A cross sectional study to assess the nutritional status of Chronic Obstructive Pulmonary Disease Patients
Abstract
Background: Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease, is a major public health concern. Therefore, the present study was conducted to assess the nutritional status in COPD patients by using anthropometric, biochemical and bioelectric impedance analysis.
Methods: This cross-sectional study conducted in the Department of Pulmonary Medicine, Medical College, Thiruvananthapuram, India from March 2013 to November 2014. A pulmonary specialist diagnosed all subjects. Using revised GOLD 2011 criteria they were divided into four groups (A, B, C, D). Anthropometric and biochemical indices, body composition analyses by bioelectric impedance, spirometry test, and determination of disease severity were performed in all subjects.
Results: A total of 435 COPD patients included 287 men (60.0%) and 148 women (34.0%), with a mean age of 60.2 (SD11.2) yr in disease stages A to D. Of all COPD patients, BMI was less than 18.5 kg/m2 for 37.9%. This Prevalence of under nutrition based on BMI was found to be statistically significant among study participants with p<0.001. Mean value of BMI, MAC, MAMC and TSF significantly lowered as the severity of COPD increased with p <0.001. Decreased mean values of FM, FMI, and FFM were significantly associated with increasing severity of COPD with p <0.001. Plasma albumin was less than 3.5 g/l among 72 (17%) patients. Total protein, less than 6 g/l was founded in 58 (13%) of patients. Plasma levels of albumin, total protein, urea, creatinine were lowered with the increase in the severity of disease.
Conclusion: The study findings highlight the importance to consider body composition in addition to body mass index as the only criterion of malnutrition, because patients do show frequent alterations in body composition, affecting the muscle store, the fat and total body water as the disease became more severe.
Downloads
References
2. Chapman KR, Mannino DM, Soriano JB, Vermeire PA, Buist AS, Thun MJ, Connell C, Jemal A, Lee TA, Miravitlles M, Aldington S, Beasley R. Epidemiology and costs of chronic obstructive pulmonary disease. Eur Respir J. 2006 Jan;27(1):188-207. [PubMed]
3. Mannino DM. COPD: epidemiology, prevalence, morbidity and mortality, and disease heterogeneity. Chest. 2002 May;121(5 Suppl):121S-126S. [PubMed]
4. Feenstra TL, van Genugten ML, Hoogenveen RT, Wouters EF, Rutten-van Mölken MP. The impact of aging and smoking on the future burden of chronic obstructive pulmonary disease: a model analysis in the Netherlands. Am J Respir Crit Care Med. 2001 Aug 15;164(4):590-6.
5. Halbert RJ, Isonaka S, George D, Iqbal A. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest. 2003 May;123(5):1684-92.
6. Orozco-Levi M, Garcia-Aymerich J, Villar J, Ramírez-Sarmiento A, Antó JM, Gea J. Wood smoke exposure and risk of chronic obstructive pulmonary disease. Eur Respir J. 2006 Mar;27(3):542-6. [PubMed]
7. Viegi G, Scognamiglio A, Baldacci S, Pistelli F, Carrozzi L. Epidemiology of chronic obstructive pulmonary disease (COPD). Respiration. 2001;68(1):4-19. [PubMed]
8. Schols AM, Fredrix EW, Soeters PB, Westerterp KR, Wouters EF. Resting energy expenditure in patients with chronic obstructive pulmonary disease. Am J Clin Nutr. 1991 Dec;54(6):983-7.
9. Goldstein S, Askanazi J, Weissman C, Thomashow B, Kinney JM. Energy expenditure in patients with chronic obstructive pulmonary disease. Chest. 1987 Feb;91(2):222-4.
10. Sinde F, Gronberg AM, Engstrom CP, Rossander- Hulthen L, Larsson S. Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir Med. 2002 May;96(5):330-6.
11. Gray-Donald K, Gibbons L, Shapiro SH, Macklem PT, Martin JG. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1996 Mar;153(3):961-6. [PubMed]
12. Steiner MC, Barton RL, Singh SJ, Morgan MD. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial. Thorax. 2003 Sep;58(9):745-51. [PubMed]
13. Cai B, Zhu Y, Ma Yi, Xu Z, Zao Yi, Wang J, Lin Y, Comer GM. Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Nutrition. 2003 Mar;19(3):229-32. [PubMed]
14. Creutzberg EC, Wouters EF, Mostert R, Weling- Scheepers CA, Schols AM. Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition. 2003 Feb;19(2):120-7.
15. Braun SR, Keim NL, Dixon RM, Clagnaz P, Anderegg A, Shrago ES. The prevalence and determinants of nutritional changes in chronic obstructive pulmonary disease. Chest. 1984 Oct;86(4):558-63. [PubMed]
16. Hallin R, Koivisto-Hursti UK, Lindberg E, Janson C. Nutritional status, dietary energy intake and the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Respir Med. 2006 Mar;100(3):561-7. [PubMed]
17. Soler-Cataluña JJ, Sánchez-Sánchez L, Martínez-García MA, Sánchez PR, Salcedo E, Navarro M. Mid-arm muscle area is a better predictor of mortality than body mass index in COPD. Chest. 2005 Oct;128(4):2108-15. [PubMed]
18. Thorsdottir I, Gunnarsdottir I, Eriksen B. Screening method evaluated by nutritional status measurements can be used to detect malnourishment in chronic obstructive pulmonary disease. J Am Diet Assoc. 2001 Jun;101(6):648-54.
19. Carlson TH . Laboratory data in nutrition assessment. In: Krause, s Food, Nutrition and Diet Therapy. Eds, Mahan LK, Escott- Stump S. 11th ed, Pennsylvania: Saunders, USA. P.440: 2004.
OAI - Open Archives Initiative
