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/28/2024] [Accepted: 02/21/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Increasing evidence indicates an association between nutritional status and Coronavirus disease 2019 (COVID-19) disease severity. The aim of the study was to describe the risk of malnutrition, body mass index (BMI) and vitamin D status of hospitalised COVID-19 patients and assess whether they are associated with duration of hospital stay, intensive care unit (ICU) admission, mechanical ventilation, and mortality. METHODS The study is a descriptive retrospective study of 273 patients with COVID-19 admitted to Hospital from February 2020 to March 2021. Patients were screened for risk of malnutrition using a validated screening tool. BMI was calculated from height and weight. Insufficient Vitamin D status was defined as 25(OH)vitD <50 nmol/L. Logistic regression analysis was used to assess the association between indicators of nutritional status of patients with COVID-19, and outcomes such as duration of stay >7 days, ICU admission, mechanical ventilation, and mortality. Interaction between risk of malnutrition and BMI of ≥30 kg/m2 was assessed using the likelihood ratio test with hospital stay, ICU admission, mechanical ventilation, and mortality as outcomes. RESULTS Screening for risk of malnutrition identified 201 (74%) patients at a medium to high risk of malnutrition. Patients defined as being at a medium or high risk of malnutrition were more likely to be hospitalised for >7 days compared to those defined as low risk (OR: 10.72; 95% CI: 3.9-29.46; p < 0.001 and OR: 61.57; 95% CI: 19.48-194.62; p < 0.001, respectively). All patients who were admitted to ICU (n = 41) and required mechanical ventilation (n = 27) were defined as having medium or high risk of malnutrition. High risk of malnutrition was also associated with increased odds of mortality (OR: 8.87; 955 CI 1.08-72,96; p = 0.042). BMI of ≥30 kg/m2 (43%) and 25(OH)vitD <50 nmol/L (20%) were not associated with duration of stay >7 days or mortality, although BMI ≥30 kg/m2 was associated with increased risk of ICU admission (OR: 7.12; 95% CI: 1.59-31.94; p = 0.010) and mechanical ventilation (OR: 8.86; 95% CI: 1.12-69.87; p = 0.038). Interactions between risk of malnutrition and BMI ≥30 kg/m2 were not significant to explain the outcomes of hospital stay >7 days, ICU admission, mechanical ventilation, or mortality. CONCLUSION High risk of malnutrition among hospitalised COVID-19 patients was associated with longer duration of hospital stay, ICU admission, mechanical ventilation and mortality, and BMI ≥30 kg/m2 was associated with ICU admission and mechanical ventilation. Insufficient Vitamin D status was not associated with duration of hospital stay, ICU admission, mechanical ventilation, or mortality.
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Affiliation(s)
| | - Ingibjörg Gunnarsdóttir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Áróra Rós Ingadóttir
- Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Bell K, Lawson J, Penz E, Cammer A. Systematic review of tailored dietary advice and dietitian involvement in the treatment of chronic obstructive pulmonary disease (COPD). Respir Med 2024; 225:107584. [PMID: 38467310 DOI: 10.1016/j.rmed.2024.107584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading public health concern globally. Interdisciplinary pulmonary rehabilitation programs exist and should ideally consider nutritional health impacts since the nutritional status of COPD patients is often compromised. However, little is known about the role of dietary counseling in COPD management. RESEARCH QUESTION Does providing tailored dietary advice to adult patients with COPD improve outcomes? STUDY DESIGN AND METHODS We conducted a systematic review. The following electronic databases and registrars were used: MEDLINE, EMBASE, Web of Science, CINAHL, Cochrane Library, and ClinicalTrials.gov. The original search was conducted in June 2021 with an updated search conducted on February 21, 2024. Validity and bias assessments were completed. RESULTS We selected 14 articles for inclusion. Multiple outcomes were considered including functional, body composition, nutritional intake, cost analyses, quality of life, and others. The most common measured outcomes were quality of life and the 6 min walk test. A number of interventions were used with most interventions being interdisciplinary pulmonary rehabilitation packages where nutrition counseling was one component. A number of interventions showed positive results but there tended to be inconsistency. INTERPRETATION Evidence shows that various interventions appear to improve outcomes, but it is difficult to determine if improvements are due to nutritional intervention specifically or a rehabilitation program as a whole. More specific randomized controlled trials should be completed regarding tailored nutritional counseling and therapy in adults with COPD to determine the benefits attributable to nutritional interventions.
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Affiliation(s)
- Kylie Bell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Josh Lawson
- Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Canadian Centre for Rural and Agricultural Health (CCRAH), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Erika Penz
- Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Respiratory Research Centre (RRC), University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Chow R, So OW, Im JHB, Chapman KR, Orchanian-Cheff A, Gershon AS, Wu R. Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) - A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2581-2617. [PMID: 38022828 PMCID: PMC10664718 DOI: 10.2147/copd.s418295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD. Methods A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the p-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035). Results In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV1, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility. Conclusion The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.
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Affiliation(s)
- Ronald Chow
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia W So
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - James H B Im
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kenneth R Chapman
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Wu
- University Health Network, University of Toronto, Toronto, ON, Canada
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Hannemann J, Thorarinnsdottir EH, Amaral AFS, Schwedhelm E, Schmidt-Hutten L, Stang H, Benediktsdottir B, Gunnarsdóttir I, Gislason T, Böger R. Biomarkers of the L-Arginine/Dimethylarginine/Nitric Oxide Pathway in People with Chronic Airflow Obstruction and Obstructive Sleep Apnoea. J Clin Med 2023; 12:5230. [PMID: 37629272 PMCID: PMC10455103 DOI: 10.3390/jcm12165230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnoea (OSA) are common chronic diseases that are associated with chronic and intermittent hypoxemia, respectively. Patients affected by the overlap of COPD and OSA have a particularly unfavourable prognosis. The L-arginine/nitric oxide (NO) pathway plays an important role in regulating pulmonary vascular function. Asymmetric (ADMA) and symmetric dimethylarginine (SDMA) interfere with NO production. METHODS We analysed the serum concentrations of ADMA, SDMA, L-arginine, L-citrulline, and L-ornithine in a large sample of the Icelandic general population together with chronic airflow obstruction (CAO), a key physiological marker of COPD that was assessed by post-bronchodilator spirometry (FEV1/FVC < LLN). OSA risk was determined by the multivariable apnoea prediction (MAP) index. RESULTS 713 individuals were analysed, of whom 78 (10.9%) showed CAO and 215 (30%) had MAP > 0.5. SDMA was significantly higher in individuals with CAO (0.518 [0.461-0.616] vs. 0.494 [0.441-0.565] µmol/L; p = 0.005), but ADMA was not. However, ADMA was significantly associated with decreasing FEV1 percent predicted among those with CAO (p = 0.002). ADMA was 0.50 (0.44-0.56) µmol/L in MAP ≤ 0.5 versus 0.52 (0.46-0.58) µmol/L in MAP > 0.5 (p = 0.008). SDMA was 0.49 (0.44-0.56) µmol/L versus 0.51 (0.46-0.60) µmol/L, respectively (p = 0.004). The highest values for ADMA and SDMA were observed in individuals with overlap of CAO and MAP > 0.5, which was accompanied by lower L-citrulline levels. CONCLUSIONS The plasma concentrations of ADMA and SDMA are elevated in COPD patients with concomitant intermittent hypoxaemia. This may account for impaired pulmonary NO production, enhanced pulmonary vasoconstriction, and disease progression.
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Affiliation(s)
- Juliane Hannemann
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, 20246 Hamburg, Germany
| | - Elin H. Thorarinnsdottir
- Primary Health Care of the Capital Area, 103 Reykjavik, Iceland;
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland; (B.B.); (T.G.)
| | - André F. S. Amaral
- National Heart and Lung Institute, Imperial College London, London SW3 6LY, UK;
- NIHR Imperial Biomedical Research Centre, London W2 1NY, UK
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
| | - Lena Schmidt-Hutten
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
| | - Heike Stang
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
| | - Bryndis Benediktsdottir
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland; (B.B.); (T.G.)
- Sleep Department, Landspitali University Hospital of Iceland, 105 Reykjavik, Iceland
| | - Ingibjörg Gunnarsdóttir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, 102 Reykjavik, Iceland;
| | - Thórarinn Gislason
- Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland; (B.B.); (T.G.)
- Sleep Department, Landspitali University Hospital of Iceland, 105 Reykjavik, Iceland
| | - Rainer Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (J.H.); (E.S.); (L.S.-H.); (H.S.)
- Institute DECIPHER, German-Chilean Institute for Research on Pulmonary Hypoxia and Its Health Sequelae, 20246 Hamburg, Germany
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Beijers RJHCG, Steiner MC, Schols AMWJ. The role of diet and nutrition in the management of COPD. Eur Respir Rev 2023; 32:32/168/230003. [PMID: 37286221 DOI: 10.1183/16000617.0003-2023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 06/09/2023] Open
Abstract
In 2014, the European Respiratory Society published a statement on nutritional assessment and therapy in COPD. Since then, increasing research has been performed on the role of diet and nutrition in the prevention and management of COPD. Here, we provide an overview of recent scientific advances and clinical implications. Evidence for a potential role of diet and nutrition as a risk factor in the development of COPD has been accumulating and is reflected in the dietary patterns of patients with COPD. Consuming a healthy diet should, therefore, be promoted in patients with COPD. Distinct COPD phenotypes have been identified incorporating nutritional status, ranging from cachexia and frailty to obesity. The importance of body composition assessment and the need for tailored nutritional screening instruments is further highlighted. Dietary interventions and targeted single or multi-nutrient supplementation can be beneficial when optimal timing is considered. The therapeutic window of opportunity for nutritional interventions during and recovering from an acute exacerbation and hospitalisation is underexplored.
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Affiliation(s)
- Rosanne J H C G Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michael C Steiner
- Leicester NIHR Biomedical Research Centre - Respiratory, Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr 2023; 42:848-858. [PMID: 37084471 DOI: 10.1016/j.clnu.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Malnutrition is a significant comorbidity among chronic obstructive pulmonary disease (COPD), but it has been often ignored. To date, the prevalence of malnutrition and its association with clinical parameters in the patients with COPD have not been well described. We aimed to investigate the prevalence of malnutrition and the prevalence of at-risk for malnutrition among COPD and the clinical impact of malnutrition on patients with COPD in a systematic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched for articles describing the prevalence of malnutrition and/or at-risk for malnutrition from January 2010 to December 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine the prevalence of malnutrition and at-risk for malnutrition and the clinical impact of malnutrition on patients with COPD. Meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Comparisons were made between individuals with and without malnutrition according to pulmonary function, degree of dyspnea, exercise capacity, and mortality risk. RESULTS Out of the 4156 references identified, 101 were read full-text, of which 36 studies were included. The total number of involved patients included in this meta-analysis was 5289. The prevalence of malnutrition was 30.0% (95% CI 20.3 to 40.6), compared with an at-risk prevalence of 50.0% (95% CI 40.8 to 59.2). Both prevalences were associated with regions and measurement tools. The prevalence of malnutrition was associated with COPD phase (acute exacerbations and stable). COPD with malnutrition showed lower forced expiratory volume 1 s % predicted (mean difference (MD) -7.19, 95% CI -11.86 to -2.52), higher modified Medical Research Council dyspnea scores (MD 0.38, 95% CI 0.12 to 0.64), poorer exercise tolerance (standardized mean difference -0.29, 95% CI -0.54 to -0.05), and higher mortality risk (hazard ratio 2.24, 95% CI 1.23 to 4.06) compared to COPD without malnutrition. CONCLUSION Malnutrition and at-risk for malnutrition are common among COPD. Malnutrition negatively impacts important clinical outcomes of COPD.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Ye Lu
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Zhou
- Respiratory Department, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
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Muscle Function in Moderate to Severe Asthma: Association With Clinical Outcomes and Inflammatory Markers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1439-1447.e3. [PMID: 36693537 DOI: 10.1016/j.jaip.2022.12.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patients with severe asthma have been shown to have low muscle mass, but the clinical consequences are unknown. OBJECTIVE In a clinical cohort of patients with moderate to severe asthma, we aimed to assess muscle mass and strength and their relation with functional and clinical outcomes, as well as with systemic inflammatory markers. METHODS Muscle mass and strength were assessed by the fat-free mass index (FFMI), creatinine excretion in a 24-hour urine sample, and handgrip strength test. Functional outcomes included pulmonary function tests and the 6-minute walking distance, whereas clinical outcomes were assessed with questionnaires on asthma control, quality of life, and health care use. Associations of muscle mass and strength with asthma outcomes were assessed with multivariable regression analyses. RESULTS A total of 114 patients participated (36% male; mean age, 51.9 ± 14.4 years; body mass index, 27.7 ± 5.7 kg/m2). According to predefined criteria, 16% had a low FFMI and 8% a low urinary creatinine excretion, which did not differ between categories of asthma severity. Both lower FFMI and urinary creatinine excretion were associated with lower values of FEV1 and 6-minute walking distance, whereas a lower handgrip strength was related to worse asthma control, poorer quality of life, and a higher probability of emergency visits (all P < .05). Except for higher leukocytes in relation to lower FFMI, we did not find associations between systemic inflammatory markers and muscle function. CONCLUSIONS This study demonstrates that low muscle mass is prevalent in patients with moderate to severe asthma and, along with low muscle strength, is associated with poorer clinical and functional outcomes. Our results encourage longitudinal studies into muscle function as a potential target for treatment to improve asthma outcomes.
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The Nutritional Status of Chronic Obstructive Pulmonary Disease Exacerbators. Can Respir J 2022; 2022:3101486. [PMID: 36276928 PMCID: PMC9584732 DOI: 10.1155/2022/3101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/21/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Malnutrition is underdiagnosed in chronic obstructive pulmonary disease. Objectives. This study aimed to evaluate the nutritional status of COPD patients and the link between dyspnea and nutritional status. Methods. This longitudinal observational study included patients hospitalized with exacerbated COPD. Nutritional status was assessed using Nutrition Risk Screening 2002, anthropometric, and biochemical assessments, in the first 48 hours of hospitalization. Results. Thirty patients were evaluated. According to the Nutrition Risk Screening 2002, half of the patients were at increased risk of malnutrition. 36.7% were classified as malnourished if we only considered the body mass index. From the evaluation of the tricipital skin fold, 69.0% were classified as malnourished, with 48.3% having severe malnutrition. According to the serum albumin level, 29.6% had malnutrition criteria. A significant association between dyspnea and increasing age (
) was found. There was a strong association between the fold classification and the degrees of severity of dyspnea (Fisher exact test: 13.60,
, V Cramer = 0.826). Most patients were malnourished and had higher grades of dyspnea. Tricipital skinfold reflects subcutaneous adipose tissue; this anthropometric measurement seems to be a good method to classify the nutritional status of COPD patients. It classified the biggest portion of patients as malnourished. Conclusion. The number of patients classified as malnourished changed with the method under analysis. The tricipital skin fold parameter was strongly associated with the dyspnea score. Most patients had adipose tissue and muscular mass depletion.
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Liu Y, Huang C, Du J, Lan G, Du X, Sun Y, Shi G. Anabolic-androgenic steroids for patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:915159. [PMID: 36148458 PMCID: PMC9485876 DOI: 10.3389/fmed.2022.915159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background Testosterone deficiency is common in chronic obstructive pulmonary disease (COPD) patients. There has been a growing interest in the potential use of anabolic-androgenic steroids (AASs) in patients with COPD recently. However, whether AASs could improve their clinical outcomes remains unknown. Methods In order to explore the efficacy of AASs in patients with COPD, systematic search of MEDLINE, Embase, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) of AASs for COPD published before March 17, 2022 was performed. Results Data were extracted from 8 articles involving 520 participants. The median number of participants per study was 39.5 and the mean follow up was 14.2 weeks. As compared to the control group, AASs therapy could significantly improve body weight (weighted mean difference (WMD), 1.38 kg; 95% CI, 0.79 to 1.97 kg), fat-free mass (WMD, 1.56 kg; 95% CI, 0.94 to 2.18 kg) and peak workload (WMD, 6.89W; 95% CI, 3.97 to 9.81W) of COPD patients, but no improvements in spirometry indicators and six-minute walking distances (WMD, 16.88 m; 95%, −3.27 to 37.04 m). Based on the available research data, it is uncertain whether AASs treatment could improve the quality of life of COPD patients. Conclusions Limited published evidence indicates that AASs therapy provides clinical benefits in patients with COPD. However, longer and larger studies are needed to better clarify the efficacy of AASs and draw final conclusions.
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Affiliation(s)
- Yahui Liu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunrong Huang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juan Du
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gelei Lan
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueqing Du
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yidan Sun
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guochao Shi
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Respiratory Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Guochao Shi
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Quncuo C, Liang Y, Li Q, She X, Cuo BM, Qiongda B, ChuTso M, Sun Y. High Prevalence of Nutritional Risk Among Pulmonary Patients Living on the Tibetan Plateau. Front Nutr 2022; 9:872457. [PMID: 35619955 PMCID: PMC9127964 DOI: 10.3389/fnut.2022.872457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nutritional risk is associated with adverse clinical outcomes and is more prevalent among pulmonology patients than among patients in other departments. High-altitude environments can affect patients with chronic respiratory diseases, but evidence of the prevalence of nutritional risk among hospitalized patients with respiratory diseases in high-altitude areas is limited. This study aimed to investigate the nutritional risk and status of inpatients with different major respiratory diagnoses permanently living on the Tibetan Plateau (≥3,000 m above sea level). Methods In this cross-sectional study, we consecutively recruited inpatients admitted to the Department of Respiratory and Critical Care Medicine at the Tibet Autonomous Region People's Hospital of Lhasa between November 2020 and May 2021. We used the Nutrition Risk Screening (NRS) 2002 tool to assess nutritional risk among these patients. An NRS 2002 score ≥3 points indicates nutritional risk; a score ≥5 indicates high nutritional risk. According to NRS-2002 scores, patients were divided into three groups (NRS-2002 0–2, 3–4, and ≥5). The differences in age, sex, major respiratory diagnoses, comorbidities, body mass index, and laboratory findings among the groups were analyzed. Results A total of 289 eligible Tibetan patients were enrolled in the study, and 46.1% (133/246) of them were at nutritional risk (NRS-2002 score ≥3). Twenty-one (7.3%) patients were at high nutritional risk (NRS-2002 score ≥5). The proportions of patients at nutritional risk were relatively high among patients with lung cancer (58.8%), interstitial lung disease (58.3%), pulmonary embolism (52.9%), and tuberculosis (50.0%). Laboratory findings showed that patients with NRS-2002 scores of 3–4 and ≥5 had lower red blood cell counts, serum albumin and hemoglobin levels, and higher C-reactive protein (CRP) levels than those with NRS-2002 scores < 3. Conclusion The prevalence of nutritional risk was high among pulmonology department inpatients permanently living on the Tibetan Plateau. Patients with lung cancer, interstitial lung disease, pulmonary embolism or tuberculosis were more likely to have nutritional risk than patients with other diagnoses. The nutritional risk of inpatients in the respiratory department in the plateau area should not be ignored, and patients at high nutritional risk should receive timely intervention.
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Affiliation(s)
- Chilie Quncuo
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Ying Liang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Qiuyu Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoli She
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Bian Ma Cuo
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Bianba Qiongda
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Meilang ChuTso
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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11
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Christensen T, Mikkelsen S, Geisler L, Holst M. Chronic obstructive pulmonary disease outpatients bear risks of both unplanned weight loss and obesity. Clin Nutr ESPEN 2022; 49:246-251. [DOI: 10.1016/j.clnesp.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
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12
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Pereira TG, Lima J, Silva FM. Undernutrition is associated with mortality, exacerbation and poorer quality of life in COPD patients: a systematic review with meta‐analysis of observational studies. JPEN J Parenter Enteral Nutr 2022; 46:977-996. [DOI: 10.1002/jpen.2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/22/2022] [Accepted: 02/10/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Thainá Gattermann Pereira
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Júlia Lima
- Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre Porto Alegre Rio Grande do Sul Brazil
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13
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YILDIZ M, ÇELİK D. The relationship between the nutritional status, body-mass index of patients with chronic obstructive pulmonary disease and respiratory failure and their 1-year survival. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1002206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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14
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[Nutritional risk and clinical outcomes in patients diagnosed with COVID-19 in a high-complexity hospital network]. NUTR HOSP 2021; 39:93-100. [PMID: 34756055 DOI: 10.20960/nh.03738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION the identification of nutritional risk at hospital admission is important to establish timely interventions in the COVID-19 patient care cycle, due to a high risk of it being associated with complications. OBJECTIVE to determine the association between the level of nutritional risk upon admission and in-hospital mortality at 28 days in patients diagnosed with COVID-19 treated between March and October 2020 in two hospital institutions in Colombia. METHODS a retrospective, observational study. Hospitalized patients with a diagnosis of COVID-19 were included and assessed by the Nutrition Service using the nutritional risk identification in emergencies scale, adapted from the NRS 2002 scale. In-hospital mortality at 28 days was analyzed as the primary endpoint, and hospital stay, admission to Intensive Care Unit (ICU), and requirement for mechanical ventilation as secondary endpoints. RESULTS a total of 1230 patients were included, with a mean age of 65.43 ± 15.90 years, mainly men (57.1 %, n = 702). A high nutritional risk (≥ 2 points) was identified in 74.3 % (n = 914). Patients with a high nutritional risk had a greater probability of in-hospital death at 28 days (HRadj: 1.64; 95 % CI: 1.11-2.44), and a greater risk of requiring mechanical ventilation (OR = 1.78; 95 % CI: 1.11-2.86) or ICU admission (OR = 1.478; 95 % CI: 1.05-2.09), as well as hospital stay longer than 7 days (OR = 1.91; 95 % CI: 1.47-2.48). CONCLUSIONS patients with a diagnosis of COVID-19 at high nutritional risk had a significantly higher in-hospital mortality at 28 days and a higher probability of requiring mechanical ventilation, ICU admission, and prolonged hospital stay.
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15
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AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity. Eur J Clin Nutr 2021; 76:685-692. [PMID: 34702965 DOI: 10.1038/s41430-021-01025-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients. SUBJECTS/METHODS Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated. RESULTS In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783-0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01-3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27-5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701-0.835), but was not associated with outcomes. CONCLUSIONS The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.
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Antoniu SA, Boiculese LV, Prunoiu V. Frailty, a Dimension of Impaired Functional Status in Advanced COPD: Utility and Clinical Applicability. ACTA ACUST UNITED AC 2021; 57:medicina57050474. [PMID: 34064756 PMCID: PMC8150879 DOI: 10.3390/medicina57050474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In advanced chronic obstructive pulmonary disease (COPD), functional status is significantly impaired mainly as a result of disease related respiratory symptoms such as dyspnea or as a result of fatigue, which is the extra-respiratory symptom the most prevalent in this setting. "Physical" frailty, considered to be an aging phenotype, has defining traits that can also be considered when studying impaired functional status, but little is known about this relationship in advanced COPD. This review discusses the relevance of this type of frailty in advanced COPD and evaluates it utility and its clinical applicability as a potential outcome measure in palliative care for COPD. Materials and Methods: A conceptual review on the functional status as an outcome measure of mortality and morbidity in COPD, and an update on the definition and traits of frailty. Results: Data on the prognostic role of frailty in COPD are rather limited, but individual data on traits of frailty demonstrating their relationship with mortality and morbidity in advanced COPD are available and supportive. Conclusions: Frailty assessment in COPD patients is becoming a relevant issue not only for its potential prognostic value for increased morbidity or for mortality, but also for its potential role as a measure of functional status in palliative care for advanced COPD.
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Affiliation(s)
- Sabina Antonela Antoniu
- Department of Medicine II and L Boiculese, Department of Interdisciplinary Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
- Correspondence: or
| | - Lucian Vasile Boiculese
- Department of Medicine II and L Boiculese, Department of Interdisciplinary Medicine, University of Medicine and Pharmacy Grigore T Popa, 700115 Iasi, Romania;
| | - Virgiliu Prunoiu
- Department 10 Surgery, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania;
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17
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Wang PY, Chen XK, Liu Q, Xu L, Zhang RX, Liu XB, Li Y. Application of four nutritional risk indexes in perioperative management for esophageal cancer patients. J Cancer Res Clin Oncol 2021; 147:3099-3111. [PMID: 33687565 PMCID: PMC7941130 DOI: 10.1007/s00432-021-03585-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/01/2021] [Indexed: 12/11/2022]
Abstract
Purpose The Prognostic Nutritional Index (PNI), Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score were devised for quantifying nutritional risk. This study evaluated their properties in detecting compromised nutrition and guiding perioperative management of esophageal cancer patients. Methods A prospective institutional database of esophageal cancer patients was reviewed and analyzed. Compromised nutritional status was defined as PNI < 50, NRI < 97.5, GNRI < 92, or CONUT score ≥ 4, respectively. The malnutrition diagnosis consensus established by the European Society of Clinical Nutrition and Metabolism (ESPEN 2015) was selected as reference. Multivariable logistic regression and receiver operating characteristic curve analysis were used. External validation was conducted. Results After reviewing the 212-patient database, 192 patients were finally included. Among the four nutritional indexes, the GNRI < 92 showed highest sensitivity (72.0%), specificity (78.9%), and consistency (AUC 0.754, 95% CI 0.672–0.836) with malnutrition diagnosed by ESPEN 2015. The GNRI < 92 showed comparable performance with ESPEN 2015 in recognizing decreased fat mass, fat-free mass, and skeletal muscle mass (all P < 0.01). Both the GNRI < 92 and ESPEN 2015 showed good property in predicting major complications, infectious complications, overall complications and delayed hospital discharge (all P < 0.01), better than PNI < 50, NRI < 97.5, and CONUT score ≥ 4. Regarding the external validation, a retrospective analysis of 155 esophageal cancer patients confirmed the better performance of GNRI < 92 in predicting perioperative morbidities than other 3 nutritional indexes. Conclusion The GNRI was optimal in perioperative management of esophageal cancer patients among the four nutritional indexes and was an appropriate alternative to ESPEN 2015 for simplifying nutritional assessment. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03585-8.
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Affiliation(s)
- Pei-Yu Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China.,Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, Henan, China
| | - Xian-Kai Chen
- Department of Thoracic Surgical Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center/Cancer Hospital, Beijing, 100021, China
| | - Qi Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, Henan, China
| | - Lei Xu
- Department of Thoracic Surgical Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center/Cancer Hospital, Beijing, 100021, China
| | - Rui-Xiang Zhang
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, Henan, China
| | - Xian-Ben Liu
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, Henan, China
| | - Yin Li
- Department of Thoracic Surgical Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center/Cancer Hospital, Beijing, 100021, China.
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18
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Aotani N, Yasui-Yamada S, Kagiya N, Takimoto M, Oiwa Y, Matsubara A, Matsuura S, Tanimura M, Tani-Suzuki Y, Kashihara H, Saito Y, Nishi M, Shimada M, Hamada Y. Malnutrition by European Society for Clinical Nutrition and Metabolism criteria predicts prognosis in patients with gastrointestinal and hepatobiliary-pancreatic cancer. Clin Nutr ESPEN 2021; 42:265-271. [PMID: 33745591 DOI: 10.1016/j.clnesp.2021.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/13/2020] [Accepted: 01/17/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS The European Society for Clinical Nutrition and Metabolism (ESPEN) proposed the ESPEN diagnostic criteria (EDC) for malnutrition in 2015. There is no report on the association between the EDC and prognosis in patients with gastrointestinal (GI) and hepatobiliary-pancreatic (HBP) cancer. This study aimed to (1) determine the prevalence of EDC malnutrition, (2) investigate the validity of the EDC as a nutritional and prognostic indicator, and (3) examine which components of the EDC are most related to long-term prognosis in patients with GI and HBP cancers. METHODS A total of 634 patients with primary GI and HBP cancers who underwent their first resection surgery between July 2014 and March 2018 were retrospectively recruited. According to the EDC, patients were divided into malnourished and non-malnourished groups. Clinical parameters and survival between these two groups were compared. The prognostic effects of the EDC and the EDC components were analyzed using Cox proportional hazard models. RESULTS The prevalence of EDC malnutrition was 22%. Anthropometric data and biochemical data were associated with EDC malnutrition. The 5-year survival rate was lower in the malnourished group (72%) than in the non-malnourished group (73%; P = 0.007). The multivariate analysis demonstrated that the malnourished group was an independent risk factor for mortality (hazard ratio = 1.70 in the malnourished group; 95% confidence interval 1.08-2.63; P = 0.024). Among EDC components, body mass index (BMI) of <18.5 kg/m2 was an independent poor prognostic factor. CONCLUSIONS EDC malnutrition is associated with poor postoperative long-term prognosis. Among the EDC components, BMI of <18.5 kg/m2 is most associated with prognosis in patients with preoperative GI and HBP cancers.
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Affiliation(s)
- Nozomi Aotani
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Sonoko Yasui-Yamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan.
| | - Natsumi Kagiya
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Mami Takimoto
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yu Oiwa
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Atsumi Matsubara
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Sayaka Matsuura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Mayu Tanimura
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yoshiko Tani-Suzuki
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan
| | - Hideya Kashihara
- Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yu Saito
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Masaaki Nishi
- Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Mitsuo Shimada
- Department of Digestive Surgery and Transplantation, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan
| | - Yasuhiro Hamada
- Department of Therapeutic Nutrition, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Tokushima 770-8503, Japan; Department of Nutrition, Tokushima University Hospital, 2-50-1, Tokushima 770-8503, Japan
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Dávalos-Yerovi V, Marco E, Sánchez-Rodríguez D, Duran X, Meza-Valderrama D, Rodríguez DA, Muñoz E, Tejero-Sánchez M, Muns MD, Guillén-Solà A, Duarte E. Malnutrition According to GLIM Criteria Is Associated with Mortality and Hospitalizations in Rehabilitation Patients with Stable Chronic Obstructive Pulmonary Disease. Nutrients 2021; 13:nu13020369. [PMID: 33530364 PMCID: PMC7911981 DOI: 10.3390/nu13020369] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/16/2021] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Malnutrition has a negative impact on patients with chronic pulmonary obstructive disease (COPD). The purpose of this study was to assess the prevalence of malnutrition, defined by the Global Leadership Initiative for Malnutrition (GLIM), in stable COPD patients referred to pulmonary rehabilitation, and to explore potential associations of malnutrition according to GLIM, and its components, with increased risk of mortality and hospitalizations in 2 years. In a post-hoc analysis of a prospective cohort of 200 rehabilitation patients with stable COPD, main outcome variables were hospital admissions, length of stay, and mortality during a 2-year follow-up. Covariates were malnutrition according to GLIM and its phenotypic criteria: unintentional weight loss, low body mass index (BMI), and low fat-free mass (FFM). Univariate and multivariate analysis were performed using logistic and proportional hazard Cox regression. Malnutrition according to GLIM showed 45% prevalence and was associated with increased mortality risk. Low age-related BMI and FFM were independently associated with mortality, which persisted after adjustment for age and lung function. Malnutrition and low BMI were also associated with increased risk of hospitalization. Malnutrition according to GLIM criteria was highly prevalent in rehabilitation patients with COPD and was associated with nearly 3 times greater mortality and hospitalization risk.
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Affiliation(s)
- Vanesa Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar Hospital de l’Esperança), Passeig Maritim de la Barceloneta 25-29, 08003 Barcelona, Spain; (V.D.-Y.); (M.T.-S.); (A.G.-S.); (E.D.)
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar Hospital de l’Esperança), Passeig Maritim de la Barceloneta 25-29, 08003 Barcelona, Spain; (V.D.-Y.); (M.T.-S.); (A.G.-S.); (E.D.)
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Campus Universitari Mar, Carrer del Doctor Aiguader 80, 08003 Barcelona, Spain;
- School of Medicine, Universitat Internacional de Catalunya, Carrer Josep Trueta s/n, Sant Cugat del Vallès, 08195 Barcelona, Spain
- Correspondence: ; Tel.: +34-603-622-596
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
- Geriatrics Department, Centre Fòrum-Hospital del Mar, Carrer Llull 410, 08019 Barcelona, Spain
- Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Carrer del Doctor Aiguader 80, 08003 Barcelona, Spain
| | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain;
| | - Delky Meza-Valderrama
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
- Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation (INMFER), Panama City 0819, Panama
- Physical Medicine and Rehabilitation Department, Caja de Seguro Social (C.S.S.), Panama City 0824, Panama
| | - Diego A. Rodríguez
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Campus Universitari Mar, Carrer del Doctor Aiguader 80, 08003 Barcelona, Spain;
- Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Carrer del Doctor Aiguader 80, 08003 Barcelona, Spain
- Respiratory Medicine Department, Hospital del Mar, Passeig Maritim de la Barceloneta 25-29, 08003 Barcelona, Spain
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Avenida Monforte de Lemos 3-5, Pabellón 11, 28019 Madrid, Spain
| | - Elena Muñoz
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
| | - Marta Tejero-Sánchez
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar Hospital de l’Esperança), Passeig Maritim de la Barceloneta 25-29, 08003 Barcelona, Spain; (V.D.-Y.); (M.T.-S.); (A.G.-S.); (E.D.)
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
| | - Maria Dolors Muns
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
- Endocrinology and Nutrition Department, Hospital del Mar-Parc de Salut Mar. Passeig Marítim de la Barceloneta, 25, 29, 08003 Barcelona, Spain
| | - Anna Guillén-Solà
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar Hospital de l’Esperança), Passeig Maritim de la Barceloneta 25-29, 08003 Barcelona, Spain; (V.D.-Y.); (M.T.-S.); (A.G.-S.); (E.D.)
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Campus Universitari Mar, Carrer del Doctor Aiguader 80, 08003 Barcelona, Spain;
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar Hospital de l’Esperança), Passeig Maritim de la Barceloneta 25-29, 08003 Barcelona, Spain; (V.D.-Y.); (M.T.-S.); (A.G.-S.); (E.D.)
- Rehabilitation Research Group, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Carrer del Doctor Aiguader 88, 08003 Barcelona, Spain; (D.S.-R.); (D.M.-V.); (E.M.); (M.D.M.)
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Campus Universitari Mar, Carrer del Doctor Aiguader 80, 08003 Barcelona, Spain;
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20
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Detection of nutritional risk and hospital stay in the hospitalized elderly adult. NUTR HOSP 2021; 38:464-469. [PMID: 33887948 DOI: 10.20960/nh.03200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Background and aims: a high nutritional risk can independently be associated with a longer hospital stay in elderly patients. This study aims to establish the prevalence of the risk of malnutrition and its associated factors in a high-complexity level hospital in Bogotá, Colombia, during 2018. Methods: a cross-sectional study. The prevalence of the risk of malnutrition was measured using a malnutrition-screening tool (MST), and the association with hospital stage, age, and patient diagnoses was assessed. Results: a total of 7,192 patients comprised the cohort. Age range was 61 to 108 years, with an average of 77.1 ± 9.2 years, and subjects were mostly female (55.5 %). We identified as main conditions urinary tract infections (8.4 %), congestive heart failure (5.4 %), and chronic obstructive pulmonary disease with an acute exacerbation (4.6 %). The prevalence of the risk of malnutrition was 41.4 %, significantly associated with longer hospital stays (p < 0.001), older age (p < 0.001), and a diagnosis of delirium (OR = 5.98, 95 % CI: 2.78 to 12.86), diarrhea and gastroenteritis (OR = 5.01, 95 % CI: 2.44 to 10.32), gastrointestinal hemorrhage (OR = 4.44, 95 % CI: 2.38 to 8.28), specified pneumonia (OR = 4.43, 95% CI: 2.11 to 9.30), and high blood pressure (3.94, 95 % CI: 2.07 to 7.50). Other diagnoses included abdominal pain (other) (OR = 3.80, 95 % CI: 1.81 to 7.99), urinary tract infections (OR = 3.64, 95 % CI: 2.07 to 6.24), acute bronchitis (OR = 3.22, 95 % CI: 1.56 to 6.65), and bacterial pneumonia (OR = 3.02, 95 % CI: 1.65 to 5.55). Conclusion: the prevalence of the risk of malnutrition in our institution is approximately one in two patients, with a significant association to increased hospital stay ≥ 8 days, patient age ≥ 80 years, and mainly diagnoses of delirium, diarrhea, and gastroenteritis of suspected infectious etiology.
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Teixeira PP, Kowalski VH, Valduga K, de Araújo BE, Silva FM. Low Muscle Mass Is a Predictor of Malnutrition and Prolonged Hospital Stay in Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Longitudinal Study. JPEN J Parenter Enteral Nutr 2020; 45:1221-1230. [PMID: 32794593 DOI: 10.1002/jpen.1998] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/31/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Malnutrition in chronic obstructive pulmonary disease (COPD) patients is more prevalent during times of exacerbation. Fat-free mass index (FFMI), calf circumference (CC), and adductor muscle pollicis thickness (AMPT) can be used to identify reduced muscle mass and have been found to be good predictors of clinical outcomes in other conditions, but they have not been investigated in COPD. Therefore, this study evaluated low muscle mass as predictor of malnutrition, prolonged length of stay (LOS), and in-hospital death in COPD patients. METHODS This prospective cohort study was carried out in hospitalized patients with COPD exacerbation. Malnutrition diagnosis was performed by Subjective Global Assessment, and muscle mass was assessed by FFMI, calculated using fat-free mass from bioelectrical impedance, CC, and AMPT. Clinical outcomes (LOS and in-hospital death) were collected from records. RESULTS One hundred seventy-six patients were included (68.2 ± 10.4 years old, 56.2% women); 74.2% were classified as Global Initiative of Chronic Obstructive Lung Disease 2 or 3 and 58.2% as malnourished. The median LOS was 11 (7-19) days, and the incidence of death was 9.1%. Low FFMI and CC predicted malnutrition (low CC: odds ratio [OR], 4.6; 95% CI, 2.2-9.7 and low FFMI: OR, 8.8; 95% CI, 3.7-20.8) and were associated with prolonged LOS (low CC: OR, 2.3; 95% CI, 1.1-4.6 and low FFMI: OR, 2.5; 95% CI, 1.3-4.8). CONCLUSION Simple, inexpensive, and noninvasive parameters of muscle mass-FFMI and CC-are good predictors of malnutrition and prolonged LOS in COPD patients experiencing exacerbation.
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Affiliation(s)
- Paula Portal Teixeira
- Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Kamila Valduga
- Endocrine Postgraduation Program of Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruna Espíndola de Araújo
- Nutrition Science Postgraduation Program of Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science Postgraduation Program in Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Sanchez-Rodriguez D, Annweiler C, Marco E, Hope S, Piotrowicz K, Surquin M, Ranhoff A, Van Den Noortgate N, Andersen-Ranberg K, Bonin-Guillaume S, Conroy S, Gordon A, Grodziki T, Landi F, Martínez-Velilla N, Münzer T, Ranhoff AH, Roller-Wirnsberger R, Singler K, Van Den Noortgate N, Al Hamad HK, Annweiler C, Beuscart JB, Blanc F, Ciurea A, Cobbaert K, Dallmeier D, Dinan P, Engvig A, Højmann AH, Hosia H, Hope S, Kerminen HM, Knapskog AB, Koutsouri A, Laurent M, Lilamand M, Marien S, Mellingsaeter M, Mendes A, Nguyen S, Ogugua C, Ommundsen N, Périvier S, Piotrowicz K, Rapo-Pylkkö S, Roitto HM, Roubaud-Baudron C, Saka B, Sanchez-Rodriguez D, Surquin M, Tarazona F, Toscano-Rico M, Tschurr G, Vande Walle N, Vetrano D, Yavuz BB. European Academy for medicine of ageing session participants' report on malnutrition assessment and diagnostic methods; an international survey. Clin Nutr ESPEN 2020; 35:75-80. [DOI: 10.1016/j.clnesp.2019.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
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23
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Yang L, Zhu Y, Huang JA, Jin J, Zhang X. A Low Lean-to-Fat Ratio Reduces the Risk of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients with a Normal or Low Body Mass Index. Med Sci Monit 2019; 25:5229-5236. [PMID: 31302663 PMCID: PMC6647929 DOI: 10.12659/msm.914783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Increased risk of acute exacerbation of chronic obstructive pulmonary disease (COPD) has been reported in patients who are overweight and obese. However, the effects of body fat in patients with normal or low body mass index (BMI) and COPD remain unknown. This study aimed to examine the association between acute exacerbations of COPD and the lean-to-fat (LTF) ratio in patients with a normal or low BMI. Material/Methods Patients with COPD (n=68) underwent assessment of body composition, in whom 43 cases had a normal BMI (18.5 to 25 kg/m2) and 14 cases were underweight (<18.5 kg/m2). Patients with COPD were treated according to current clinical guidelines and underwent regular follow-up for one year. Acute exacerbations of COPD were recorded. Results BMI, the fat-free mass index (FFMI), skeletal muscle mass index (SMMI), and LTF ratio had no significant effect of the risk of acute exacerbations of COPD in the whole study cohort, but a low LTF ratio was significantly associated with reduced risk of acute exacerbations of COPD in the subgroup with a BMI<25 kg/m2 (OR=4.528; P<0.05). The Fat Mass Index (FMI) had a protective effect in the whole cohort (OR=0.292; P=0.024) and in the subgroup with BMI <25 kg/m2 (OR=0.253, P=0.049). The cumulative incidence of acute exacerbations of COPD was significantly increased in the patients with a high LTF ratio in the whole cohort (P=0.047) and in the subgroup with BMI <25 kg/m2 (P=0.014). Conclusions In patients with BMI <25 kg/m2, the LTF ratio was positively correlated with the risk of occurrence of acute exacerbations of COPD.
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Affiliation(s)
- Lingyi Yang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Yehan Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jian-An Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jianqiang Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Xiuqin Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
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de Blasio F, Scalfi L, Di Gregorio A, Alicante P, Bianco A, Tantucci C, Bellofiore B, de Blasio F. Raw Bioelectrical Impedance Analysis Variables Are Independent Predictors of Early All-Cause Mortality in Patients With COPD. Chest 2019; 155:1148-1157. [DOI: 10.1016/j.chest.2019.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 01/02/2019] [Indexed: 02/07/2023] Open
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Dávalos-Yerovi V, Marco E, Sánchez-Rodríguez D, Guillen-Solà A, Duran X, Pascual EM, Muniesa JM, Escalada F, Duarte E. Sarcopenia According to the Revised European Consensus on Definition and Diagnosis (EWGSOP2) Criteria Predicts Hospitalizations and Long-Term Mortality in Rehabilitation Patients With Stable Chronic Obstructive Pulmonary Disease. J Am Med Dir Assoc 2019; 20:1047-1049. [PMID: 31133471 DOI: 10.1016/j.jamda.2019.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Vanesa Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain
| | - Ester Marco
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain
| | - Anna Guillen-Solà
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Xavier Duran
- Methodology & Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain
| | - Eva M Pascual
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Ferran Escalada
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
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Colombo C, Nobili RM, Alicandro G. Challenges with optimizing nutrition in cystic fibrosis. Expert Rev Respir Med 2019; 13:533-544. [PMID: 31094240 DOI: 10.1080/17476348.2019.1614917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction. Optimizing nutrition remains the cornerstone of therapy for patients with cystic fibrosis (CF) since it is associated with better pulmonary function and survival. However, a significant proportion of patients still fail to achieve normal growth and nutritional status. Areas covered. This review describes the current challenges in providing effective nutritional therapy in CF with a focus on the current issues related to energy imbalance, dietary composition, adherence to nutritional recommendations, pancreatic enzyme replacement therapy, and the effects of modulators of the CF transmembrane conductance regulator. Expert opinion. CF is a multisystemic disease that requires a personalized nutritional approach with accurate evaluation of energy balance. There is an urgent need for evidence-based recommendations on the dietary composition, in consideration of the increasing prevalence of overweight, diabetes and the potential effects of fatty acids on inflammation and immune response. More research into new pancreatic enzyme formulations is also required.
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Affiliation(s)
- Carla Colombo
- a Department of Pathophysiology and Transplantation , Università degli Studi di Milano , Milan , Italy.,b Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre , Milan , Italy
| | - Rita Maria Nobili
- b Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cystic Fibrosis Centre , Milan , Italy
| | - Gianfranco Alicandro
- c Department of Clinical Sciences and Community Health , Università degli Studi di Milano , Milano , Italy
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Ingadottir AR, Bjorgvinsdottir EB, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Birgisdottir BE, Gislason T, Gunnarsdottir I. Effect of two different nutritional supplements on postprandial glucose response and energy- and protein intake in hospitalised patients with COPD: A randomised cross-over study. Clin Nutr 2019; 39:1085-1091. [PMID: 31064666 DOI: 10.1016/j.clnu.2019.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/08/2019] [Accepted: 04/11/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Oral nutrition support is frequently used in treatment of malnutrition in patients with chronic obstructive pulmonary disease (COPD). Considering the use of corticoidsteroids in patients with COPD, little is known about the effect on postprandial glucose response and if they might interfere with glucose control. Our aims were to compare the effect of a liquid oral nutritional supplement (ONS) and semi solid inbetween meal snack (snack) on postprandial glucose and energy- and protein intake, and to compare the effect of timing of each intervention on postprandial glucose and energy- and protein intake. METHODS Patients with COPD (n = 17) admitted to the Department of Pulmonary Medicine, Iceland and defined as at low or medium nutritional risk (score 0-3) were recruited. In a randomised cross-over design, subjects consumed ONS or snack either in a fasting state (study 1) or following breakfast (study 2) and postprandial glucose responses were assessed at regular intervals for two hours (t = 15, t = 30, t = 45, t = 60, t = 90, t = 120 min). Energy- and protein intake was estimated using a validated plate diagram sheet. Wilcoxon Signed-Rank test was used to compare the two interventions. RESULTS In study 2, following breakfast, postprandial glucose was significantly higher after consuming ONS than the snack after 60 min (9.7 ± 2.4 mmol/L vs. 8.2 ± 3.2 mmol/L, p = 0.013 and 120 min 9.2 ± 3.2 mmol/L vs. 7.9 ± 2.4 mmol/L, p = 0.021, respectively). No difference was found in postprandial glucose concentrations between ONS and the snack when consumed after overnight fasting (study 1). No difference in energy or protein intake from hospital food was seen between supplement types neither in study 1 or 2. CONCLUSION Lower postprandial glucose concentrations were associated with the snack compared to ONS when taken after a meal compared to either type directly after overnight fasting. The clinical relevance of higher postprandial blood glucose after consuming a liquid ONS after breakfast compared with a semi solid snack needs to be studied further.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland.
| | - Eva Bjorg Bjorgvinsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Anne Marie Beck
- Faculty of Health and Copenhagen University College, Copenhagen N, Denmark; Research Unit for Nutrition, Herlev and Gentofte Hospital, DK-2820, Gentofte, Denmark
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | - C Elizabeth Weekes
- Department of Nutrition & Dietetics, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; The Icelandic Gerontological Research Institute, Landspitali University Hospital & University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Bryndis Eva Birgisdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital & Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland; Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Holst M, Beck A, Rasmussen H, Lange P. Insufficient intake of energy and protein is related to physical functional capacity among COPD patients referred to municipality based pulmonary rehabilitation. Clin Nutr ESPEN 2019; 30:35-41. [DOI: 10.1016/j.clnesp.2019.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/30/2019] [Accepted: 02/14/2019] [Indexed: 01/11/2023]
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Ingadottir AR, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Gislason T, Gunnarsdottir I. Oral nutrition supplements and between-meal snacks for nutrition therapy in patients with COPD identified as at nutritional risk: a randomised feasibility trial. BMJ Open Respir Res 2019; 6:e000349. [PMID: 30687503 PMCID: PMC6326325 DOI: 10.1136/bmjresp-2018-000349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 11/27/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction Intervention studies have mainly used oral nutritional supplements (ONS) for the management of patients with chronic obstructive pulmonary disease (COPD) identified as at nutritional risk. In this 12-month randomised feasibility trial, we assessed the (1) feasibility of the recruitment, retention and provision of two interventions: ONS and between-meal snacks (snacks) and (2) the potential impact of the provision of snacks and ONS on body weight and quality of life in patients with COPD. Methods Hospitalised patients with COPD, at nutritional risk, were randomised to ONS (n=19) or snacks (n=15) providing 600 kcal and 22 g protein a day in addition to regular daily diet. The intervention started in hospital and was continued for 12 months after discharge from the hospital. Results Study recruitment rate was n=34 (45%) and retention rate at 12 months was similar for both groups: n=13 (68%) in the ONS group and n=10 (67%) in the Snacks group. Both groups gained weight from baseline to 12 months (2.3±4.6 kg (p=0.060) in the ONS group and 4.4±6.4 kg (p=0.030) in the Snacks group). The St George’s Respiratory Questionnaire total score improved from baseline to 12 months in both groups (score 3.9±11.0 (p=0.176) in the ONS group and score 8.9±14.1 (p=0.041) in the Snacks group). Discussion In patients with COPD who are at nutritional risk snacks are at least as feasible and effective as ONS, however, adequately powered trials that take account of the difficulties in recruiting this patient group are required to confirm this effect.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
| | - Anne Marie Beck
- Faculty of Health, Copenhagen University College, Copenhagen, Denmark.,Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,The Icelandic Gerontological Research Institute, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Sánchez-Rodríguez D, Marco E, Schott AM, Rolland Y, Blain H, Vázquez-Ibar O, Escalada F, Duran X, Muniesa JM, Annweiler C. Malnutrition according to ESPEN definition predicts long-term mortality in general older population: Findings from the EPIDOS study-Toulouse cohort. Clin Nutr 2018; 38:2652-2658. [PMID: 30551898 DOI: 10.1016/j.clnu.2018.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/23/2018] [Accepted: 11/26/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The European Society of Clinical Nutrition and Metabolism (ESPEN) has developed a consensus definition of malnutrition. This study aimed to determine the prevalence of malnutrition according to the ESPEN definition in otherwise healthy community-dwelling older women and to explore its value for predicting long-term mortality in this population. METHODS This prospective population-based cohort study included 181 women (age ≥75 years) from a subsample of the EPIDémiologie de l'OStéoporose (EPIDOS) study participants from Toulouse. Inclusion criteria were the availability of the data on variables required to apply the ESPEN definition and survival after 7 years of follow-up. Primary outcome was mortality at 12-year follow-up; main covariates were malnutrition assessment according to the ESPEN consensus and its components (unintentional weight loss, BMI, and FFMI). Body composition was assessed by dual-energy X-ray absorptiometry at baseline and at 7-year follow-up. Kaplan-Meier survival curves and adjusted Cox regressions were performed. Analysis was adjusted for age, hypertension, diabetes mellitus, and coronary heart disease as potential confounders. RESULTS Complete data were available for 179 of the 181 women in the EPIDOS-Toulouse cohort (83.1 ± 2.2 years) and 13 (7.3%) fulfilled the ESPEN definition for malnutrition at 7-year follow-up. Malnutrition was associated with increased risk of mortality (adjusted HR = 4.4 [95%CI: 1.7-11.3]). Among the ESPEN components, only BMI was associated with increased mortality (adjusted HR=0.6 [95%CI: 0.4-0.9]). CONCLUSIONS Although malnutrition prevalence according to the ESPEN definition was relatively low (7.3%) in this sample of otherwise healthy community-dwelling older French women, malnutrition was associated with 4.4-fold higher mortality risk at 12-year follow-up.
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Affiliation(s)
- Dolores Sánchez-Rodríguez
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain; School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Ester Marco
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain; Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain; Universitat Internacional de Catalunya, Barcelona, Spain
| | - Anne-Marie Schott
- Department IMER, Lyon University Hospital, EA 4129, RECIF, University of Lyon, Inserm, U831, Lyon, France.
| | - Yves Rolland
- Department of Geriatrics, Toulouse University Hospital, Gerontopole of Toulouse, INSERM U1027, University of Toulouse III, Toulouse, France.
| | - Hubert Blain
- Department of Internal Medicine and Geriatrics, Montpellier University Hospital, University of Montpellier 1, Montpellier, France
| | - Olga Vázquez-Ibar
- Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Spain; School of Medicine, Universitat Pompeu Fabra, Barcelona, Spain
| | - Ferran Escalada
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain; Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain
| | - Xavier Duran
- Methodology and Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques, (IMIM), Barcelona, Spain
| | - Josep M Muniesa
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Spain; Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Spain
| | - Cédric Annweiler
- Department of Neurosciences and Aging, Division of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, UNAM, Angers, France; Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Mete B, Pehlivan E, Gülbaş G, Günen H. Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity. Int J Chron Obstruct Pulmon Dis 2018; 13:3307-3312. [PMID: 30349235 PMCID: PMC6188194 DOI: 10.2147/copd.s179609] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of the study was to determine the nutritional status and anthropometric values in a group of patients with COPD and to examine the relationship between these factors and disease severity. Methods A total of 105 COPD patients were included in this cross-sectional study. The patients underwent spirometric exmination. Mini nutritional assessment form was applied, and the anthropometric values of the patients were measured by bioelectrical impedance method. Nutrient registration forms were given using a 3-day, 24-hour recall method to assess the nutrient uptake. COPD severity was determined using the Global Initiative for Chronic Obstructive Lung Disease criteria, and the correlations between nutritional status and disease severity parameters were measured. Results The prevalence of malnutrition in our patients with COPD was found to be 17%. Spirometric parameters were found to be significantly lower in patients with low body mass index (BMI) and malnutrition. As the modified Medical Research Council dyspnea scale score increased, the frequency of malnutrition increased (P=0.002). Positive significant correlation was found between spirometric variables and muscle mass and fat external tissue volume of the patients. Patients receiving higher protein content in diet showed a better muscle mass amount (P<0.001). Conclusion Our study results confirmed that malnutrition is an important and frequently encountered problem in COPD patients, and spirometric values of the patients with malnourishment and with low BMI are significantly lower. We think that nutritional status should be evaluated in every COPD patient, and nutritional intake should be tailored individually.
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Affiliation(s)
- Burak Mete
- Department of Public Health, Faculty of Medicine, Inönü University, Malatya, Turkey,
| | - Erkan Pehlivan
- Department of Public Health, Faculty of Medicine, Inönü University, Malatya, Turkey,
| | - Gazi Gülbaş
- Department of Pulmonary. Medicine, Faculty of Medicine, Inönü University, Malatya, Turkey
| | - Hakan Günen
- Sureyyapasa Research and Training Center for Chest Diseases and Thoracic Surgery, Health Sciences University, Ministry of Health, Istanbul, Turkey
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Yang M, Huang Z, Chen J, Jiang J, Zuo Y, Hao Q. Applications of the new ESPEN definition of malnutrition and SARC-F in Chinese nursing home residents. Sci Rep 2018; 8:14971. [PMID: 30297795 PMCID: PMC6175895 DOI: 10.1038/s41598-018-33350-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/27/2018] [Indexed: 02/05/2023] Open
Abstract
We aimed to compare the predictive capacity of malnutrition, sarcopenia, and malnutrition combined with sarcopenia for mortality in nursing home residents. We conducted a prospective study in four nursing homes in China. Nutrition status and sarcopenia were measured according to the new European Society of Clinical Nutrition and Metabolism (ESPEN) definition and SARC-F, respectively. The study population was divided into four groups: malnutrition with sarcopenia (MN+/SA+), malnutrition without sarcopenia (MN+/SA−), sarcopenia without malnutrition (MN−/SA+), and normal nutrition without sarcopenia (MN−/SA−). The participants were followed up for 12 months. We included 329 participants. Thirty-eight participants (11.6%) had MN+/SA+, 38 participants (11.6%) had MN+/SA−, and 93 participants (28.3%) had MN−/SA+. The 1-year mortality was 18.3%, 21.5%, 18.4%, and 47.4% in the MN−/SA−, MN−/SA+, MN+/SA−, and MN+/SA+ groups, respectively. Compared to participants with MN−/SA−, participants with MN+/SA+ were at a significantly higher risk of mortality (adjusted hazard ratio [HR]: 3.19, 95% confidence interval [CI] 1.71–5.95); however, MN−/SA+ (adjusted HR: 1.24, 95% CI 0.69–2.22) and MN+/SA− (adjusted HR: 0.95, 95% CI 0.41–2.19) were not predictors of mortality. In conclusion, the coexistence of malnutrition and sarcopenia is a significant predictor of mortality in a study population of Chinese nursing home residents.
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Affiliation(s)
- Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China.
| | - Zhaojing Huang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Jing Chen
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Jiaojiao Jiang
- The Center of Rehabilitation, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
| | - Yun Zuo
- The Health Management Center, Shangjin Nanfu Hospital, No. 253 Shangjin Street, Chengdu, Sichuan, China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, Chengdu, Sichuan, China
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Marco E, Sánchez-Rodríguez D, Dávalos-Yerovi VN, Duran X, Pascual EM, Muniesa JM, Rodríguez DA, Aguilera-Zubizarreta A, Escalada F, Duarte E. Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease. Clin Nutr 2018; 38:2180-2186. [PMID: 30342931 DOI: 10.1016/j.clnu.2018.09.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/09/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutritional disorders are frequent in patients with chronic pulmonary obstructive disease (COPD) and have negative health impacts. This study aimed to explore the value of the European Society of Clinical Nutrition and Metabolism (ESPEN) definition of malnutrition (and/or its individual components) to predict hospitalizations and mortality at 2 years, and to determine the prevalence of malnutrition in COPD patients referred to pulmonary rehabilitation. METHODS The study was a prospective analysis of 118 patients with COPD free of exacerbations and/or hospital admissions in the previous two months. Main outcome variables were mortality, hospital admissions, and length of stay at 2-year follow-up; main covariates were malnutrition assessment according to the ESPEN definition and its components: unintentional weight loss, body mass index, and fat-free mass index (FFMI). Body composition was assessed by bioimpedance analysis. Kaplan-Meier survival curves and linear regression analyses were performed, adjusting for age and airflow obstruction as potential confounders. RESULTS The observed prevalence of malnutrition was 24.6%. Malnutrition was associated with increased mortality risk (HR = 3.9 [95% CI: 1.4-10.62]). FFMI was independently associated with increased mortality (HR = 17.0 [95% CI: 2.24-129.8]), which persisted after adjustment for age and lung function (adjusted HR = 13.0 [95% CI: 1.67-101.7]). Low age-related body mass index was associated with increased risk of hospital admissions. CONCLUSIONS Malnutrition according to ESPEN criteria, highly prevalent in patients with stable COPD referred to pulmonary rehabilitation, was associated with 4 times greater mortality risk after 2 years. Low FFMI was associated with a 17-fold increase in mortality risk, suggesting independent predictive value.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain.
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain
| | - Vanesa N Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Xavier Duran
- Methodology & Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain
| | - Eva M Pascual
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Diego A Rodríguez
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain; Respiratory Medicine Department, Parc Salut Mar (Hospital del Mar - Centre Fòrum del Hospital del Mar), Barcelona, Catalonia, Spain; Muscle and Respiratory System Research Unit (URMAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Aguilera-Zubizarreta
- Hospital Home-care Unit, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ferran Escalada
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
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Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease. Br J Nutr 2018; 119:543-551. [DOI: 10.1017/s0007114517003919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractLow 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.
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