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      Nutritional State during COPD Exacerbation: Clinical and Prognostic Implications

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          Abstract

          Aims: To estimate the prevalence of malnutrition in chronic obstructive pulmonary disease (COPD) patients hospitalized for exacerbation and to evaluate its clinical and prognostic influence on the exacerbation. Subjects/Methods: The subjects were 78 consecutive patients with moderate-to-severe COPD who were admitted to hospital with a diagnosis of exacerbation. Nutritional status was assessed by means of body mass index (BMI), bioelectric impedance analysis and levels of plasmatic albumin. Previous spirometry, 6-min walk test, severity of the exacerbation, days of hospitalization and readmission in the following 3 months were also evaluated. Results: Malnutrition [BMI <20 or fat-free mass (FFM) index ≤16] occurred in 38% of patients, while in 40% the involuntary weight loss revealed a malnutrition risk and in 18% patients the plasmatic albumin levels were <3 g/dl. FFM was correlated with forced expiratory volume in 1 s, forced vital capacity and distance walked in 6 min. Number of days of hospitalization were related to FFM, muscle mass, BMI and albumin. The patients readmitted in the following 3 months had less FFM than the patients who were not readmitted. Conclusions: The high prevalence of malnutrition among hospitalized COPD patients is related to their lung function and exercise tolerance. Moreover, nutritional parameters during exacerbation are related to length of hospitalization and readmission.

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          Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the ‘malnutrition universal screening tool’ (‘MUST’) for adults

          Rebecca J Stratton, Annemarie Hackston, David Longmore … (2004)
          Article 0 comments Cited 107 times – based on 0 reviews     Review now
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            Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD.

            Yolande Vermeeren, E Wouters, Jos Schols (1997)
            In this study, we investigated the influence of an acute disease exacerbation on the nutritional and metabolic status of patients with chronic obstructive pulmonary disease (COPD). The study group consisted of 23 patients acutely admitted to the hospital for standardized medical treatment. Dietary intake (dietary records and diet history), resting energy expenditure (ventilated hood), body composition (bioelectrical impedance spectroscopy) and disease symptoms (visual analogue scale) were assessed on admission, daily throughout the hospitalization period, at discharge and 3 months thereafter in stable clinical condition. Dietary intake, since aggravation of disease symptoms, prior to admission, (5,640+/-2,671 kJ) was significantly lower than habitual intake (7,863+/-2,005 kJ). The balance between dietary intake with measured resting energy expenditure and estimated diet-induced thermogenesis was severely impaired during the first 3 days of hospitalization, stabilizing thereafter to 145+/-24% at discharge. Resting energy expenditure decreased from 6,812+/-900 kJ (123+/-11%) on admission to 6,196+/-795 kJ (113+/-14%) at discharge (p<0.001). During treatment, no significant shift in water compartments, fat-free mass and body weight was seen. Follow-up data were obtained from 10 out of 23 patients. Three months after admission, dietary intake was not significantly different from usual dietary intake (8,512+/-2,290 and 8,415+/-2,600 kJ, respectively), resting energy expenditure was similar to the value at discharge, and a significant body weight gain was seen. We conclude that an acute exacerbation of chronic obstructive pulmonary disease is accompanied by an impaired energy balance due to a decreased dietary intake and an increased resting energy expenditure.
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              Bioelectrical impedance analysis in estimating nutritional status and outcome of patients with chronic obstructive pulmonary disease and acute respiratory failure.

              J P Laaban, B Kouchakji, C Faisy … (2000)
              To evaluate bioelectrical impedance analysis (BIA) in estimating the nutritional status and outcome of patients with chronic obstructive pulmonary disease (COPD) and acute respiratory failure (ARF) in comparison with measurements of anthropometric parameters and plasma levels of visceral proteins. Retrospective study. A ten-bed intensive care unit (ICU) in a university teaching hospital. 51 COPD patients with ARF in whom BIA data, anthropometric parameters, and measurements of visceral proteins were available. BIA results in patients requiring mechanical ventilation (MV) vs. those who did not showed lower active cell mass (ACM; 37.5 +/- 6.5% vs. 42.4 +/- 7.2% body weight, P = 0.01) and a higher extra-/intracellular water volume ratio (ECW/ICW; 1.25 +/- 0.2 vs. 1.04 +/- 0.2, P = 0.0001), suggesting a more severe alteration in the nutritional status among those on MV. Anthropometric data showed the opposite results, since body weight, body mass index (BMI), triceps skinfold thickness (TSF), and fat mass were significantly higher in the invasively ventilated patients, whereas middle-arm muscle circumference (MAMC) did not differ between the two groups. The marked inflation of the extracellular compartment (ECW, ECW/ICW) that was well shown by BIA in the invasively ventilated patients presumably lead to inaccurate anthropometric results (overestimation of TSF and fat mass, and erroneous measure of MAMC). A higher death rate (38% vs. 0%, P = 0.01) was observed in the patients with ACM depletion (ACM < or = 40.6% body weight, n = 26) than in those without ACM depletion (n = 25). Low albumin level (< 30 g/l) was associated with increased mortality (33% vs. 7%, P = 0.04), but the differences in the other biological and anthropometric parameters (prealbumin and transferrin levels, body weight, BMI, TSF, MAMC, fat mass, and fat-free mass) were not associated with mortality. This study suggests that the decrease in BIA-derived ACM is a good indication of malnutrition and of poor outcome in COPD patients with ARF.
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                Author and article information

                Journal
                Journal ID (publisher-id): ANM
                Journal ID (nlm-ta): Ann Nutr Metab
                Journal ID (doi): 10.1159/issn.0250-6807
                Title: Annals of Nutrition and Metabolism
                Publisher: S. Karger AG
                ISSN (Print): 0250-6807
                ISSN (Electronic): 1421-9697
                Publication date Subscription-year: 2009
                Publication date (Print): March 2009
                Publication date (Electronic): 02 March 2009
                Volume: 54
                Issue: 1
                Pages: 52-58
                Affiliations
                aServicio de Neumología, bSección de Nutrición, and cUnidad de Epidemiología Clínica, Hospital Universitario de la Princesa, and dServicio de Neumología, Hospital Universitario La Paz, Madrid, Spain
                Article
                Publisher ID: 205960 Other ID: Ann Nutr Metab 2009;54:52–58
                DOI: 10.1159/000205960
                PubMed ID: 19252400
                SO-VID: 6c4e0308-36b2-4559-b902-87684d855e2e
                Copyright © © 2009 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 02 May 2008
                Date accepted : 23 December 2008
                Page count
                Figures: 1, Tables: 3, References: 33, Pages: 7
                Categories
                Subject: Original Paper

                ScienceOpen disciplines: Nutrition & Dietetics,Health & Social care,Public health
                Keywords: Chronic obstructive pulmonary disease,Malnutrition,Bioimpedance,Fat-free mass
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics, Health & Social care, Public health
                Keywords: Chronic obstructive pulmonary disease, Malnutrition, Bioimpedance, Fat-free mass

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