Nutritional Status and Body Composition in Patients Suffering From Chronic Respiratory Diseases and Its Correlation With Pulmonary Rehabilitation

As part of an individualized intervention to improve the physical, emotional, and social functioning of patients with chronic respiratory diseases in general and chronic obstructive pulmonary disease in particular, awareness of the presence and consequences of changes in body composition increased enormously during the last decades, and nutritional intervention is considered as an essential component in the comprehensive approach of these patients. This review describes the prevalence and the clinical impact of body composition changes and also provides an update of current intervention strategies. It is argued that body composition, preferentially a three-component evaluation of fat, lean, and bone mass, must become part of a thorough assessment of every patient, admitted for pulmonary rehabilitation.

Reduced calf circumference is an independent predictor of worse quality of life, severity of disease, frequent exacerbation, and death in patients with chronic obstructive pulmonary disease admitted to a pulmonary rehabilitation program: A historic cohort study

BACKGROUND

Muscle wasting is associated with worse outcomes in chronic obstructive pulmonary disease (COPD) patients. We assessed the association of calf circumference (CC) measurements with clinical outcomes in COPD patients referred to an outpatient pulmonary rehabilitation program (PRP).

METHODS

In this single-center, retrospective study, we analyzed demographic and clinical data ( spirometry tests, comorbidities, COPD exacerbations, dyspnea scoring, exercise capacity, quality-of-life scores, BMI, CC measurements, and all-cause deaths [for 2 years]) from COPD patients PRP medical records. Patients were grouped according to CC into reduced CC (male, ≤34 cm; female, ≤33 cm) or adequate CC groups.

RESULTS

We evaluated 144 patients (aged 64.6 ± 8.5 years; mostly males; forced expiratory volume in 1 s, 40.3% ± 15.8%, predicted). Eighteen patients (12.5%) died during the 2 years of follow-up. Logistic regression showed that patients with reduced CC were more likely to present worse outcomes compared with COPD patients with adequate CC: more advanced disease severity (odds ratio [OR] = 5.09; 95% CI, 2.00-12.96), COPD frequent exacerbators (OR = 2.34; 95% CI, 1.11-4.91), worse total quality-of-life score (OR = 2.70, 95% CI, 1.22-6.00), and higher mortality (OR = 3.69; 95% CI, 1.06-12.87).

CONCLUSION

Reduced CC in COPD patients under initial assessment for PRP admission was associated with disease severity, frequent exacerbation, poor health status, and higher mortality in 2 years of follow-up. Considering its clinical applicability, CC measurement should be introduced in the nutrition assessment of COPD patients admitted to the PRP.

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.

Mini Nutritional Assessment Short-Form predicts exacerbation frequency in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVE

Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity, mortality and reduced health status. Thus, to predict and prevent exacerbations is essential for the management of COPD. The aims of this study were to determine whether nutritional status as assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) predicts COPD exacerbation and to compare the ability of the MNA-SF to predict COPD exacerbation with that of the COPD Assessment Test (CAT).

METHODS

Pulmonary function, the modified Medical Research Council (mMRC) scale and body mass index (BMI) were evaluated in 60 stable patients with COPD (mean age, 72 years; mean forced expiratory volume in 1 s (FEV1 ), 51.1% predicted). The MNA-SF and CAT were also completed. Exacerbations were recorded prospectively for 1 year after the initial assessment.

RESULTS

The mean MNA-SF score was 11.4 ± 2.4 (well nourished, 51%; at risk, 37%; and malnourished, 12%). The mean CAT score was 14.4 ± 7.5 (low impact, 37%; medium impact, 38%; high impact, 20%; and very high impact, 5%). The CAT scores were significantly associated with the mMRC scale and %FEV₁, but were not associated with BMI and the MNA-SF score. The exacerbation frequency was associated with the MNA-SF score but not with the CAT score.

CONCLUSIONS

The MNA-SF predicts COPD exacerbation independently of the CAT.

Mini nutritional assessment

PURPOSE OF REVIEW

To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA).

RECENT FINDINGS

Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving.

SUMMARY

The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.

Is serum albumin a marker of malnutrition in chronic disease? The scleroderma paradigm

BACKGROUND

Malnutrition is common in many chronic diseases, but physicians may rely on a low albumin value before deciding that malnutrition is present.

OBJECTIVE

To determine the relationship between serum albumin and malnutrition in systemic sclerosis (SSc) as a paradigm for other chronic diseases.

DESIGN

Cross-sectional, multicenter study of patients from the Canadian Scleroderma Research Group Registry. We used the Malnutrition Universal Screening Tool (MUST) to evaluate patients for malnutrition. Disease extent was measured in several ways, including physician global assessment. Multiple linear regression was performed to identify independent predictors of serum albumin.

RESULTS

Two hundred fifty-eight patients were studied. The mean (SD) serum albumin level was 44.4 (4.2) g/L. Only 2% of the values were below normal and all these patients were in MUST category > or =2, or high risk for malnutrition, which included 21.3% of the cohort. MUST, shorter disease duration, greater disease severity (physician global assessment of disease severity and modified Rodnan skin score), and greater disease activity (physician global assessment of disease activity, C-reactive protein, and Scleroderma Disease Activity Index) all correlated significantly but weakly with albumin. Multivariate analysis demonstrated that a higher MUST score and worse disease severity were independently associated with lower serum albumin, but only 7% of the variance of albumin was explained in the adjusted model.

CONCLUSIONS

Serum albumin is not useful as a marker for malnutrition in SSc and should not be assumed to be useful as a marker in other chronic diseases. More attention should be paid to clinical features of malnutrition, including assessment of body mass index and unplanned weight loss, and overall disease severity.

Falls in patients with chronic obstructive pulmonary disease: a call for further research

Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress. The effects of COPD, however, are not exclusively limited to respiratory function and people with COPD face many non-respiratory manifestations that affect both function and mobility. Deficits in function and mobility have been associated with an increased risk for falling in older adults. The purpose of this study was to provide a theoretical framework to identify risks factors for falls in people with COPD. We have analyzed the literature to identify possible relationships between pathophysiological changes observed in COPD and common risk factors for falls. Well-established fall risk factors in people with COPD include lower limb muscle weakness and impaired activities of daily living. Other intrinsic risk factors such as gait and balance deficits, nutritional depletion, malnutrition, depression, cognitive impairments and medications are possible risk factors that need to be confirmed with more studies. There is no evidence that visual deficits are common in COPD. The role that precipitating factors such as syncope and postural hypotension may have on fall risk is unclear. Exacerbations and dyspnea do not have a precipitating effect on fall risk but they contribute to the progressive physical deterioration that may theoretically increase the risk for falls. While these results suggest that people with COPD might have an increased susceptibility to fall compared to their healthy peers, further research is needed to determine the prevalence of falls and specific risk factors for falls in people living with COPD.