Article information
Changes in nutritional status, such as weight loss and malnutrition, are a very common complication in patients with chronic obstructive pulmonary disease (COPD). These changes primarily affect the patients' quality of life and functional capacity and they are also independent prognostic indicators of both morbidity and mortality. Malnutrition in these patients is due to multiple factors including increases in resting energy expenditure, decreased food intake, the effects of certain drugs, and, perhaps most importantly, a high systemic inflammatory response.
The present review covers the most important facets of the prevalence, etiology, pathogenesis, and consequences of malnutrition in COPD and considers which parameters for nutritional assessment are the most satisfactory for use in routine clinical practice. The strategy used to ensure correct nutritional status in these patients is also discussed.
Key words:
Chronic bronchitis
COPD
Malnutrition
Nutritional assessment
Las alteraciones nutricionales, entendidas como pérdida de peso o desnutrición, son una complicación muy frecuente en los pacientes con enfermedad pulmonar obstructiva cró-nica (EPOC) y afectan principalmente a su capacidad fun-cional y calidad de vida, además de constituir un indicador pronóstico de morbilidad y mortalidad independientes. Los factores que contribuyen a la desnutrición son múltiples; en-tre ellos cabe mencionar el aumento del gasto energético en reposo, el descenso de la ingesta, el efecto de determinados fármacos y, quizá el más importante, una elevada respuesta inflamatoria sistémica.
En este artículo se pretende revisar los aspectos más im-portantes sobre la prevalencia, etiopatogenia y efectos de la desnutrición en la EPOC, además de discutir los parámetros de valoración nutricional más adecuados en la práctica clí-nica diaria y la estrategia para que estos pacientes manten-gan un correcto estado nutricional.
Palabras clave:
Bronquitis crónica
EPOC
Desnutrición
Valo-ración nutricional
Full text is only aviable in PDF
REFERENCES
[1]
AG Agustí, A Noguera, J Sauleda, E Sala, J Pons, X Busquet.
Systemic effects of chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 347-360
[2]
C Coronel, M Orozco-Levi, A Ramírez-Sarmiento, J Martínez-Llorens, J Broquetas, J Gea.
Síndrome de bajo peso asociado a la EPOC en nuestro medio.
Arch Bronconeumol, 38 (2002), pp. 580-584
[3]
RJ Foley, R ZuWallack.
The impact of nutritional depletion in chronic obstructive pulmonary disease.
J Cardiopulm Rehabil, 21 (2001), pp. 1041-1052
[4]
DO Wilson, RM Rogers, MH Sanders.
Nutritional intervention in malnourished emphysema patients.
Am Rev Respir Dis, 134 (1986), pp. 672-677
[5]
MP Engelen, AM Schols, WC Baken.
Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in outpatients with COPD.
Eur Respir J, 7 (1994), pp. 1793-1797
[6]
JM Pascual, F Carrión, B Sánchez, C González.
Alteraciones nutricionales en pacientes con enfermedad pulmonar obstructiva crónica avanzada.
Med Clin (Barc), 107 (1996), pp. 486-489
[7]
JJ Soler, L Sánchez, P Román, MA Martínez, M Perpiñá.
Prevalencia de la desnutrición en pacientes ambulatorios con enfermedad pulmonar obstructiva crónica.
Arch Bronconeumol, 40 (2004), pp. 250-258
[8]
C Landbo, E Prescot, P Lange, J Vestbo, TP Almdal.
Prognostic value of nutritional status in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 160 (1999), pp. 1856-1861
[9]
BR Celli, CG Cote, JM Marín, C Casanova, M Montes de Oca, RA Méndez, et al.
The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[10]
MJ Gómez, FM González, C Sánchez.
Estudio del estado nutricional en la población anciana hospitalizada.
Nutr Hosp, 20 (2005), pp. 286-292
[11]
AM Schols, PB Soeters, R Mostert, WH Saris, EF Wouters.
Energy balance in chronic obstructive pulmonary disease.
Am Rev Respir Dis, 143 (1991), pp. 1248-1252
[12]
M di Francia, D Barbier, JL Mege, J Orehek.
Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 150 (1994), pp. 1453-1455
[13]
P Amoroso, SR Wilson, J Moxham, J Ponte.
Acute effects of inhaled salbutamol on metabolic rate normal subjects.
Thorax, 48 (1993), pp. 882-885
[14]
MA Vermeeren, AM Schols, EF Wouters.
Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD.
Eur Respir J, 10 (1997), pp. 2264-2269
[15]
M Calikoglu, G Sahin, A Unlu, C Ozturk, L Tamer, B Ercan, et al.
Leptin and TNF-alpha levels in patients with chronic obstructive pulmonary disease and their relationship to nutritional parameters.
Respiration, 71 (2004), pp. 45-50
[16]
B Celli, R Goldstein, J Jardim, K Knobil.
Future perspectives in COPD.
Respir Med, 99 (2005), pp. 41-48
[17]
J Acosta, V Gómez-Tello, S Ruiz.
Valoración del estado nutricional en el paciente grave.
Nutr Hosp, 20 (2005), pp. 5-8
[18]
F Slinde, A Gronberg, CP Engstrom, L Rossander-Hulthen, S Larsson.
Body composition by bioelectrical impedance predicts mortality in chronic obstructive pulmonary disease patients.
Respir Med, 99 (2005), pp. 1004-1009
[19]
A Mallampalli.
Nutritional management of the patient with chronic obstructive pulmonary disease.
Nutr Clin Pract, 19 (2004), pp. 550-556
[20]
L Villamayor, G Llimera, V Jorge, C González, C Iniesta, MC Mira, et al.
Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías.
Nutr Hosp, 21 (2006), pp. 163-172
[21]
Mota-Casals S.
¿Cuál es el papel del entrenamiento de los músculos inspiratorios en el tratamiento de la EPOC? Arch Bronconeumol, 41 (2005), pp. 601-606
[22]
H Verea-Hernández.
Corticoides en las exacerbaciones de la EPOC: sí, pero menos.
Arch Bronconeumol, 41 (2005), pp. 641
[23]
B Dureuil, Y Matuszczak.
Alteration in nutritional status and diaphragm muscle function.
Reprod Nutr Dev, 38 (1998), pp. 175-180
[24]
J Gea, M Orozco-Levi, E Barreiro.
Particularidades fisiopatológicas de las alteraciones musculares del paciente con EPOC.
Nutr Hosp, 21 (2006), pp. 62-68
[25]
F de Benedetto, A del Ponte, S Marinari.
The role of nutritional status in the global assessment of severe COPD patients.
Monaldi Arch Chest Dis, 59 (2003), pp. 314-319
[27]
H Sahebjami, M Domino.
Effects of repeated cycles of starvation and refeeding on lungs of growing rats.
J Appl Physiol, 73 (1992), pp. 2349-2354
[28]
JM Anon, A García de Lorenzo, R Álvarez-Sala, MP Escuela.
Tratamiento y pronóstico de la reagudización grave en la enfermedad pulmonar obstructiva crónica.
Rev Clin Esp, 201 (2001), pp. 658-666
[29]
AM Schols, EF Wouters.
Nutritional considerations in the treatment of chronic obstructive pulmonary disease.
Clin Nutr, 14 (1995), pp. 64-73
[30]
IM Ferreira, D Brooks, Y Lacasse, RS Goldstein, J White.
Nutritional supplementation for stable chronic obstructive pulmonary disease.
Cochrane Database Syst Rev, 18 (2005),
[31]
J López, M Planas, JM Añón.
Nutrición artificial en la insuficiencia respiratoria.
Nutr Hosp, 20 (2005), pp. 28-30
[32]
MP Engelen, EF Wouters, NE Deutz, PP Menheere, AM Schols.
Factors contributing to alterations in skeletal muscle and plasma amino acid profiles in patients with chronic obstructive pulmonary disease.
Am J Clin Nutr, 72 (2000), pp. 1415-1416
[33]
G Hu, PA Cassano.
Antioxidants nutrients and pulmonary function: the Third National Health and Nutrition examination Survey (NHANES III).
Am J Epidemiol, 151 (2000), pp. 975-981
[34]
R Broekhuizen, EC Creutzberg, CA Weling-Scheepers, EF Wouters, AM Schols.
Optimizing oral nutritional drink supplementation in patients with chronic obstructive pulmonary disease.
Br J Nutr, 93 (2005), pp. 965-971
[35]
AH Goris, MA Vermeeren, EF Wouters, AM Schols, KR Westerterp.
Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation.
Br J Nutr, 89 (2003), pp. 725-731
[36]
MK Sridhar, A Galloway, ME Lean, SW Banham.
An out-patient nutritional supplementation programme in COPD patients.
Eur Respir J, 7 (1994), pp. 720-724
[37]
EC Creutzberg, AM Schols, CA Weling-Scheepers, WA Buurman, EF Wouters.
Characterization of nonresponse to high caloric oral nutritional therapy in depleted patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 161 (2000), pp. 745-752
[38]
P Serón, P Riedemann, S Muñoz, A Doussoulin, P Villarroel, X Cea.
Efecto del entrenamiento muscular inspiratorio sobre la fuerza muscular y la calidad de vida en pacientes con limitación del flujo aéreo. Ensayo clínico aleatorizado.
Arch Bronconeumol, 41 (2005), pp. 601-606
[39]
COPD Guidelines Group of the Standards of Care Committee of the BTS.
Pulmonary rehabilitation.
Thorax, 56 (2001), pp. 827-834
[40]
J Álvarez.
Enfoque terapéutico global de la disfunción muscular en la EPOC.
Nutr Hosp, 21 (2006), pp. 76-83
[41]
MD Mesa, CM Aguilera, A Gil.
Importancia de los lípidos en el tratamiento nutricional de las patologías de base inflamatoria.
Nutr Hosp, 21 (2006), pp. 30-43
[42]
VA Angelillo, S Bedi, D Durfee.
Effects of low and high carbohydrate feeding in ambulatory patients with chronic obstructive pulmonary disease and chronic hypercapnia.
Ann Inter Med, 103 (1985), pp. 883-885
[43]
B García, T Grau.
La nutrición enteral precoz en el enfermo grave.
Nutr Hosp, 20 (2005), pp. 93-100
[44]
ASPEN. Board of Directors and The Guidelines Task Force.
Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients.
JPEN, 26 (2002), pp. 63-64
[45]
B Cai, Y Zhu, Y Ma, Z Xu, Y Zao, J Wang, et al.
Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients.
Nutrition, 19 (2003), pp. 229-232
[46]
A Lang, E Bardan, Y Chowers, E Sakhnini, HH Fidder, S Bar-Meir, et al.
Risk factors for mortality in patients undergoing percutaneous endoscopic gastrostomy.
Endoscopy, 36 (2004), pp. 522-526
[47]
JS Whittaker, CF Ryan, PA Buckley, JD Road.
The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive pulmonary disease patients.
Am Rev Respir Dis, 142 (1990), pp. 283-288
[48]
I Ferreira, IT Verreschi, LE Nery.
The influence of 6 months of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients.
Chest, 114 (1998), pp. 19-28
[49]
JK Berry, C Baum.
Reversal of chronic obstructive pulmonary disease-associated weight loss: are there pharmacological treatment options?.
Drugs, 64 (2004), pp. 1041-1052
[50]
AM Schols, PB Soeters, R Mostert.
Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease: placebo-controlled randomized trial.
Am J Respir Crit Care Med, 152 (1995), pp. 1268-1274
Copyright © 2007. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
