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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [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: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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2
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Li M, Zhao L, Hu C, Li Y, Yang Y, Zhang X, Li Q, Ma A, Cai J. Improvement of Lung Function by Micronutrient Supplementation in Patients with COPD: A Systematic Review and Meta-Analysis. Nutrients 2024; 16:1028. [PMID: 38613061 PMCID: PMC11013492 DOI: 10.3390/nu16071028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND A healthy, well-balanced diet plays an essential role in respiratory diseases. Since micronutrient deficiency is relatively common in patients with chronic obstructive pulmonary disease (COPD), micronutrient supplementation might have the beneficial health effects in those patients. This systematic review and meta-analysis aimed to demonstrate the impact of micronutrient supplementation on the lung function of patients with COPD. METHODS The PubMed, Cochrane Library, and Web of Science databases were searched from their corresponding creation until February 2024. Search terms included 'chronic obstructive pulmonary disease', 'COPD', 'micronutrients', 'dietary supplements', 'vitamins', 'minerals', and 'randomized controlled trials'. Meta-analysis was performed to evaluate the effects of micronutrient supplementation alone or complex on lung function in patients with COPD. RESULTS A total of 43 RCTs fulfilled the inclusion criteria of this study. Meta-analysis revealed that vitamin D supplementation could significantly improve FEV1% (WMDdifferences between baseline and post-intervention (de): 6.39, 95% CI: 4.59, 8.18, p < 0.01; WMDpost-intervention indicators (af): 7.55, 95% CI: 5.86, 9.24, p < 0.01) and FEV1/FVC% (WMDde: 6.88, 95%CI: 2.11, 11.65, WMDaf: 7.64, 95% CI: 3.18, 12.10, p < 0.001), decrease the odds of acute exacerbations, and improve the level of T-cell subsets, including CD3+%, CD4+%, CD8+%, and CD4+/CD8+% (all p < 0.01). The effects of compound nutrients intervention were effective in improving FEV1% (WMDde: 8.38, 95%CI: 1.89, 14.87, WMDaf: 7.07, 95%CI: -0.34, 14.48) and FEV1/FVC% (WMDde: 7.58, 95% CI: 4.86, 10.29, WMDaf: 6.00, 95% CI: 3.19, 8.81). However, vitamin C and vitamin E supplementation alone had no significant effects on lung function (p > 0.05). CONCLUSIONS Micronutrient supplementation, such as vitamin D alone and compound nutrients, has improved effect on the lung function of patients with COPD. Therefore, proper supplementation with micronutrients would be beneficial to stabilize the condition and restore ventilation function for COPD patients.
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Affiliation(s)
- Mingxin Li
- School of Public Health, Qingdao University, Qingdao 266000, China; (M.L.); (L.Z.); (C.H.); (Y.Y.); (A.M.)
| | - Liangjie Zhao
- School of Public Health, Qingdao University, Qingdao 266000, China; (M.L.); (L.Z.); (C.H.); (Y.Y.); (A.M.)
| | - Chenchen Hu
- School of Public Health, Qingdao University, Qingdao 266000, China; (M.L.); (L.Z.); (C.H.); (Y.Y.); (A.M.)
| | - Yue Li
- Endemic and Parasitic Diseases Prevention and Control Division, Binzhou Centre for Disease Prevention and Control, Binzhou 256600, China;
| | - Yang Yang
- School of Public Health, Qingdao University, Qingdao 266000, China; (M.L.); (L.Z.); (C.H.); (Y.Y.); (A.M.)
- Institute of Nutrition and Health, Qingdao University, Qingdao 266000, China
| | - Xiaoqi Zhang
- Department of Respiratory, Weifang No. 2 People’s Hospital, Weifang 261000, China; (X.Z.); (Q.L.)
| | - Quanguo Li
- Department of Respiratory, Weifang No. 2 People’s Hospital, Weifang 261000, China; (X.Z.); (Q.L.)
| | - Aiguo Ma
- School of Public Health, Qingdao University, Qingdao 266000, China; (M.L.); (L.Z.); (C.H.); (Y.Y.); (A.M.)
- Institute of Nutrition and Health, Qingdao University, Qingdao 266000, China
| | - Jing Cai
- School of Public Health, Qingdao University, Qingdao 266000, China; (M.L.); (L.Z.); (C.H.); (Y.Y.); (A.M.)
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Huang WJ, Ko CY. Systematic review and meta-analysis of nutrient supplements for treating sarcopenia in people with chronic obstructive pulmonary disease. Aging Clin Exp Res 2024; 36:69. [PMID: 38483650 PMCID: PMC10940388 DOI: 10.1007/s40520-024-02722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024]
Abstract
Individuals with chronic obstructive pulmonary disease (COPD) are prone to malnutrition and sarcopenia as a result of nutritional deficiencies and increased energy metabolism. However, the effects of nutrient supplements (NS) on treating sarcopenia in patients with COPD are not well established from systematic evidence. This meta-analysis examined the effect of NS on sarcopenia in patients with COPD. A systematic search of multiple databases was conducted, and 29 randomized controlled trials involving 1625 participants (age, mean [SD] = 67.9 [7.8] years) were analyzed. NS demonstrated significant improvements in body weight (MD,1.33 kg; 95% CI, 0.60, 2.05 kg; P = 0.0003; I2 = 87%), fat-free mass index (MD, 0.74 kg/m2; 95% CI, 0.21, 1.27 kg/m2; P = 0.007; I2 = 75%), and 6-min walk test (MD, 19.43 m; 95% CI, 4.91, 33.94 m; P = 0.009; I2 = 81%) compared with control. However, NS had nonsignificant effects on handgrip strength (SMD, 0.36; 95% CI, - 0.15, 0.88; P = 0.16; I2 = 87%) and quadriceps muscle strength (SMD, 0.11; 95% CI, - 0.06, 0.27; P = 0.20; I2 = 25%) compared with the control. In conclusion, NS may be an effective treatment for improving body composition and physical performance in COPD. Future studies should explore the effects of intervention durations, specific NS types, or combined training in patients with COPD and sarcopenia.
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Affiliation(s)
- Wen-Jian Huang
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, No. 34, Zhongshanbei Rd, Licheng District, Quanzhou, 362000, Fujian, China
- Huidong Center for Chronic Disease Control, Huizhou, 516300, Guangdong, China
| | - Chih-Yuan Ko
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, No. 34, Zhongshanbei Rd, Licheng District, Quanzhou, 362000, Fujian, China.
- School of Public Health, Fujian Medical University, Fuzhou, Fujian, China.
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4
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Brauwers B, Machado FVC, Beijers RJHCG, Spruit MA, Franssen FME. Combined Exercise Training and Nutritional Interventions or Pharmacological Treatments to Improve Exercise Capacity and Body Composition in Chronic Obstructive Pulmonary Disease: A Narrative Review. Nutrients 2023; 15:5136. [PMID: 38140395 PMCID: PMC10747351 DOI: 10.3390/nu15245136] [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: 11/29/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic respiratory disease that is associated with significant morbidity, mortality, and healthcare costs. The burden of respiratory symptoms and airflow limitation can translate to reduced physical activity, in turn contributing to poor exercise capacity, muscle dysfunction, and body composition abnormalities. These extrapulmonary features of the disease are targeted during pulmonary rehabilitation, which provides patients with tailored therapies to improve the physical and emotional status. Patients with COPD can be divided into metabolic phenotypes, including cachectic, sarcopenic, normal weight, obese, and sarcopenic with hidden obesity. To date, there have been many studies performed investigating the individual effects of exercise training programs as well as nutritional and pharmacological treatments to improve exercise capacity and body composition in patients with COPD. However, little research is available investigating the combined effect of exercise training with nutritional or pharmacological treatments on these outcomes. Therefore, this review focuses on exploring the potential additional beneficial effects of combinations of exercise training and nutritional or pharmacological treatments to target exercise capacity and body composition in patients with COPD with different metabolic phenotypes.
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Affiliation(s)
- Bente Brauwers
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine, Life Sciences, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Felipe V. C. Machado
- BIOMED (Biomedical Research Institute), REVAL (Rehabilitation Research Centre), Hasselt University, 3590 Hasselt, Belgium;
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| | - Martijn A. Spruit
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
| | - Frits M. E. Franssen
- Department of Research and Development, Ciro, Centre of Expertise for Chronic Organ Failure, 6085 NM Horn, The Netherlands; (M.A.S.); (F.M.E.F.)
- Department of Respiratory Medicine, NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, 6200 MD Maastricht, The Netherlands;
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5
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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: 3] [Impact Index Per Article: 3.0] [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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6
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Russo C, Valle MS, Casabona A, Spicuzza L, Sambataro G, Malaguarnera L. Vitamin D Impacts on Skeletal Muscle Dysfunction in Patients with COPD Promoting Mitochondrial Health. Biomedicines 2022; 10:biomedicines10040898. [PMID: 35453648 PMCID: PMC9026965 DOI: 10.3390/biomedicines10040898] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 12/16/2022] Open
Abstract
Skeletal muscle dysfunction is frequently associated with chronic obstructive pulmonary disease (COPD), which is characterized by a permanent airflow limitation, with a worsening respiratory disorder during disease evolution. In COPD, the pathophysiological changes related to the chronic inflammatory state affect oxidant–antioxidant balance, which is one of the main mechanisms accompanying extra-pulmonary comorbidity such as muscle wasting. Muscle impairment is characterized by alterations on muscle fiber architecture, contractile protein integrity, and mitochondrial dysfunction. Exogenous and endogenous sources of reactive oxygen species (ROS) are present in COPD pathology. One of the endogenous sources of ROS is represented by mitochondria. Evidence demonstrated that vitamin D plays a crucial role for the maintenance of skeletal muscle health. Vitamin D deficiency affects oxidative stress and mitochondrial function influencing disease course through an effect on muscle function in COPD patients. This review will focus on vitamin-D-linked mechanisms that could modulate and ameliorate the damage response to free radicals in muscle fibers, evaluating vitamin D supplementation with enough potent effect to contrast mitochondrial impairment, but which avoids potential severe side effects.
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Affiliation(s)
- Cristina Russo
- Section of Pathology, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy;
| | - Maria Stella Valle
- Section of Physiology, Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (M.S.V.); (A.C.)
| | - Antonino Casabona
- Section of Physiology, Laboratory of Neuro-Biomechanics, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy; (M.S.V.); (A.C.)
| | - Lucia Spicuzza
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (L.S.); (G.S.)
| | - Gianluca Sambataro
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy; (L.S.); (G.S.)
| | - Lucia Malaguarnera
- Section of Pathology, Department of Biomedical and Biotechnological Sciences, School of Medicine, University of Catania, 95123 Catania, Italy;
- Correspondence:
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Rafiq R, Aleva FE, Schrumpf JA, Daniels JM, Bet PM, Boersma WG, Bresser P, Spanbroek M, Lips P, van den Broek TJ, Keijser BJF, van der Ven AJAM, Hiemstra PS, den Heijer M, de Jongh RT. Vitamin D supplementation in chronic obstructive pulmonary disease patients with low serum vitamin D: a randomized controlled trial. Am J Clin Nutr 2022; 116:491-499. [PMID: 35383823 PMCID: PMC9348978 DOI: 10.1093/ajcn/nqac083] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is frequently found in patients with chronic obstructive pulmonary disease (COPD). Vitamin D has antimicrobial, anti-inflammatory, and immunomodulatory effects. Therefore, supplementation may prevent COPD exacerbations, particularly in deficient patients. OBJECTIVES We aimed to assess the effect of vitamin D supplementation on exacerbation rate in vitamin D-deficient patients with COPD. METHODS We performed a multicenter, double-blind, randomized controlled trial. COPD patients with ≥1 exacerbations in the preceding year and a vitamin D deficiency (15-50 nmol/L) were randomly allocated in a 1:1 ratio to receive either 16,800 International Units (IU) vitamin D3 or placebo once a week during 1 y. Primary outcome of the study was exacerbation rate. Secondary outcomes included time to first and second exacerbations, time to first and second hospitalizations, use of antibiotics and corticosteroids, pulmonary function, maximal respiratory mouth pressure, physical performance, skeletal muscle strength, systemic inflammatory markers, nasal microbiota composition, and quality of life. RESULTS The intention-to-treat population consisted of 155 participants. Mean ± SD serum 25-hydroxyvitamin D [25(OH)D] concentration after 1 y was 112 ± 34 nmol/L in the vitamin D group, compared with 42 ± 17 nmol/L in the placebo group. Vitamin D supplementation did not affect exacerbation rate [incidence rate ratio (IRR): 0.90; 95% CI: 0.67, 1.21]. In a prespecified subgroup analysis in participants with 25(OH)D concentrations of 15-25 nmol/L (n = 31), no effect of vitamin D supplementation was found (IRR: 0.91; 95% CI: 0.43, 1.93). No relevant differences were found between the intervention and placebo groups in terms of secondary outcomes. CONCLUSIONS Vitamin D supplementation did not reduce exacerbation rate in COPD patients with a vitamin D deficiency.This trial was registered at clinicaltrials.gov as NCT02122627.
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Affiliation(s)
| | - Floor E Aleva
- Department of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jasmijn A Schrumpf
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Johannes M Daniels
- Department of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pierre M Bet
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Wim G Boersma
- Department of Pulmonology, NorthWest Clinics, Alkmaar, Netherlands
| | - Paul Bresser
- Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Michiel Spanbroek
- Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Paul Lips
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Pieter S Hiemstra
- Department of Pulmonology, Leiden University Medical Center, Leiden, Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - PRECOVID-study group
den HeijerMartinDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsT de JonghRenateDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsLipsPaulDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsRafiqRachidaDepartment of Internal Medicine and Endocrinology, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, NetherlandsAlevaFloor EDepartment of Pulmonology, Radboud University Medical Center, Nijmegen, Netherlandsvan der VenAndréDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, NetherlandsHiemstraPieter SDepartment of Pulmonology, Leiden University Medical Center, Leiden, NetherlandsSchrumpfJasmijn ADepartment of Pulmonology, Leiden University Medical Center, Leiden, NetherlandsSlatsAnnelies MDepartment of Pulmonology, Leiden University Medical Center, Leiden, NetherlandsDaniëlsJohannes M ADepartment of Pulmonology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, NetherlandsBetPierre MDepartment of Clinical Pharmacology and Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, NetherlandsBoersmaWim GDepartment of Pulmonology, NorthWest Clinics, Alkmaar, NetherlandsBresserPaulDepartment of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, NetherlandsSpanbroekMichielDepartment of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, NetherlandsHuismanPetraDepartment of Pulmonology, Amstelland Hospital, Amstelveen, Netherlandsvan WolferenSerge ADepartment of Pulmonology, Zaans Medical Center, Zaandam, NetherlandsBroedersMarielle E A CDepartment of Pulmonology, Jeroen Bosch Hospital, Den Bosch, Netherlandsvan HengelPeterDepartment of Pulmonology, Flevoziekenhuis, Almere, NetherlandsBraunstahlGert-JanDepartment of Pulmonology, Sint Franciscus Gasthuis, Rotterdam, Netherlands
- Department of Internal Medicine and Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Beijers RJ, van Iersel LEJ, Schuurman LT, Hageman RJJ, Simons SO, van Helvoort A, Gosker HR, Schols AM. Effect of targeted nutrient supplementation on physical activity and health-related quality of life in COPD: study protocol for the randomised controlled NUTRECOVER trial. BMJ Open 2022; 12:e059252. [PMID: 35296491 PMCID: PMC8928317 DOI: 10.1136/bmjopen-2021-059252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Physical and mental health are often affected in chronic obstructive pulmonary disease (COPD) adversely affecting disease course and quality of life. Abnormalities in whole body and cellular energy metabolism, dietary and plasma nutrient status and intestinal permeability have been well established in these patients as systemic determinants of functional decline and underexplored treatable traits. The aim of this study is to investigate the efficacy of 1 year targeted nutrient supplementation on physical activity level and health-related quality of life in patients with COPD. METHODS AND ANALYSIS This study is a single-centre randomised, placebo-controlled, double-blind trial in 166 patients with COPD recruited from multiple hospitals in the Netherlands. The intervention group will receive a multinutrient supplement, including vitamin D, tryptophan, long-chain polyunsaturated fatty acids and prebiotic dietary fibres as main components (94 kCal per daily dose). The control group will receive an isocaloric isonitrogenous placebo. Both groups will ingest one portion per day for at least 12 months and will additionally receive counselling on healthy lifestyle and medical adherence over the course of the study. Coprimary outcomes are physical activity assessed by triaxial accelerometry and health-related quality of life measured by the EuroQol-5 dimensions questionnaire. Secondary outcomes are cognitive function, psychological well-being, physical performance, patient-reported outcomes and the metabolic profile assessed by body composition, systemic inflammation, plasma nutrient levels, intestinal integrity and microbiome composition. Outcomes will be measured at baseline and after 12 months of supplementation. In case patients are hospitalised for a COPD exacerbation, a subset outcome panel will be measured during a 4-week recovery period after hospitalisation. ETHICS AND DISSEMINATION This study was approved by the local Ethics Committee of Maastricht University. Subjects will be included after written informed consent is provided. Study outcomes will be disseminated through presentations at (inter)national conferences and through peer-reviewed journals. TRIAL REGISTRATION NCT03807310.
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Affiliation(s)
- Rosanne Jhcg Beijers
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Lieke E J van Iersel
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Lisanne T Schuurman
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | | | - Sami O Simons
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Ardy van Helvoort
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
- Danone Nutricia Research, Utrecht, the Netherlands
| | - Harry R Gosker
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Annemie Mwj 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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9
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Aschauer R, Unterberger S, Zöhrer PA, Draxler A, Franzke B, Strasser EM, Wagner KH, Wessner B. Effects of Vitamin D3 Supplementation and Resistance Training on 25-Hydroxyvitamin D Status and Functional Performance of Older Adults: A Randomized Placebo-Controlled Trial. Nutrients 2021; 14:nu14010086. [PMID: 35010961 PMCID: PMC8746949 DOI: 10.3390/nu14010086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/26/2022] Open
Abstract
Vitamin D status is associated with muscle strength and performance in older adults. To examine the additive effects of vitamin D3 supplementation during resistance training, 100 seniors (65–85 years) participated in a 16-week intervention. Besides a daily dose of 400 mg of calcium, participants received either 800 IU vitamin D3 per day (VDD), 50,000 IU vitamin D3 per month (VDM) or nothing (CON). After the initial loading phase of four weeks, all groups started a 10-week resistance training program. Assessments of 25-hydroxyvitamin D (25(OH)D) status, muscle strength endurance (30-s chair stand and arm curl tests), aerobic capacity (6-min walk test) and functional mobility (gait speed and timed up and go test) were undertaken at baseline, after four weeks and at the end of the study. 25(OH)D status significantly improved in VDD and VDM, but not in CON (time x group: p = 0.021), as 15.2% of CON, 40.0% of VDD and 61.1% of VDM reached vitamin D sufficiency (>30 ng/mL; p = 0.004). Chair stand test, arm curl test, 6-min walk test, gait speed and timed up and go test improved over the whole intervention period (p < 0.05), however only chair stand and arm curl test were selectively affected by resistance training (p < 0.001). Neither muscle strength endurance, nor functional mobility or aerobic capacity were modulated by vitamin D supplementation. Therefore, the mere amelioration of 25(OH)D status of older adults does not lead to an additive effect on muscular performance during RT.
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Affiliation(s)
- Rudolf Aschauer
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Centre for Sport Science and University Sports, University of Vienna, 1150 Vienna, Austria
| | - Sandra Unterberger
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Centre for Sport Science and University Sports, University of Vienna, 1150 Vienna, Austria
| | - Patrick A. Zöhrer
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | - Agnes Draxler
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | - Bernhard Franzke
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | - Eva-Maria Strasser
- Karl Landsteiner Institute for Remobilization and Functional Health/Institute for Physical Medicine and Rehabilitation, Kaiser Franz Joseph Hospital, Social Medical Center South, 1100 Vienna, Austria;
| | - Karl-Heinz Wagner
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Department of Nutritional Sciences, University of Vienna, 1090 Vienna, Austria
| | - Barbara Wessner
- Research Platform Active Ageing, University of Vienna, 1090 Vienna, Austria; (R.A.); (S.U.); (P.A.Z.); (A.D.); (B.F.); (K.-H.W.)
- Centre for Sport Science and University Sports, University of Vienna, 1150 Vienna, Austria
- Correspondence: ; Tel.: +43-1-4277-48875
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10
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Effect of Vitamin D Supplementation on Muscle Status in Old Patients Recovering from COVID-19 Infection. ACTA ACUST UNITED AC 2021; 57:medicina57101079. [PMID: 34684116 PMCID: PMC8537350 DOI: 10.3390/medicina57101079] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/22/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023]
Abstract
Background and Objectives: Vitamin D, in addition to its effect on mineral homeostasis, plays a key role in muscle metabolism. Vitamin D supplementation is involved in muscle recovery after damage as a consequence of either pathology or after high-intensity exercise. In this context, the aim of this study was to analyze the effect of vitamin D on muscle fitness in elderly patients in the recovery phase after SARS-CoV-2 (COVID-19) infection. Materials and Methods: This pilot study was conducted at the Soria Norte Health Center. The study consisted of a double-blind trial with two groups of men (placebo and vitamin D-supplemented) (n = 15/group). Treatment with vitamin D (cholecalciferol: 2000 IU/day) and placebo was carried out for 6 weeks. Circulating hematological and biochemical parameters (total protein, glucose, vitamin D, urea, uric acid, aspartate aminotransferase/glutamic-oxaloacetic transaminase, alanine aminotransferase/glutamic-pyruvic transaminase, creatine kinase, lactate dehydrogenase, aldolase, gamma-glutamyl transferase and myoglobin) and the hormones cortisol and testosterone were determined. As for respiratory function tests, FEV1 and respiratory flow were also studied. For physical fitness tests, the “six-minute walk test” (6MWT) was used. Results: After vitamin D supplementation, we observed that serum creatine kinase levels returned to optimal values. This change suggests a protective role of vitamin D against muscle catabolism compared to placebo. In terms of physical test results, we observed only slight non-significant improvements, although patients reported feeling better. Conclusions: Vitamin D supplementation produces decreases in indicators of muscle damage, which may ultimately contribute to improving the health status and quality of life of patients who have suffered from COVID-19, during the recovery process.
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Bislev LS, Grove-Laugesen D, Rejnmark L. Vitamin D and Muscle Health: A Systematic Review and Meta-analysis of Randomized Placebo-Controlled Trials. J Bone Miner Res 2021; 36:1651-1660. [PMID: 34405916 DOI: 10.1002/jbmr.4412] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/20/2022]
Abstract
The objective of this study was to investigate the effects of vitamin D supplementation versus placebo on muscle health. For this systematic review and trial-level meta-analysis of placebo-controlled trials, a systematic search of randomized controlled trials published until October 2020 was performed in Medline, Embase, and Google Scholar. We included studies in humans (except athletes) on supplementation with vitamin D2 or D3 versus placebo, regardless of administration form (daily, bolus, and duration) with or without calcium co-supplementation. The predefined endpoints were physical performance reported as timed up and go test (TUG; seconds), chair rising test (seconds), 6-minute walking distance (m), and Short Physical Performance Battery (SPPB; points). Furthermore, endpoints were maximum muscle strength (Newton) measured at handgrip, elbow flexion, elbow extension, knee flexion, and knee extension, as well as muscle (lean tissue) mass (kg). Falls were not included in the analysis. Cochrane Review Manager (version 5.4.1.) calculating mean difference (MD) using a random effect model was used. In total, 54 randomized controlled trials involving 8747 individuals were included. Vitamin D versus placebo was associated with a significantly longer time spent performing the TUG (MD 0.15 [95% confidence interval (CI) 0.03 to 0.26] seconds, N = 19 studies, I2 = 0%, n = 5223 participants) and a significant lower maximum knee flexion strength (MD -3.3 [-6.63 to -0.03] Newton, N = 12 studies, I2 = 0%, n = 765 participants). Total score in the SPPB showed a tendency toward worsening in response to vitamin D compared with placebo (MD -0.18 [-0.37 to 0.01] points, N = 8 studies, I2 = 0%, n = 856 participants). Other measures of muscle health did not show between-group differences. In subgroup analyses, including studies with low vitamin D levels, effects of vitamin D supplementation did not differ from placebo. Available evidence does not support a beneficial effect of vitamin D supplementation on muscle health. Vitamin D may have adverse effects on muscle health, which needs to be considered when recommending vitamin D supplementation. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Lise Sofie Bislev
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Diana Grove-Laugesen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Jorde I, Stegemann-Koniszewski S, Papra K, Föllner S, Lux A, Schreiber J, Lücke E. Association of serum vitamin D levels with disease severity, systemic inflammation, prior lung function loss and exacerbations in a cohort of patients with chronic obstructive pulmonary disease (COPD). J Thorac Dis 2021; 13:3597-3609. [PMID: 34277053 PMCID: PMC8264670 DOI: 10.21037/jtd-20-3221] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/18/2021] [Indexed: 12/17/2022]
Abstract
Background Vitamin D deficiency has been associated with chronic disorders including chronic obstructive pulmonary disease (COPD) but the relationships with inflammation, exacerbations and disease progression remain unclear. Methods In this monocentric cross-sectional observational study we analyzed the disease status, systemic inflammation, prior exacerbation frequency and loss in lung function in relation to serum 25-hydroxyvitamin D (25-OHD) levels in a cohort of 94 patients with COPD. Serum 25-OHD, C-reactive protein, interleukin-6 and tumor necrosis factor-α were quantified. Exacerbation frequencies and sunlight exposure were assessed. These parameters were analyzed in correlation to the current forced expiratory volume in 1 s (FEV1), the individual average 3-year FEV1 decline and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage. Results We observed fair correlation between serum 25-OHD and the current FEV1 (r=0.38, P<0.001). Furthermore, mean serum 25-OHD was significantly altered between patients of GOLD stages I–IV (P=0.013). There was weak negative correlation of 25-OHD and the average annual change of the FEV1 (r=−0.26, P<0.05). Furthermore, we observed fair negative correlation between 25-OHD and C-reactive protein (r=−0.32, P<0.01) as well as weak negative correlation with interleukin-6 (r=−0.23, P<0.05). While the exacerbation frequency significantly differed between GOLD stages (P=0.04), there was no direct association between exacerbations and 25-OHD levels. Conclusion Our data confirm frequent vitamin D deficiency in COPD and point out correlations between 25-OHD levels, systemic inflammation, disease severity and progression.
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Affiliation(s)
- Ilka Jorde
- Department of Pneumology, University Hospital and Medical Faculty, Health Campus Immunology, Infectiology, and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sabine Stegemann-Koniszewski
- Department of Pneumology, University Hospital and Medical Faculty, Health Campus Immunology, Infectiology, and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Kristin Papra
- Department of Pneumology, University Hospital and Medical Faculty, Health Campus Immunology, Infectiology, and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Sebastian Föllner
- Department of Pneumology, University Hospital and Medical Faculty, Health Campus Immunology, Infectiology, and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jens Schreiber
- Department of Pneumology, University Hospital and Medical Faculty, Health Campus Immunology, Infectiology, and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Eva Lücke
- Department of Pneumology, University Hospital and Medical Faculty, Health Campus Immunology, Infectiology, and Inflammation, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Burkes RM, Couper DJ, Barjaktarevic IZ, Cooper CB, Labaki WW, Han MK, Woodruff PG, Lazarus SC, Parekh TM, Paine, III R, Comellas AP, Bowler RP, Loehr LR, Putcha N, Wise RA, Brown TT, Drummond MB. Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:277-291. [PMID: 33829714 PMCID: PMC8237982 DOI: 10.15326/jcopdf.2020.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata. METHODS Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George's Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans' Specific Activity Questionnaire, and the 6-minute walk test distance. RESULTS InIn the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group. DISCUSSION When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.
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Affiliation(s)
- Robert M. Burkes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - David J. Couper
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - Igor Z. Barjaktarevic
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Christopher B. Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Meilan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Stephen C. Lazarus
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Trisha M. Parekh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Robert Paine, III
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Hospital, Denver, Colorado, United States
| | - Laura R. Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert A. Wise
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Todd T. Brown
- Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
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Mandru R, Zhou CY, Pauley R, Burkes RM. Considerations for and Mechanisms of Adjunct Therapy in COPD. J Clin Med 2021; 10:jcm10061225. [PMID: 33809583 PMCID: PMC7999347 DOI: 10.3390/jcm10061225] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/26/2022] Open
Abstract
Inhaled bronchodilators and corticosteroids, when indicated, form the backbone of COPD therapy. However, over the last decade there has been an emergence of adjunct therapies in oral or inhaled form that are now part of the therapeutic approach to COPD. While these therapies have shown to be beneficial when used in the appropriate instances, there are particular considerations that need to be minded when using these therapies. This review article discussed the mechanism of roflumilast, macrolide antibiotics, other chronic antibiotic regimens, vitamin D supplementation, oral corticosteroids, n-acetylcysteine, and nebulized hypertonic saline, the clinical data behind each of these therapies, adverse events associated with therapy, and the expert recommendations for their utilization. Our goal is to provide a brief but informative and clinically useful review of commonly encountered therapies used in advanced COPD.
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Affiliation(s)
- Rachana Mandru
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Christine Y. Zhou
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45221, USA; (C.Y.Z.); (R.P.)
| | - Rachel Pauley
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45221, USA; (C.Y.Z.); (R.P.)
| | - Robert M. Burkes
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH 45221, USA;
- Correspondence:
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Saleem A, Sharif S, Jarvis S, Madouros N, Koumadoraki E, Khan S. A Comprehensive Review on Vitamin D as a Novel Therapeutic Agent in Chronic Obstructive Pulmonary Disease. Cureus 2021; 13:e13095. [PMID: 33728117 PMCID: PMC7935199 DOI: 10.7759/cureus.13095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Vitamin D has been playing an important role in the treatment of lung diseases. The non-calcemic effects of this vitamin and its role in chronic obstructive pulmonary disease (COPD) has drawn significant attention recently. Many studies have been conducted to explore the relationship between the two. We tested the hypothesis that vitamin D can act as an effective therapeutic agent for COPD by reviewing the correlation between the two and effectiveness along with the safety of supplemental vitamin D when used to treat chronic bronchitis and emphysema through clinical trials. An electronic search was conducted using combinations of keywords “vitamin D” and “COPD” from PubMed and Google scholar. Only relevant, human studies of all types were included from the last decade. A total of 36 articles were selected for review. Observational studies indicate a correlation between low serum 25(OH)D levels and obstructive lung disease pathology as well as clinical outcomes. Moreover, clinical trials were aimed to understand the impact of the use of vitamin D in improving disease indexes. These clinical trials used different drug regimes, mode of administration, and intervention duration with contrasting outcomes. Hypovitaminosis D is a common and harmful variant of this group of obstructive lung diseases, and correcting this deficiency can improve exacerbations, inflammation, lung functions, symptoms, and quality of life. These benefits are more prevalent in patients with low baseline serum 25 hydroxyvitamin D(25(OH)D) levels. Peroral is the most frequently used route of drug administration, however, further work is required to explore the pharmacological properties of vitamin D. There was not enough literature available about the safety of the drug of intervention.
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Affiliation(s)
- Amber Saleem
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Shayka Sharif
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sommer Jarvis
- Anatomy/Cell Biology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nikolaos Madouros
- Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Evgenia Koumadoraki
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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16
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Hornikx M, Buys R, Cornelissen V, Deroma M, Goetschalckx K. Effectiveness of high intensity interval training supplemented with peripheral and inspiratory resistance training in chronic heart failure: a pilot study. Acta Cardiol 2020; 75:339-347. [PMID: 31125296 DOI: 10.1080/00015385.2019.1591676] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Cardiac rehabilitation (CR) is an evidence-based therapy in chronic heart failure (CHF). There is still debate about the optimal training protocol in CHF. The use of high intensity interval training (HIIT) supplemented with peripheral (PRT) and inspiratory resistance training (IRT) might be more beneficial because of the higher impact on the peripheral and inspiratory muscles, with less symptoms of dyspnoea and lower amount of dropouts as a result. We compared our standard exercise-based CR programme, mainly consisting of moderate intensity interval training to a programme combining HIIT, PRT and IRT (resistance training supplemented HIIT (RHIIT) programme).Design: Randomised controlled pilot study.Methods: Twenty patients with CHF were randomised on a 1:1 basis to the standard or RHIIT programme. At baseline and after 3 months, peak exercise capacity (VO2peak), peripheral (QF) and inspiratory respiratory muscle strength (MIP), quality of life (QOL) and physical activity were measured.Results: The RHIIT programme resulted in a significantly larger improvement in QF (ΔQF RHIIT programme: 19.3 ± 11.8 vs standard programme: -6.89 ± 19.0 Nm (p < .01)) and MIP (ΔMIP RHIIT programme: -44.9 ± 29.9 vs standard programme: 0.56 ± 19.4 cmH2O (p < .01)). Both programmes equally improved in VO2peak (p = .91), whereas ventilatory efficiency and physical activity remained stable.Conclusion: HIIT supplemented with PRT and IRT might be applicable as standard protocol in CHF. Larger studies are warranted to confirm our findings. The RHIIT programme resulted in similar training effects in VO2peak in a shorter training period. This might be beneficial in a chronic patient population such as CHF, where adherence is difficult.
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Affiliation(s)
- Miek Hornikx
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Roselien Buys
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Veronique Cornelissen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Michel Deroma
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Kaatje Goetschalckx
- Department of Cardiovascular Sciences, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
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Sarandi E, Thanasoula M, Anamaterou C, Papakonstantinou E, Geraci F, Papamichael MM, Itsiopoulos C, Tsoukalas D. Metabolic profiling of organic and fatty acids in chronic and autoimmune diseases. Adv Clin Chem 2020; 101:169-229. [PMID: 33706889 DOI: 10.1016/bs.acc.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Metabolomics is a powerful tool of omics that permits the simultaneous identification of metabolic perturbations in several autoimmune and chronic diseases. Several parameters can affect a metabolic profile, from the population characteristics to the selection of the analytical method. In the current chapter, we summarize the main analytical methods and results of the metabolic profiling of fatty and organic acids performed in human metabolomic studies for asthma, COPD, psoriasis and Hashimoto's thyroiditis. We discuss the most significant metabolic alterations associated with these diseases, after comparison of either a single patient's group with healthy controls or several patient's subgroups of different disease severity and phenotype with healthy controls or of a patient's group before and after treatment. Finally, we present critical metabolic patterns that are associated with each disease and their potency for the unraveling of disease pathogenesis, prediction, diagnosis, patient stratification and treatment selection.
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Affiliation(s)
- Evangelia Sarandi
- Metabolomic Medicine Clinic, Athens, Greece; Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, Heraklion, Greece
| | - Maria Thanasoula
- Metabolomic Medicine Clinic, Athens, Greece; European Institute of Nutritional Medicine, E.I.Nu.M, Rome, Italy
| | | | | | - Francesco Geraci
- European Institute of Nutritional Medicine, E.I.Nu.M, Rome, Italy
| | - Maria Michelle Papamichael
- Department of Rehabilitation, Nutrition & Sport, La Trobe University, School of Allied Health, Melbourne, VIC, Australia
| | - Catherine Itsiopoulos
- Department of Rehabilitation, Nutrition & Sport, La Trobe University, School of Allied Health, Melbourne, VIC, Australia
| | - Dimitris Tsoukalas
- Metabolomic Medicine Clinic, Athens, Greece; European Institute of Nutritional Medicine, E.I.Nu.M, Rome, Italy.
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Cholecalciferol or Calcifediol in the Management of Vitamin D Deficiency. Nutrients 2020; 12:nu12061617. [PMID: 32486496 PMCID: PMC7352679 DOI: 10.3390/nu12061617] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/19/2020] [Accepted: 05/23/2020] [Indexed: 12/16/2022] Open
Abstract
Vitamin D deficiency is a global health problem due to its high prevalence and its negative consequences on musculoskeletal and extra-skeletal health. In our comparative review of the two exogenous vitamin D supplementation options most used in our care setting, we found that cholecalciferol has more scientific evidence with positive results than calcifediol in musculoskeletal diseases and that it is the form of vitamin D of choice in the most accepted and internationally recognized clinical guidelines on the management of osteoporosis. Cholecalciferol, unlike calcifediol, guarantees an exact dosage in IU (International Units) of vitamin D and has pharmacokinetic properties that allow either daily or even weekly, fortnightly, or monthly administration in its equivalent doses, which can facilitate adherence to treatment. Regardless of the pattern of administration, cholecalciferol may be more likely to achieve serum levels of 25(OH)D (25-hydroxy-vitamin D) of 30-50 ng/mL, an interval considered optimal for maximum benefit at the lowest risk. In summary, the form of vitamin D of choice for exogenous supplementation should be cholecalciferol, with calcifediol reserved for patients with liver failure or severe intestinal malabsorption syndromes.
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19
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Malliaraki N, Lakiotaki K, Vamvoukaki R, Notas G, Tsamardinos I, Kampa M, Castanas E. Translating vitamin D transcriptomics to clinical evidence: Analysis of data in asthma and chronic obstructive pulmonary disease, followed by clinical data meta-analysis. J Steroid Biochem Mol Biol 2020; 197:105505. [PMID: 31669573 DOI: 10.1016/j.jsbmb.2019.105505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 09/29/2019] [Accepted: 10/22/2019] [Indexed: 12/29/2022]
Abstract
Vitamin D (VitD) continues to trigger intense scientific controversy, regarding both its bi ological targets and its supplementation doses and regimens. In an effort to resolve this dispute, we mapped VitD transcriptome-wide events in humans, in order to unveil shared patterns or mechanisms with diverse pathologies/tissue profiles and reveal causal effects between VitD actions and specific human diseases, using a recently developed bioinformatics methodology. Using the similarities in analyzed transcriptome data (c-SKL method), we validated our methodology with osteoporosis as an example and further analyzed two other strong hits, specifically chronic obstructive pulmonary disease (COPD) and asthma. The latter revealed no impact of VitD on known molecular pathways. In accordance to this finding, review and meta-analysis of published data, based on an objective measure (Forced Expiratory Volume at one second, FEV1%) did not further reveal any significant effect of VitD on the objective amelioration of either condition. This study may, therefore, be regarded as the first one to explore, in an objective, unbiased and unsupervised manner, the impact of VitD levels and/or interventions in a number of human pathologies.
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Affiliation(s)
- Niki Malliaraki
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece; Laboratory of Clinical Chemistry/Biochemistry, University Hospital, Heraklion, Greece
| | - Kleanthi Lakiotaki
- Department of Computer Science, University of Crete, School of Sciences, Heraklion, Greece
| | - Rodanthi Vamvoukaki
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece
| | - George Notas
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece
| | - Ioannis Tsamardinos
- Department of Computer Science, University of Crete, School of Sciences, Heraklion, Greece; Gnosis Data Analysis PC, Heraklion, Greece
| | - Marilena Kampa
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece
| | - Elias Castanas
- Laboratory of Experimental Endocrinology, University of Crete, School of Medicine, Heraklion, Greece.
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van Beers M, Rutten-van Mölken MP, van de Bool C, Boland M, Kremers SP, Franssen FM, van Helvoort A, Gosker HR, Wouters EF, Schols AM. Clinical outcome and cost-effectiveness of a 1-year nutritional intervention programme in COPD patients with low muscle mass: The randomized controlled NUTRAIN trial. Clin Nutr 2020; 39:405-413. [DOI: 10.1016/j.clnu.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/20/2019] [Accepted: 03/04/2019] [Indexed: 01/18/2023]
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21
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Aldhahir AM, Rajeh AMA, Aldabayan YS, Drammeh S, Subbu V, Alqahtani JS, Hurst JR, Mandal S. Nutritional supplementation during pulmonary rehabilitation in COPD: A systematic review. Chron Respir Dis 2020; 17:1479973120904953. [PMID: 32054293 PMCID: PMC7019390 DOI: 10.1177/1479973120904953] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/10/2019] [Indexed: 11/29/2022] Open
Abstract
Uptake of nutritional supplementation during pulmonary rehabilitation (PR) for people with chronic obstructive pulmonary disease (COPD) has been limited by an absence of rigorous evidence-based studies supporting use. The objective was to report and summarise the current evidence supporting the use of nutritional supplementation to improve outcomes during PR in stable COPD patients. A systematic search was conducted up to 7 August 2019 (registration number CRD42018089142). The preferred reporting items for systematic reviews and meta-analyses guidelines were used. Six databases were included: Medical Literature Analysis and Retrieval System Online or MEDLARS Online, Allied and Complementary Medicine Database, the Cochrane Database of Systematic Reviews, Excerpta Medica dataBASE, Cumulative Index of Nursing and Allied Health Literature and Web of Science. This systematic search generated 580 initial matches, of which 22 studies (917 COPD participants) met the pre-specified criteria and were included. Sixteen of 19 studies that used nutritional supplements in addition to PR did not show additional benefit compared to PR alone when measuring exercise capacity. Nutritional supplements significantly increased body weight in 7 of 11 studies. Body mass index increased significantly in two of six studies. Handgrip strength did not improve, while quadriceps muscle strength significantly improved in 3 of 11 studies. Four of eight studies showed a significant improvement in inspiratory muscle function. Only 2 of 14 studies demonstrated a significant improvement in quality of life with supplementation in addition to PR. There remains insufficient evidence on the effect of nutritional supplementation on improving outcomes during PR in patients with COPD due to heterogeneity in supplements, outcome measures and PR programmes. Therefore, controversy remains and further research is needed.
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Affiliation(s)
- Abdulelah M Aldhahir
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
- Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan
University, Jazan, Saudi Arabia
| | - Ahmed M Al Rajeh
- Respiratory Care Department, College of Applied Medical Sciences, King
Faisal University, Al-Ahsa, Saudi Arabia
| | - Yousef S Aldabayan
- Respiratory Care Department, College of Applied Medical Sciences, King
Faisal University, Al-Ahsa, Saudi Arabia
| | - Salifu Drammeh
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
| | | | - Jaber S Alqahtani
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
- Department of Respiratory Care, Prince Sultan Military College of Health
Sciences, Dhahran, Saudi Arabia
| | - John R Hurst
- UCL Respiratory, Royal Free Campus, University College London, London,
UK
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22
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Tsoukalas D, Sarandi E, Thanasoula M, Docea AO, Tsilimidos G, Calina D, Tsatsakis A. Metabolic Fingerprint of Chronic Obstructive Lung Diseases: A New Diagnostic Perspective. Metabolites 2019; 9:E290. [PMID: 31779131 PMCID: PMC6949962 DOI: 10.3390/metabo9120290] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 12/14/2022] Open
Abstract
Chronic obstructive lung disease (COLD) is a group of airway diseases, previously known as emphysema and chronic bronchitis. The heterogeneity of COLD does not allow early diagnosis and leads to increased morbidity and mortality. The increasing number of COLD incidences stresses the need for precision medicine approaches that are specific to the patient. Metabolomics is an emerging technology that allows for the discrimination of metabolic changes in the cell as a result of environmental factors and specific genetic background. Thus, quantification of metabolites in human biofluids can provide insights into the metabolic state of the individual in real time and unravel the presence of, or predisposition to, a disease. In this article, the advantages of and potential barriers to putting metabolomics into clinical practice for COLD are discussed. Today, metabolomics is mostly lab-based, and research studies with novel COLD-specific biomarkers are continuously being published. Several obstacles in the research and the market field hamper the translation of these data into clinical practice. However, technological and computational advances will facilitate the clinical interpretation of data and provide healthcare professionals with the tools to prevent, diagnose, and treat COLD with precision in the coming decades.
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Affiliation(s)
- Dimitris Tsoukalas
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
- Metabolomic Medicine Clinic, Health Clinics for Autoimmune and Chronic Diseases, 10674 Athens, Greece; (E.S.); (M.T.); (G.T.)
| | - Evangelia Sarandi
- Metabolomic Medicine Clinic, Health Clinics for Autoimmune and Chronic Diseases, 10674 Athens, Greece; (E.S.); (M.T.); (G.T.)
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, 71003 Heraklion, Greece;
| | - Maria Thanasoula
- Metabolomic Medicine Clinic, Health Clinics for Autoimmune and Chronic Diseases, 10674 Athens, Greece; (E.S.); (M.T.); (G.T.)
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Gerasimos Tsilimidos
- Metabolomic Medicine Clinic, Health Clinics for Autoimmune and Chronic Diseases, 10674 Athens, Greece; (E.S.); (M.T.); (G.T.)
| | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Aristides Tsatsakis
- Laboratory of Toxicology and Forensic Sciences, Medical School, University of Crete, 71003 Heraklion, Greece;
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23
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Billingsley HE, Rodriguez-Miguelez P, Del Buono MG, Abbate A, Lavie CJ, Carbone S. Lifestyle Interventions with a Focus on Nutritional Strategies to Increase Cardiorespiratory Fitness in Chronic Obstructive Pulmonary Disease, Heart Failure, Obesity, Sarcopenia, and Frailty. Nutrients 2019; 11:nu11122849. [PMID: 31766324 PMCID: PMC6950118 DOI: 10.3390/nu11122849] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/03/2019] [Accepted: 11/15/2019] [Indexed: 12/11/2022] Open
Abstract
Cardiorespiratory fitness (CRF) is an independent predictor for all-cause and disease-specific morbidity and mortality. CRF is a modifiable risk factor, and exercise training and increased physical activity, as well as targeted medical therapies, can improve CRF. Although nutrition is a modifiable risk factor for chronic noncommunicable diseases, little is known about the effect of dietary patterns and specific nutrients on modifying CRF. This review focuses specifically on trials that implemented dietary supplementation, modified dietary pattern, or enacted caloric restriction, with and without exercise training interventions, and subsequently measured the effect on peak oxygen consumption (VO2) or surrogate measures of CRF and functional capacity. Populations selected for this review are those recognized to have a reduced CRF, such as chronic obstructive pulmonary disease, heart failure, obesity, sarcopenia, and frailty. We then summarize the state of existing knowledge and explore future directions of study in disease states recently recognized to have an abnormal CRF.
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Affiliation(s)
- Hayley E. Billingsley
- Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23284, USA; (H.E.B.); (A.A.)
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Paula Rodriguez-Miguelez
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA 23284, USA;
| | - Marco Giuseppe Del Buono
- Department of Cardiovascular and Thoracic Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Antonio Abbate
- Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23284, USA; (H.E.B.); (A.A.)
| | - Carl J. Lavie
- Department of Cardiovascular Diseases, Ochsner Clinical School, New Orleans, LA 70121, USA;
| | - Salvatore Carbone
- Department of Internal Medicine, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23284, USA; (H.E.B.); (A.A.)
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA 23284, USA;
- Correspondence: ; Tel.: +1-804-628-3980
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24
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Machado A, Quadflieg K, Oliveira A, Keytsman C, Marques A, Hansen D, Burtin C. Exercise Training in Patients with Chronic Respiratory Diseases: Are Cardiovascular Comorbidities and Outcomes Taken into Account?-A Systematic Review. J Clin Med 2019; 8:E1458. [PMID: 31540240 PMCID: PMC6780679 DOI: 10.3390/jcm8091458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = -0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.
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Affiliation(s)
- Ana Machado
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
| | - Kirsten Quadflieg
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
| | - Ana Oliveira
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Respiratory Medicine, West Park Healthcare Centre, Toronto, ON M6M 2J5, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Charly Keytsman
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA), University of Aveiro, 3810 Aveiro, Portugal
- Institute of Biomedicine (iBiMED), University of Aveiro, 3810 Aveiro, Portugal
| | - Dominique Hansen
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium
- Jessa hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Chris Burtin
- REVAL-Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, 3590 Diepenbeek, Belgium.
- BIOMED-Biomedical Research Institute, Hasselt University, 3590 Diepenbeek, Belgium.
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25
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Abrigo J, Simon F, Cabrera D, Vilos C, Cabello-Verrugio C. Mitochondrial Dysfunction in Skeletal Muscle Pathologies. Curr Protein Pept Sci 2019; 20:536-546. [PMID: 30947668 DOI: 10.2174/1389203720666190402100902] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/26/2022]
Abstract
Several molecular mechanisms are involved in the regulation of skeletal muscle function. Among them, mitochondrial activity can be identified. The mitochondria is an important and essential organelle in the skeletal muscle that is involved in metabolic regulation and ATP production, which are two key elements of muscle contractibility and plasticity. Thus, in this review, we present the critical and recent antecedents regarding the mechanisms through which mitochondrial dysfunction can be involved in the generation and development of skeletal muscle pathologies, its contribution to detrimental functioning in skeletal muscle and its crosstalk with other typical signaling pathways related to muscle diseases. In addition, an update on the development of new strategies with therapeutic potential to inhibit the deleterious impact of mitochondrial dysfunction in skeletal muscle is discussed.
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Affiliation(s)
- Johanna Abrigo
- Laboratory of Muscle Pathology, Fragility and Aging, Departamento de Ciencias Biologicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Santiago, Chile.,Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago, Chile
| | - Felipe Simon
- Millennium Institute on Immunology and Immunotherapy, Santiago, Chile.,Laboratory of Integrative Physiopathology, Departamento de Ciencias Biológicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile
| | - Daniel Cabrera
- Departamento de Gastroenterologia, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile.,Departamento de Ciencias Químicas y Biológicas, Facultad de Salud, Universidad Bernardo O Higgins, Santiago, Chile
| | - Cristian Vilos
- Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago, Chile.,Laboratory of Nanomedicine and Targeted Delivery, Center for Medical Research, School of Medicine. Universidad d e Talca, Talca, Chile
| | - Claudio Cabello-Verrugio
- Laboratory of Muscle Pathology, Fragility and Aging, Departamento de Ciencias Biologicas, Facultad de Ciencias de la Vida, Universidad Andres Bello, Santiago, Chile.,Millennium Institute on Immunology and Immunotherapy, Santiago, Chile.,Center for the Development of Nanoscience and Nanotechnology (CEDENNA), Universidad de Santiago de Chile, Santiago, Chile
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26
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Alavi Foumani A, Mehrdad M, Jafarinezhad A, Nokani K, Jafari A. Impact of vitamin D on spirometry findings and quality of life in patients with chronic obstructive pulmonary disease: a randomized, double-blinded, placebo-controlled clinical trial. Int J Chron Obstruct Pulmon Dis 2019; 14:1495-1501. [PMID: 31360062 PMCID: PMC6625601 DOI: 10.2147/copd.s207400] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 05/17/2019] [Indexed: 11/23/2022] Open
Abstract
COPD is an irreversible chronic illness with airflow limitation. The aim of the current study was to assess the role of vitamin D3 on quality of life and pulmonary function in patients with COPD. A randomized, double-blinded clinical trial was conducted in 63 patients with COPD. Patients were placed into intervention and placebo groups. Each individual in the intervention group took 50,000 IU vitamin D3once a week for 8 weeks and then once a month for 4 months. There was no significant difference among FEV1, FEV1/FVC, and number of exacerbations in patients with COPD (P>0.05). In the intervention group, a significant difference was observed in quality of life at 2 months (P<0.001) and 6 months (P<0.001). In addition, qualitative analysis showed that the status of exacerbation had not got worse six months after initiation in the intervention group. The current study shows that consumption of 50,000 IU vitamin D3, as a convenient supplementation in a daily diet, is able to increase quality of life in patients with COPD.
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Affiliation(s)
- Ali Alavi Foumani
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mojtaba Mehrdad
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.,Razi Clinical Research Development Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafarinezhad
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Khadijeh Nokani
- Student Research Committee, Department of Internal Medicine, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafari
- Inflammatory Lung Diseases Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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27
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Vitamin D Supplementation and Post-Stroke Rehabilitation: A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients 2019; 11:nu11061295. [PMID: 31181657 PMCID: PMC6628052 DOI: 10.3390/nu11061295] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 01/11/2023] Open
Abstract
Low vitamin D levels are associated with poorer outcomes after stroke. However, it is not clear whether post-stroke vitamin D supplementation can improve these outcomes. In this study, we investigated the effects of vitamin D supplementation on outcomes in hospitalized patients undergoing rehabilitation after acute stroke. A multicenter, randomized, controlled, double-blind, parallel-group trial was conducted from January 2012 through July 2017. One hundred patients admitted to a convalescent rehabilitation ward after having an acute stroke were randomized, and each one received either vitamin D3 (2000 IU/day) or a placebo. The primary outcome was a gain in the Barthel Index scores at week 8. Secondary outcomes were seen in Barthel Index efficiency, hand grip strength, and calf circumference at week 8. Ninety-seven patients completed the study. There were no significant differences in the demographic characteristics between the groups. The mean (±standard deviation) gain in the Barthel Index score was 19.0 ± 14.8 in the supplementation group and 19.5 ± 13.1 in the placebo group (p = 0.88). The Barthel Index efficiency was 0.32 ± 0.31 in the supplementation group and 0.28 ± 0.21 in the placebo group (p = 0.38). There were no between-group differences in the other secondary outcomes. Our findings suggest that oral vitamin D3 supplementation does not improve rehabilitation outcomes after acute stroke.
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28
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Tzilas V, Bouros E, Barbayianni I, Karampitsakos T, Kourtidou S, Ntassiou M, Ninou I, Aidinis V, Bouros D, Tzouvelekis A. Vitamin D prevents experimental lung fibrosis and predicts survival in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther 2019; 55:17-24. [DOI: 10.1016/j.pupt.2019.01.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 12/22/2022]
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29
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Bislev LS, Langagergaard Rødbro L, Rolighed L, Sikjaer T, Rejnmark L. Effects of Vitamin D3 Supplementation on Muscle Strength, Mass, and Physical Performance in Women with Vitamin D Insufficiency: A Randomized Placebo-Controlled Trial. Calcif Tissue Int 2018; 103:483-493. [PMID: 29931459 DOI: 10.1007/s00223-018-0443-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022]
Abstract
Vitamin D insufficiency and hyperparathyroidism have been associated with reduced muscle strength, physical performance, postural stability, well-being, and quality of life. In a double-blinded, randomized placebo-controlled trial, we aimed to investigate effects of vitamin D3 supplementation on above-mentioned outcomes in healthy community-dwelling postmenopausal women with plasma levels of 25-hydroxyvitamin D (25(OH)D) below < 50 nmol/l and high parathyroid hormone (PTH) levels. Participants (N = 81) were 1:1 treated with vitamin D3, 70 µg (2800 IU)/day or identical placebo for three months during wintertime (56°N). Vitamin D3 supplementation increased levels of 25(OH)D and 1,25(OH)2D by 230% (95% CI 189 to 272)%, p < 0.001 and 58% (190 to 271%), p < 0.001, respectively, and reduced PTH by 17% (- 23 to - 11%), p < 0.001. Compared with placebo, vitamin D3 significantly reduced maximal handgrip strength by 9% (- 15 to - 3%; p < 0.01) and knee flexion strength by 13% (- 24 to - 2%; p = 0.02) and increased the time spent on performing the Timed Up and Go test by 4.4%; (0.1-8.6%; p < 0.05). Levels of physical activity, total lean body mass, appendicular lean mass index, postural stability, well-being, and quality of life did not change in response to treatment. Compared with placebo, a daily supplement with a relatively high dose of vitamin D3 had no beneficial effects on any outcomes. In some measures of muscle strength and physical performance, we even saw a small unfavorable effect. Our data call for caution on use of relatively high daily doses of vitamin D3 in the treatment of vitamin D insufficiency.
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Affiliation(s)
- Lise Sofie Bislev
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | - Lars Rolighed
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Otolaryngology, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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30
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Carson EL, Pourshahidi LK, Madigan SM, Baldrick FR, Kelly MG, Laird E, Healy M, Strain JJ, Mulhern MS. Vitamin D status is associated with muscle strength and quality of life in patients with COPD: a seasonal prospective observation study. Int J Chron Obstruct Pulmon Dis 2018; 13:2613-2622. [PMID: 30214179 PMCID: PMC6118240 DOI: 10.2147/copd.s166919] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Owing to hospitalization, reduced functional capacity and consequently, less sunlight exposure, suboptimal vitamin D status (25-hydroxyvitamin D [25(OH)D]⩽50 nmol/L) is prevalent among COPD patients. Objective This study aimed to investigate seasonal changes in vitamin D status and any associated changes in fat-free mass (FFM), muscle strength and quality of life (QoL) in COPD patients. Patients and methods COPD patients living in Northern Ireland (n=51) completed study visits at the end of winter (March/April) and at the end of summer (September/October), corresponding to the nadir and peak of vitamin D status, respectively. At both time points, serum concentration of 25(OH)D was quantified by liquid chromatography-tandem mass spectrometry, FFM (kg) was measured using bioelectrical impedance and muscle strength (kg) was measured using handgrip dynamometry. QoL was assessed using the validated St George’s Respiratory Questionnaire. Results Mean±SD 25(OH)D concentration was significantly higher at the end of summer compared to the end of winter (52.5±30.5 nmol/L vs 33.7±28.4 nmol/L, P<0.001); and house- bound patients had significantly lower 25(OH)D concentration compared to nonhousebound patients at the end of summer (42.9±4.2 vs 57.2±9.9 nmol/L; P⩽0.001). Muscle strength (at both time points) and QoL (end of summer only) were positively predicted by 25(OH)D concentration, independent of age, sex and smoking status. Conclusion This study highlights the need for health policies to include a recommendation for year-round vitamin D supplementation in housebound COPD patients, and wintertime supplementation in nonhousebound patients, to maintain optimal 25(OH)D concentrations to protect musculoskeletal health. Furthermore, an optimal vitamin D status may have potential benefits for QoL in these patients.
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Affiliation(s)
- Emma L Carson
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK,
| | - L Kirsty Pourshahidi
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK,
| | - Sharon M Madigan
- Respiratory Dietitian, Pulmonary Rehabilitation Team, Belfast Health and Social Care Trust, Belfast, UK
| | - Francina R Baldrick
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK,
| | - Martin G Kelly
- Respiratory Team, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, UK
| | - Eamon Laird
- School of Medicine, Trinity College, Dublin, Ireland
| | - Martin Healy
- Department of Biochemistry, Central Pathology Laboratory, St James Hospital, Dublin, Ireland
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK,
| | - Maria S Mulhern
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, University of Ulster, Coleraine, Co. Londonderry, UK,
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31
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Liu Z, Ren Z, Zhang J, Chuang CC, Kandaswamy E, Zhou T, Zuo L. Role of ROS and Nutritional Antioxidants in Human Diseases. Front Physiol 2018; 9:477. [PMID: 29867535 PMCID: PMC5966868 DOI: 10.3389/fphys.2018.00477] [Citation(s) in RCA: 391] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 04/16/2018] [Indexed: 12/13/2022] Open
Abstract
The overproduction of reactive oxygen species (ROS) has been implicated in the development of various chronic and degenerative diseases such as cancer, respiratory, neurodegenerative, and digestive diseases. Under physiological conditions, the concentrations of ROS are subtlety regulated by antioxidants, which can be either generated endogenously or externally supplemented. A combination of antioxidant-deficiency and malnutrition may render individuals more vulnerable to oxidative stress, thereby increasing the risk of cancer occurrence. In addition, antioxidant defense can be overwhelmed during sustained inflammation such as in chronic obstructive pulmonary diseases, inflammatory bowel disease, and neurodegenerative disorders, cardiovascular diseases, and aging. Certain antioxidant vitamins, such as vitamin D, are essential in regulating biochemical pathways that lead to the proper functioning of the organs. Antioxidant supplementation has been shown to attenuate endogenous antioxidant depletion thus alleviating associated oxidative damage in some clinical research. However, some results indicate that antioxidants exert no favorable effects on disease control. Thus, more studies are warranted to investigate the complicated interactions between ROS and different types of antioxidants for restoration of the redox balance under pathologic conditions. This review highlights the potential roles of ROS and nutritional antioxidants in the pathogenesis of several redox imbalance-related diseases and the attenuation of oxidative stress-induced damages.
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Affiliation(s)
- Zewen Liu
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Department of Anesthesiology, Affiliated Ezhou Central Hospital, Wuhan University, Ezhou, China
| | - Zhangpin Ren
- Department of Pediatrics, Affiliated Ezhou Central Hospital, Wuhan University, Ezhou, China
| | - Jun Zhang
- Department of Rehabilitation, Affiliated Ezhou Central Hospital, Wuhan University, Ezhou, China
| | - Chia-Chen Chuang
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, United States
| | - Eswar Kandaswamy
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Tingyang Zhou
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, United States
| | - Li Zuo
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, United States
- Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, United States
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Lakhdar R, Rabinovich RA. Can muscle protein metabolism be specifically targeted by nutritional support and exercise training in chronic obstructive pulmonary disease? J Thorac Dis 2018; 10:S1377-S1389. [PMID: 29928520 PMCID: PMC5989103 DOI: 10.21037/jtd.2018.05.81] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) associates with several extra-pulmonary effects. Muscle dysfunction and wasting is one of the most prominent extra-pulmonary effects and contributes to exercise limitation and health related quality of life (HRQoL), morbidity as well as mortality. The loss of muscle mass is characterised by an impaired balance between protein synthesis (anabolism) and protein breakdown (catabolism) which relates to nutritional disturbances, muscle disuse and the presence of a systemic inflammation, among other factors. Current approaches to reverse skeletal muscle dysfunction and wasting attain only modest improvements. The development of new therapeutic strategies aiming at improving skeletal muscle dysfunction and wasting are needed. This requires a better understanding of the underlying molecular pathways responsible for these abnormalities. In this review we update recent research on protein metabolism, nutritional depletion as well as physical (in)activity in relation to muscle wasting and dysfunction in patients with COPD. We also discuss the role of nutritional supplementation and exercise training as strategies to re-establish the disrupted balance of protein metabolism in the muscle of patients with COPD. Future areas of research and clinical practice directions are also addressed.
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Affiliation(s)
- Ramzi Lakhdar
- ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
| | - Roberto A. Rabinovich
- ELEGI Colt Laboratory, MRC Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Scotland, UK
- Respiratory Medicine Department, Royal Infirmary of Edinburgh, Scotland, UK
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Kentson M, Leanderson P, Jacobson P, Persson HL. The influence of disease severity and lifestyle factors on the peak annual 25(OH)D value of COPD patients. Int J Chron Obstruct Pulmon Dis 2018; 13:1389-1398. [PMID: 29731626 PMCID: PMC5927355 DOI: 10.2147/copd.s156121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background The prevalence of individuals deficient in vitamin D (defined as a serum level of the stable metabolite 25(OH)D <50 nmol/L) is increasing in countries with low annual ultraviolet (UV) radiation and among individuals unable to perform outdoor activities, for example, COPD patients. Objective To assess the role of vitamin D deficiency, independently of seasonal variation, the peak annual value of 25(OH)D was measured in subjects with advanced COPD ± long-term oxygen therapy (LTOT) and lung healthy control subjects. A method to grade the individual annual UV light exposure was designed and tested. Subjects and methods Sixty-six Caucasians with advanced COPD (28 with LTOT) and 47 control subjects were included, and the levels of 25(OH)D were determined in late summer/early fall when the annual peak was assumed. Questionnaires about COPD symptoms, general health, lifestyle, dietary habits and QoL were used to collect data. Lung function tests and blood sampling were performed. Results The peak annual 25(OH)D of COPD subjects was significantly lower than in the control subjects, but there was no significant difference between COPD patients with and without LTOT. Ongoing vitamin D supplementation was the single most important intervention to maintain 25(OH)D levels ≥50 nmol/L. Among vitamin D-deficient COPD subjects, 25(OH) D correlated positively with forced expiratory volume in 1 second as % predicted, Modified British Medical Research Council score, blood oxygenation, food portion size, Mediterranean Diet Score and Ultraviolet Score. Conclusion Vitamin D deficiency was common among healthy individuals and COPD subjects. Peak annual 25(OH)D levels of COPD subjects correlated with clinically important outcomes. The present study emphasizes the need to routinely monitor vitamin D status among patients with advanced COPD and to consider to medicate those with vitamin D deficiency with vitamin D supplementation.
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Affiliation(s)
- Magnus Kentson
- Division of Medicine, Ryhov Hospital, Jönköping, Sweden.,Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Per Leanderson
- Department of Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine (IKE), Linköping University, Linköping, Sweden
| | - Petra Jacobson
- Department of Respiratory Medicine.,Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
| | - Hans Lennart Persson
- Department of Respiratory Medicine.,Department of Medical and Health Sciences (IMH), Linköping University, Linköping, Sweden
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Anar C, Yüksel Yavuz M, Güldaval F, Varol Y, Kalenci D. Assessment of osteoporosis using the FRAX method and the importance of vitamin D levels in COPD patients. Multidiscip Respir Med 2018; 13:1. [PMID: 29318009 PMCID: PMC5756431 DOI: 10.1186/s40248-017-0116-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/01/2017] [Indexed: 01/09/2023] Open
Abstract
Background The aim of this paper was to evaluate the availability of FRAX for assessing osteoporosis risk, and to demonstrate the importance of vitamin D levels in COPD patients. Methods Fourty-six males who fulfilled the COPD diagnostic criteria defined by GOLD were included. Age, race, BMI, physical activity frequency, smoking and dietary habits, age at COPD diagnosis, disease duration, fractures history, and medications use were determined. Levels of 25(OH)D were detected. BMD was measured by DXA at lumbar spine, femoral neck, and entire femur, and classified according to ISCD. FRAX score was calculated. Control group was composed of 40 non-smoker individuals without previous history of pulmonary diseases. Results 25(OH)D levels were significantly different between patients and controls. In the COPD group, a statistically significant difference in vitamin D levels was detected among the A, B, C, and D grades, while no such significant differences in FRAX scores were detected. 25(OH)D levels were significantly low in COPD patients with disease exacerbations and hospitalizations in the previous one year. No correlation was detected between vitamin D levels and the FRAX score. A positive correlation was observed between vitamin D levels and T-score. FRAX scores were higher and vitamin D levels were lower in osteoporotic COPD patients than in non-osteoporotic COPD patients. Conclusion Using FRAX for assessing osteoporosis in COPD can reduce fracture risk and allow adequate treatment. Since vitamin D levels are related to exacerbations and hospitalizations, vitamin D supplementation may be needed in COPD patients, especially in those with high FRAX scores.
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Affiliation(s)
- Ceyda Anar
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Melike Yüksel Yavuz
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Filiz Güldaval
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Yelda Varol
- Department of Chest Diseases, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, Gaziler Cad. No: 331, 35110 İzmir, Turkey
| | - Dilek Kalenci
- Department of Biochemistry, İzmir Dr. Suat Seren Chest Diseases and Surgery Training Research Hospital, İzmir, Turkey
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Jolliffe DA, James WY, Hooper RL, Barnes NC, Greiller CL, Islam K, Bhowmik A, Timms PM, Rajakulasingam RK, Choudhury AB, Simcock DE, Hyppönen E, Walton RT, Corrigan CJ, Griffiths CJ, Martineau AR. Prevalence, determinants and clinical correlates of vitamin D deficiency in patients with Chronic Obstructive Pulmonary Disease in London, UK. J Steroid Biochem Mol Biol 2018; 175:138-145. [PMID: 28161533 DOI: 10.1016/j.jsbmb.2017.01.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/21/2017] [Accepted: 01/29/2017] [Indexed: 11/16/2022]
Abstract
Vitamin D deficiency is common in patients with chronic obstructive pulmonary disease (COPD), yet a comprehensive analysis of environmental and genetic determinants of serum 25-hydroxyvitamin D (25[OH]D) concentration in patients with this condition is lacking. We conducted a multi-centre cross-sectional study in 278 COPD patients aged 41-92 years in London, UK. Details of potential environmental determinants of vitamin D status and COPD symptom control and severity were collected by questionnaire, and blood samples were taken for analysis of serum 25(OH)D concentration and DNA extraction. All participants performed spirometry and underwent measurement of weight and height. Quadriceps muscle strength (QS) was measured in 134 participants, and sputum induction with enumeration of lower airway eosinophil and neutrophil counts was performed for 44 participants. Thirty-seven single nucleotide polymorphisms (SNP) in 11 genes in the vitamin D pathway (DBP, DHCR7, CYP2R1, CYP27B1, CYP24A1, CYP27A1, CYP3A4, LRP2, CUBN, RXRA, and VDR) were typed using Taqman allelic discrimination assays. Linear regression was used to identify environmental and genetic factors independently associated with serum 25(OH)D concentration and to determine whether vitamin D status or genetic factors independently associated with % predicted forced expiratory volume in one second (FEV1), % predicted forced vital capacity (FVC), the ratio of FEV1 to FVC (FEV1:FVC), daily inhaled corticosteroid (ICS) dose, respiratory quality of life (QoL), QS, and the percentage of eosinophils and neutrophils in induced sputum. Mean serum 25(OH)D concentration was 45.4nmol/L (SD 25.3); 171/278 (61.5%) participants were vitamin D deficient (serum 25[OH]D concentration <50nmol/L). Lower vitamin D status was independently associated with higher body mass index (P=0.001), lower socio-economic position (P=0.037), lack of vitamin D supplement consumption (P<0.001), sampling in Winter or Spring (P for trend=0.006) and lack of a recent sunny holiday (P=0.002). Vitamin D deficiency associated with reduced % predicted FEV1 (P for trend=0.060) and % predicted FVC (P for trend=0.003), but it did not associate with FEV1:FVC, ICS dose, QoL, QS, or the percentage of eosinophils or neutrophils in induced sputum. After correction for multiple comparisons testing, genetic variation in the vitamin D pathway was not found to associate with serum 25(OH)D concentration or clinical correlates of COPD severity. Vitamin D deficiency was common in this group of COPD patients in the UK, and it associated independently with reduced % predicted FEV1 and FVC. However, genetic variation in the vitamin D pathway was not associated with vitamin D status or severity of COPD.
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Affiliation(s)
- David A Jolliffe
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
| | - Wai Yee James
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Richard L Hooper
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Neil C Barnes
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK
| | - Claire L Greiller
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kamrul Islam
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Angshu Bhowmik
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, UK
| | - Peter M Timms
- Homerton University Hospital NHS Foundation Trust, Homerton Row, London, UK
| | | | | | | | - Elina Hyppönen
- Centre for Population Health Research, School of Health Sciences and Sansom Institute of Health Research, University of South Australia South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Robert T Walton
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Christopher J Corrigan
- MRC and the Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Christopher J Griffiths
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK; MRC and the Asthma UK Centre for Allergic Mechanisms in Asthma, King's College London, London, UK
| | - Adrian R Martineau
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; Asthma UK Centre for Applied Research, Blizard Institute, Queen Mary University of London, London, UK.
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Role of Vitamin D Replacement on Health Related Quality of Life in Hospitalized Patients with "Acute Exacerbation of Chronic Obstructive Pulmonary Disease". IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2018; 17:801-810. [PMID: 29881436 PMCID: PMC5985196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Burden of Chronic Obstructive Pulmonary Disease (COPD) is substantial and increasing in the world. There are controversial reports regarding vitamin D supplementation in COPD. We investigated relationship between vitamin D3 (Cholecalciferol) supplementation with Health Related Quality of Life (HRQOL) and symptom recovery in AECOPD patients with concurrent Vitamin D Deficiency (VDD). A placebo-controlled randomized clinical trial was designed. AECOPD patients with VDD were randomly allocated to receive either vitamin D 300,000 IU (n = 35) or placebo (n = 35) by intramuscular injection. Primary outcomes included the HRQOL assessed by St. George's Respiratory Questionnaire (SGRQ), and the symptom recovery evaluated by the modified Medical Research Council (mMRC) Dyspnea scale, determined at baseline and at days 30 and 120 post-intervention. Secondary endpoints were length of hospital stay (LOS), rehospitalization and mortality rates. Sixty-two patients, 30 patients in the vitamin D and 32 patients in the placebo groups, with mean ± SD age of 63.42 ± 8.48 years accomplished the study. Baseline vitamin D levels in the vitamin D and placebo groups were 10.59 ± 3.39 and 11.12 ± 3.17 ng/mL, respectively. These levels reached 36.85 ± 11.80 and 12.30 ± 3.66 in the vitamin D and placebo groups, respectively, at day 120 (p < 0.001). Correction of vitamin D levels in the intervention group resulted in statistically significant improvement in patients' HRQOL by day 120 compared to that of the placebo group (p = 0.001); however no significant difference was observed in LOS, rehospitalization, and mortality rates. Single parenteral high dose of vitamin D as adjunctive therapy could improve HRQOL in hospitalized AECOPD patients with deficient levels of vitamin D.
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Miłkowska-Dymanowska J, Białas AJ, Makowska J, Wardzynska A, Górski P, Piotrowski WJ. Geroprotectors as a therapeutic strategy for COPD - where are we now? Clin Interv Aging 2017; 12:1811-1817. [PMID: 29123386 PMCID: PMC5661461 DOI: 10.2147/cia.s142483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Although current therapies in chronic obstructive pulmonary disease (COPD) improve the quality of life, they do not satisfactorily reduce disease progression or mortality. There are still many gaps in knowledge about the cellular, molecular, and genetic mechanisms contributing to pathobiology of this disease. However, increasing evidence suggests that accelerated aging, chronic systemic inflammation, and oxidative stress play major roles in pathogenesis in COPD, thus opening new opportunities in therapy. Therefore, the aim of our review was to describe and discuss some of the most widely used therapeutics that affect the root cause of aging and oxidative stress (metformin, melatonin, sirolimus, statins, vitamin D, and testosterone) in context of COPD therapy.
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Affiliation(s)
| | - Adam J Białas
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine
- Healthy Aging Research Centre
| | | | - Aleksandra Wardzynska
- Healthy Aging Research Centre
- Department of Immunology, Rheumatology, and Allergy, Medical University of Lodz, Lodz, Poland
| | - Paweł Górski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine
- Healthy Aging Research Centre
| | - Wojciech J Piotrowski
- Department of Pneumology and Allergy, 1st Chair of Internal Medicine
- Healthy Aging Research Centre
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van de Bool C, Rutten EP, van Helvoort A, Franssen FM, Wouters EF, Schols AM. A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD. J Cachexia Sarcopenia Muscle 2017; 8:748-758. [PMID: 28608438 PMCID: PMC5659064 DOI: 10.1002/jcsm.12219] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/21/2017] [Accepted: 05/04/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence regarding the efficacy of nutritional supplementation to enhance exercise training responses in COPD patients with low muscle mass is limited. The objective was to study if nutritional supplementation targeting muscle derangements enhances outcome of exercise training in COPD patients with low muscle mass. METHODS Eighty-one COPD patients with low muscle mass, admitted to out-patient pulmonary rehabilitation, randomly received oral nutritional supplementation, enriched with leucine, vitamin D, and omega-3 fatty acids (NUTRITION) or PLACEBO as adjunct to 4 months supervised high intensity exercise training. RESULTS The study population (51% males, aged 43-80) showed moderate airflow limitation, low diffusion capacity, normal protein intake, low plasma vitamin D, and docosahexaenoic acid. Intention-to-treat analysis revealed significant differences after 4 months favouring NUTRITION for body mass (mean difference ± SEM) (+1.5 ± 0.6 kg, P = 0.01), plasma vitamin D (+24%, P = 0.004), eicosapentaenoic acid (+91%,P < 0.001), docosahexaenoic acid (+31%, P < 0.001), and steps/day (+24%, P = 0.048). After 4 months, both groups improved skeletal muscle mass (+0.4 ± 0.1 kg, P < 0.001), quadriceps muscle strength (+12.3 ± 2.3 Nm,P < 0.001), and cycle endurance time (+191.4 ± 34.3 s, P < 0.001). Inspiratory muscle strength only improved in NUTRITION (+0.5 ± 0.1 kPa, P = 0.001) and steps/day declined in PLACEBO (-18%,P = 0.005). CONCLUSIONS High intensity exercise training is effective in improving lower limb muscle strength and exercise performance in COPD patients with low muscle mass and moderate airflow obstruction. Specific nutritional supplementation had additional effects on nutritional status, inspiratory muscle strength, and physical activity compared with placebo.
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Affiliation(s)
- Coby van de Bool
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
| | | | - Ardy van Helvoort
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
- Nutricia Research, Nutricia Advanced Medical NutritionUtrechtThe Netherlands
| | - Frits M.E. Franssen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
- Department of Research and EducationCIRO+ HornHaelenThe Netherlands
| | - Emiel F.M. Wouters
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
- On behalf of the CIRO network
| | - Annemie M.W.J. Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in MetabolismMaastricht University Medical Center+MaastrichtThe Netherlands
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Eslami1 O, Shidfar1 F, Akbari-Fakhrabadi2 M. Vitamin D and Cardiorespiratory Fitness in the General Population: A Systematic Review. INT J VITAM NUTR RES 2017; 87:330-341. [DOI: 10.1024/0300-9831/a000490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Abstract. Background: Up to now, the association between vitamin D and cardiorespiratory fitness (CRF) is still inconsistent and there is a lack of a comprehensive review on this topic. Aim: To systematically review the literature including both observational studies and randomized controlled trials (RCTs) on the association between vitamin D and CRF in the general population. Methods: The literature was investigated by exploring databases of PubMed, EMBASE, Scopus and ISI Web of Science as well as a manual search up to April 2017 by using related MeSH terms and key words. All the English-language articles that were conducted in the general population without any restriction on age range of participants and date of publication were included in the study. Results: Among the 731 records which were found initially, a total of 20 articles including 18 cross-sectional studies and 2 RCTs fulfilled the inclusion criteria. Among the cross-sectional studies, findings on the association between serum 25(OH) D and CRF were incongruent. Additionally, studies which had reported significant results varied remarkably in terms of sample size, study population and the effect size of the association. In addition, RCTs found no significant improvement in CRF following vitamin D supplementation. Conclusion: Overall, evidence from cross-sectional studies does not support a strong association between vitamin D and CRF, although a number of studies demonstrated modest positive associations. Furthermore, limited RCTs did not confirm such an association. Further high quality research is needed to obtain a definite conclusion on this topic. “
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Affiliation(s)
- Omid Eslami1
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Farzad Shidfar1
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Rafiq R, Prins HJ, Boersma WG, Daniels JM, den Heijer M, Lips P, de Jongh RT. Effects of daily vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients: a pilot trial. Int J Chron Obstruct Pulmon Dis 2017; 12:2583-2592. [PMID: 28894361 PMCID: PMC5584776 DOI: 10.2147/copd.s132117] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Although vitamin D is well known for its function in calcium homeostasis and bone mineralization, several studies have shown positive effects on muscle strength and physical function. In addition, vitamin D has been associated with pulmonary function and the incidence of airway infections. As vitamin D deficiency is highly prevalent in chronic obstructive pulmonary disease (COPD) patients, supplementation might have a beneficial effect in these patients. Objective To assess the effect of vitamin D supplementation on respiratory muscle strength and physical performance in vitamin D-deficient COPD patients. Secondary outcomes are pulmonary function, handgrip strength, exacerbation rate, and quality of life. Methods We performed a randomized, double-blind, placebo-controlled pilot trial. Participants were randomly allocated to receive 1,200 IU vitamin D3 per day (n=24) or placebo (n=26) during 6 months. Study visits were conducted at baseline, and at 3 and 6 months after randomization. During the visits, blood was collected, respiratory muscle strength was measured (maximum inspiratory and expiratory pressure), physical performance and 6-minute walking tests were performed, and handgrip strength and pulmonary function were assessed. In addition, participants kept a diary card in which they registered respiratory symptoms. Results At baseline, the mean (standard deviation [SD]) serum 25-hydroxyvitamin D (25(OH)D) concentration (nmol/L) was 42.3 (15.2) in the vitamin D group and 40.6 (17.0) in the placebo group. Participants with vitamin D supplementation had a larger increase in serum 25(OH)D compared to the placebo group after 6 months (mean difference (SD): +52.8 (29.8) vs +12.3 (25.1), P<0.001). Primary outcomes, respiratory muscle strength and physical performance, did not differ between the groups after 6 months. In addition, no differences were found in the 6-minute walking test results, handgrip strength, pulmonary function, exacerbation rate, or quality of life. Conclusion Vitamin D supplementation did not affect (respiratory) muscle strength or physical performance in this pilot trial in vitamin D-deficient COPD patients.
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Affiliation(s)
- Rachida Rafiq
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
| | - Hendrik J Prins
- Department of Pulmonary Diseases, Northwest Hospital group, Alkmaar
| | - Wim G Boersma
- Department of Pulmonary Diseases, Northwest Hospital group, Alkmaar
| | - Johannes Ma Daniels
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
| | - Paul Lips
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
| | - Renate T de Jongh
- Department of Internal Medicine and Endocrinology, VU University Medical Center, Amsterdam
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Khan DM, Ullah A, Randhawa FA, Iqtadar S, Butt NF, Waheed K. Role of Vitamin D in reducing number of acute exacerbations in Chronic Obstructive Pulmonary Disease (COPD) patients. Pak J Med Sci 2017; 33:610-614. [PMID: 28811780 PMCID: PMC5510112 DOI: 10.12669/pjms.333.12397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Chronic obstructive pulmonary disease (COPD) is characterized by chronic incompletely reversible poor airflow and air trapping and usually this debilitating disorder limits the outside activities of the patients depriving them of sunlight which is a rich source of Vitamin D. The objective of this study was to determine the effect of vitamin D supplementation in reducing number of acute exacerbation in COPD patients. METHODS This randomized control trial was conducted at East Medical Ward Mayo Hospital Lahore from January to December 2015 as exacerbations of COPD are season dependent. Diagnosis was confirmed by performing Pulmonary Function Tests (PFTs). Basic demographical information was obtained and baseline PFTs of the patient was done. Only Group A patients was treated with oral vitamin D intake of 2000 IU daily for 6 months. Vitamin D level was measured at 0, 2, 4, and 6 months and exacerbation of COPD, FEV1 and FVC was measured weekly. Both the groups were given standard treatment for exacerbation of COPD. Spirometry was repeated at each visit. Blood samples were collected every 2 months for vitamin D. Supplementation was stopped if vitamin D level exceeded 100ng/ml. RESULTS The mean age of the patients was 46.28±8.83 years, the male to female ratio was 1.8:1. The mean 25(OH) level at baseline was 24.08±2.58 and at 6th month was 29.60±8.74. The mean FVC at baseline was 77.83±5.49 and at 6th month was 91.34±5.52. The exacerbation at baseline was present in all 120(100%) patients and at 6th month was reduced to 4(3.3%). CONCLUSION Vitamin D supplementation has significant effect in reducing number of acute exacerbation in COPD patients when it is given for prolonged period.
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Affiliation(s)
- Dur Muhammad Khan
- Dr. Dur Muhammad Khan, FRCP. Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Aziz Ullah
- Dr. Aziz Ullah, Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Fawad Ahmad Randhawa
- Dr. Fawad Ahmad Randhawa, FCPS, MCPS, FCPS. Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Somia Iqtadar
- Dr. Somia Iqtadar, FCPS. Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Nasir Farooq Butt
- Dr. Nasir Farooq Butt, MCPS, FCPS. Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | - Khadija Waheed
- Dr. Khadija Waheed, FCPS. Department of Gynecology & Obstetrics, Department of Gynecology & Obstetrics King Edward Medical University, Lahore, Pakistan
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Kokturk N, Baha A, Oh YM, Young Ju J, Jones PW. Vitamin D deficiency: What does it mean for chronic obstructive pulmonary disease (COPD)? a compherensive review for pulmonologists. CLINICAL RESPIRATORY JOURNAL 2017; 12:382-397. [PMID: 27925404 DOI: 10.1111/crj.12588] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 11/15/2016] [Accepted: 11/23/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Vitamin D deficiency and Chronic Obstructive Pulmonary Disease (COPD) are both under-recognized health problems, world-wide. Although Vitamin D has long been known for calcemic effects it also has less known noncalcemic effects. Recent data have shown that Vitamin D deficiency is highly prevalent in patients with COPD and correlates with forced expiratory volume in one second (FEV1 ) and FEV1 decline. The objective of this work was to review the current literature on vitamin D deficiency in relation with COPD. DATA SOURCE A literature search, using the words "vitamin D" and "COPD", was undertaken in Pubmed database. RESULTS The noncalcemic effects of vitamin D relating with COPD may be summarised as increasing antimicrobial peptide production, regulation of inflammatory response and airway remodelling. Vitamin D inhibits the production of several proinflammatory cytokines and leads to suppression Th1 and Th17 responses which may be involved in the pathogenesis of COPD. Vitamin D insufficiency may also contribute to chronic respiratory infections and airway colonization so returning vitamin D concentrations to an optimal range in patients with COPD might reduce bacterial load and concomitant exacerbations.Vitamin D is also important for COPD-related comorbodities such as osteoporosis, muscle weakness and cardiovascular diseases. Data about the effect of Vitamin D supplementation on those comorbidities in relation with COPD are been scarce. CONCLUSION Improving the blood level of Vitamin D into the desired range may have a beneficial effect bones and muscles, but more studies are needed to test to test that hypothesis.
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Affiliation(s)
- Nurdan Kokturk
- Department of Pulmonary Medicine, School of Medicine, Gazi University, Ankara, Turkey.,Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asian Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ayse Baha
- Department of Pulmonary Medicine, School of Medicine, Gazi University, Ankara, Turkey
| | - Yeon-Mok Oh
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asian Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung Young Ju
- Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, Asian Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Paul W Jones
- Department of Pulmonology, School of Medicine, Clinical Science Center, St George University, London, UK
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Paulin FV, Zagatto AM, Chiappa GR, Müller PDT. Addition of vitamin B12 to exercise training improves cycle ergometer endurance in advanced COPD patients: A randomized and controlled study. Respir Med 2016; 122:23-29. [PMID: 27993287 DOI: 10.1016/j.rmed.2016.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 08/16/2016] [Accepted: 11/20/2016] [Indexed: 01/08/2023]
Abstract
Vitamin B12 is essential in the homocysteine, mitochondrial, muscle and hematopoietic metabolisms, and its effects on exercise tolerance and kinetics adjustments of oxygen consumption (V'O2p) in rest-to-exercise transition in COPD patients are unknown. This randomized, double-blind, controlled study aimed to verify a possible interaction between vitamin B12 supplementation and these outcomes. After recruiting 69 patients, 35 subjects with moderate-to-severe COPD were eligible and 32 patients concluded the study, divided into four groups (n = 8 for each group): 1. rehabilitation group; 2. rehabilitation plus B12 group; 3. B12 group; and 4. placebo group. The primary endpoint was cycle ergometry endurance before and after 8 weeks and the secondary endpoints were oxygen uptake kinetics parameters (time constant). The prevalence of vitamin B12 deficiency was high (34.4%) and there was a statistically significant interaction (p < 0.05), favoring a global effect of supplementation on exercise tolerance in the supplemented groups compared to the non-supplemented groups, even after adjusting for confounding variables (p < 0.05). The same was not found for the kinetics adjustment variables (τV'O2p and MRTV'O2p, p > 0.05 for both). Supplementation with vitamin B12 appears to lead to discrete positive effects on exercise tolerance in groups of subjects with more advanced COPD and further studies are needed to establish indications for long-term supplementation.
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Affiliation(s)
- Fernanda Viana Paulin
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, MS, Brazil.
| | - Alessandro Moura Zagatto
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, MS, Brazil; Department of Physical Education, UNESP - Universidade Estadual Paulista, Bauru, São Paulo, Brazil.
| | - Gaspar R Chiappa
- Department of Physical Therapy, University of Brasilia (UnB), Brasilia, Brazil.
| | - Paulo de Tarso Müller
- Laboratory of Respiratory Pathophysiology (LAFIR), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, MS, Brazil.
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Sanjari M, Soltani A, Habibi Khorasani A, Zareinejad M. The effect of vitamin D on COPD exacerbation: a double blind randomized placebo-controlled parallel clinical trial. J Diabetes Metab Disord 2016; 15:33. [PMID: 27570748 PMCID: PMC5002185 DOI: 10.1186/s40200-016-0257-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 08/15/2016] [Indexed: 12/20/2022]
Abstract
Background To investigate the effect of supplementation of standard treatment (inhaled long-acting β2 agonists, anticholinergics and corticosteroids) with vitamin D on C reactive protein and pulmonary function tests in patients with COPD exacerbation. Methods Design: Randomized, single-center, double-blind, placebo-controlled parallel trial. One teaching hospital Participants: 135 patients in pulmonary ward with moderate to severe COPD and exacerbations.120 patients fulfilled the study protocol. Interventions: Patients were randomly divided into three groups receiving 7 day treatment with 0.25 μg calcitriol daily (n = 45), 50000 IU daily of vitamin D (n = 45) or placebo (n = 45). An independent nurse was responsible for allocation, preparation, and accounting of trial medications. Main Outcome measures: Maximal expiratory flow volume (FEV1) and forced volume capacity curves (FVC) and Modified Medical Research Council (MMRC) scale. Results Out of 135 patients who were recruited consecutively, 45 patients randomly were randomly assigned in three groups (balance blocked randomization.15 patients were dropped out due to non-compliance for second PFT. Intention to treat analysis was carried out for 120 participants. The difference between before and after treatment FEV1 and FEV1/FVC ratio had no significant difference between treatment groups and placebo. (P = 0.43, P = 0.51, respectively)but clinical improvement was significant in patients who received calcitriol. No side effects were reported. Conclusions Short term treatment with either calcitriol or 25(OH) 2Vit D didn’t changed FEV1 or FVC in vitamin D sufficient patients with COPD exacerbation; nevertheless it can provide clinical benefit. Trial registration Trial registration: Iranian Registry of Clinical Trials no. IRCT138712271774N1. Registered 10 April 2011.
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Affiliation(s)
- Mojgan Sanjari
- Endocrinology and Metabolism Research Center, Basic and Clinical Physiology Institute, Kerman University of Medical Sciences, Kerman, Iran
| | - Akbar Soltani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, EBM Group, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Zareinejad
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
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Taivassalo T, Hussain SN. Contribution of the Mitochondria to Locomotor Muscle Dysfunction in Patients With COPD. Chest 2016; 149:1302-12. [DOI: 10.1016/j.chest.2015.11.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/09/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022] Open
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Demeyer H, Burtin C, Hornikx M, Camillo CA, Van Remoortel H, Langer D, Janssens W, Troosters T. The Minimal Important Difference in Physical Activity in Patients with COPD. PLoS One 2016; 11:e0154587. [PMID: 27124297 PMCID: PMC4849755 DOI: 10.1371/journal.pone.0154587] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/16/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Changes in physical activity (PA) are difficult to interpret because no framework of minimal important difference (MID) exists. We aimed to determine the minimal important difference (MID) in physical activity (PA) in patients with Chronic Obstructive Pulmonary Disease and to clinically validate this MID by evaluating its impact on time to first COPD-related hospitalization. METHODS PA was objectively measured for one week in 74 patients before and after three months of rehabilitation (rehabilitation sample). In addition the intraclass correlation coefficient was measured in 30 patients (test-retest sample), by measuring PA for two consecutive weeks. Daily number of steps was chosen as outcome measurement. Different distribution and anchor based methods were chosen to calculate the MID. Time to first hospitalization due to an exacerbation was compared between patients exceeding the MID and those who did not. RESULTS Calculation of the MID resulted in 599 (Standard Error of Measurement), 1029 (empirical rule effect size), 1072 (Cohen's effect size) and 1131 (0.5SD) steps.day-1. An anchor based estimation could not be obtained because of the lack of a sufficiently related anchor. The time to the first hospital admission was significantly different between patients exceeding the MID and patients who did not, using the Standard Error of Measurement as cutoff. CONCLUSIONS The MID after pulmonary rehabilitation lies between 600 and 1100 steps.day-1. The clinical importance of this change is supported by a reduced risk for hospital admission in those patients with more than 600 steps improvement.
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Affiliation(s)
- Heleen Demeyer
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000 Leuven, Belgium
- Center for research in environmental epidemiology (CREAL), Barcelona, Spain
| | - Chris Burtin
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Miek Hornikx
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- University Hospitals Leuven, Department of Cardiovascular Sciences, B-3000 Leuven, Belgium
| | - Carlos Augusto Camillo
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000 Leuven, Belgium
| | - Hans Van Remoortel
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000 Leuven, Belgium
- Red Cross Flanders, Centre for Evidence-Based Practice, Mechelen, Belgium
| | - Daniel Langer
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000 Leuven, Belgium
| | - Wim Janssens
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000 Leuven, Belgium
| | - Thierry Troosters
- KU Leuven-University of Leuven, Department of Rehabilitation Sciences, B-3000 Leuven, Belgium
- University Hospitals Leuven, Department of Respiratory Diseases, B-3000 Leuven, Belgium
- * E-mail:
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Kim C, Jung JY, Kim YS, Lee JS, Rhee CK, Lee JH, Lee JH, Kim TH, Lim SY, Sheen SS, Yoo KH, Seo JB, Oh YM, Lee SD, Park YB. Vitamin D Deficiency Is Associated with Rapid Decline in Exercise Capacity in Male Patients with Chronic Obstructive Pulmonary Disease. Respiration 2016; 91:351-8. [DOI: 10.1159/000445266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
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Camillo CA, Osadnik CR, van Remoortel H, Burtin C, Janssens W, Troosters T. Effect of "add-on" interventions on exercise training in individuals with COPD: a systematic review. ERJ Open Res 2016; 2:00078-2015. [PMID: 27730178 PMCID: PMC5005161 DOI: 10.1183/23120541.00078-2015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/16/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of this review was to identify the effectiveness of therapies added on to conventional exercise training to maximise exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Electronic databases were searched, identifying trials comparing exercise training with exercise training plus "add-on" therapy. Outcomes included peak oxygen uptake (V'O2peak), work rate and incremental/endurance cycle and field walking tests. Individual trial effects on exercise capacity were extracted and collated into eight subgroups and pooled for meta-analysis. Sensitivity analyses were conducted to explore the stability of effect estimates across studies employing patient-centred designs and those deemed to be of "high" quality (PEDro score >5 out of 10). 74 studies (2506 subjects) met review inclusion criteria. Interventions spanned a broad scope of clinical practice and were most commonly evaluated via the 6-min walking distance and V'O2peak. Meta-analysis revealed few clinically relevant and statistically significant benefits of "add-on" therapies on exercise performance compared with exercise training. Benefits favouring "add-on" therapies were observed across six different interventions (additional exercise training, noninvasive ventilation, bronchodilator therapy, growth hormone, vitamin D and nutritional supplementation). The sensitivity analyses included considerably fewer studies, but revealed minimal differences to the primary analysis. The lack of systematic benefits of "add-on" interventions is a probable reflection of methodological limitations, such as "one size fits all" eligibility criteria, that are inherent in many of the included studies of "add-on" therapies. Future clarification regarding the exact value of such therapies may only arise from adequately powered, multicentre clinical trials of tailored interventions for carefully selected COPD patient subgroups defined according to distinct clinical phenotypes.
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Affiliation(s)
- Carlos A Camillo
- KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium; Both authors contributed equally
| | - Christian R Osadnik
- KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; Monash University, Dept of Physiotherapy, Victoria, Australia; Institute for Breathing and Sleep, Victoria, Australia; Monash Health, Monash Lung and Sleep, Victoria, Australia; Both authors contributed equally
| | - Hans van Remoortel
- KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; Belgian Red Cross, Flanders, Mechelen, Belgium
| | - Chris Burtin
- KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; Hasselt University, Rehabilitation Research Centre, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Diepenbeek, Belgium
| | - Wim Janssens
- University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
| | - Thierry Troosters
- KU Leuven, Dept of Rehabilitation Sciences, Leuven, Belgium; University Hospital Leuven, Respiratory Division and Rehabilitation, Leuven, Belgium
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49
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Todd JJ, McSorley EM, Pourshahidi LK, Madigan SM, Laird E, Healy M, Magee PJ. Vitamin D 3 supplementation using an oral spray solution resolves deficiency but has no effect on VO 2 max in Gaelic footballers: results from a randomised, double-blind, placebo-controlled trial. Eur J Nutr 2016; 56:1577-1587. [PMID: 27015912 PMCID: PMC5486642 DOI: 10.1007/s00394-016-1202-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/07/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE Vitamin D inadequacy is a global health concern in athletes as well as the general population. Whilst the role of vitamin D in skeletal health is well defined, there remains uncertainty over whether vitamin D supplementation has an added benefit beyond bone health. METHODS This randomised placebo-controlled trial in healthy male and female Gaelic footballers (n = 42) investigated the effect of vitamin D3 supplementation [3000 IU (75 µg) daily for 12 weeks, via an oral spray solution] on VO2 max which was the primary outcome measure. Secondary outcomes included skeletal muscle and lung function. RESULTS Supplementation significantly increased total 25-hydroxyvitamin D concentrations compared to the placebo group (mean ± SD change from baseline, 36.31 ± 32.34 vs. 6.11 ± 23.93 nmol/L, respectively; P = 0.006). At baseline, 50 and 22 % of footballers presented with vitamin D insufficiency (31-49 nmol/L) and deficiency (<30 nmol/L), respectively. Total 25-hydroxyvitamin D concentration did not significantly correlate with any measure of physical performance. Analysis of covariance (ANCOVA) models demonstrated that vitamin D supplementation over 12 weeks had no significant effect on VO2 max (P = 0.375), vertical jump height (P = 0.797), left and right handgrip strength (P = 0.146 and P = 0.266, respectively), forced vital capacity (P = 0.573) or forced expiratory volume at 1 s (P = 0.665), after adjusting for confounders. The high prevalence of vitamin D inadequacy observed in this cohort of collegiate Gaelic footballers supports the need for vitamin D supplementation during wintertime to avoid being at risk of poor bone health. CONCLUSIONS Twelve-week daily supplementation with 3000 IU (75 µg) vitamin D3 successfully resolved deficiency but did not have any significant effect on VO2 max, skeletal muscle or lung function.
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Affiliation(s)
- Joshua J Todd
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, UK
| | - Emeir M McSorley
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, UK
| | - L Kirsty Pourshahidi
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, UK
| | - Sharon M Madigan
- Irish Institute of Sport, Sports Campus Ireland, Abbotstown, Dublin 15, UK
| | - Eamon Laird
- Institute of Molecular Medicine, Trinity College, Dublin, UK
| | - Martin Healy
- Department of Medicine, Trinity Centre for Health Science St. James's Hospital, Dublin, UK
| | - Pamela J Magee
- Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, UK.
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50
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Hejazi ME, Modarresi-Ghazani F, Entezari-Maleki T. A review of Vitamin D effects on common respiratory diseases: Asthma, chronic obstructive pulmonary disease, and tuberculosis. J Res Pharm Pract 2016; 5:7-15. [PMID: 26985430 PMCID: PMC4776550 DOI: 10.4103/2279-042x.176542] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Despite the classic role of Vitamin D in skeletal health, new aspects of Vitamin D have been discovered in tissues and organs other than bones. Epidemiological and observational studies demonstrate a link between Vitamin D deficiency and risk of developing respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), and tuberculosis (TB). To review the literature, we searched the terms "Vitamin D" (using the set operator) and "asthma," "COPD" and "TB" in electronic databases, including PubMed/MEDLINE, Scopus, and Google Scholar until July 2015. Non-English articles or articles with unavailable full text were excluded. Both in vivo and in vitro studies were included. All the reviewed articles state that Vitamin D deficiency is very common among patients with respiratory diseases. The present data regarding Vitamin D and asthma is still controversial, but data about COPD and TB are more encouraging. The relevant studies have been conducted in different populations therefore it is not particularly possible to compare the data due to genetic variations. In order to point out a role for Vitamin D, large clinical trials with Vitamin D deficient subjects and sufficient Vitamin D supplementation are needed.
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Affiliation(s)
- Mohammad Esmaeil Hejazi
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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