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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To determine the prevalence of malnutrition in outpatients with stable chronic obstructive pulmonary disease &#40;COPD&#41; followed at a respiratory clinic&#46;</p> <span class="elsevierStyleSectionTitle">Material and method</span><p class="elsevierStyleSimplePara elsevierViewall">In this prospective study&#44; we assessed the nutritional status of consecutive outpatients with stable COPD by investigating various anthropometric parameters&#46; Patients were malnourished &#40;low body weight&#41; if their body mass index was within the bottom quartile of a reference population&#46; Muscle mass was determined from the midarm muscle area and if this mass was at or within the bottom quartile&#44; muscle wasting was present&#46; Albumin and transferrin plasma concentrations were used as a measure of visceral protein stores&#46; Fat stores were assessed from body fat and if this value was at or within the bottom quartile&#44; calorific malnutrition was present&#46; All patients underwent arterial blood gas sampling at rest and spirometry&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 178 patients&#8212;one woman &#40;0&#46;6&#37;&#41; and 177 men &#40;99&#46;4&#37;&#41;&#8212;were enrolled in the study&#44; with a mean &#40;SD&#41; age of 69 &#40;9&#41; years&#46; We found low body weight in 19&#46;1&#37; of the patients&#44; muscle wasting in 47&#46;2&#37;&#44; visceral protein depletion in 17&#46;4&#37;&#44; and fat depletion in 19&#46;1&#37;&#46; Of the patients with normal weight&#44; 62&#46;9&#37; showed muscle wasting&#46; The proportion of patients with a body mass index or midarm muscle area at or within the bottom quartile increased significantly with increased bronchial obstruction &#40;<span class="elsevierStyleItalic">P</span> &#60;&#46;001 and <span class="elsevierStyleItalic">P</span>&#61;&#46;015&#44; respectively&#41;&#44; though 35&#46;7&#37; of the patients showed muscle wasting even when COPD was mild&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Many patients with stable COPD suffer malnutrition&#46; Nutritional state is worse with more severe COPD&#46; Depletion involves both fat stores and muscle and visceral protein stores&#44; but the greatest effect is seen in muscle wasting&#46; A significant number of patients with normal weight also suffer muscle wasting&#46; Although changes in body composition were common in our patients&#44; low body weight was less prevalent than has been reported for populations in countries that are socially and economically similar to Spain&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Determinar la prevalencia de la desnutrici&#243;n en pacientes con enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; estable&#44; controlados en una consulta especializada de neumolog&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Material Y M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio prospectivo y con-secutivo en pacientes con EPOC estable controlados de forma ambulatoria&#46; Para valorar el estado nutricional empleamos diversos par&#225;metros antropom&#201;tricos&#46; Se defini&#243; desnutrici&#243;n global &#40;bajo peso corporal&#41; como la presencia de un &#237;ndice de masa corporal inferior al percentil 25 del valor de referencia&#46; Para valorar el compartimiento proteico muscular se determin&#243; el &#225;rea muscular del brazo y se defini&#243; la depleci&#243;n muscular como un valor de &#225;rea muscular del brazo igual o inferior al percentil 25&#46; Como valoraci&#243;n de la prote&#237;na visceral se midieron las concen-traciones plasm&#225;ticas de alb&#250;mina y transferrina&#46; El compartimiento graso se estudi&#243; mediante la determinaci&#243;n de la grasa corporal total&#46; Un valor de &#201;sta igual o inferior al percentil 25 se utiliz&#243; como criterio de desnutrici&#243;n cal&#243;rica&#46; Se realizaron a to-dos los pacientes espirometr&#237;a y gasometr&#237;a arterial en reposo&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; en el estudio a 178 pacientes -una mujer &#40;0&#44;6&#37;&#41; y 177 varones &#40;99&#44;4&#37;&#41;-&#44; con una edad media de 69 &#177; 9 a&#241;os&#46; Las prevalencias de bajo peso corporal&#44; desnutrici&#243;n proteica&#44; muscular o visceral y depleci&#243;n grasa fueron del 19&#44;1&#44; el 47&#44;2&#44; el 17&#44;4 y el 19&#44;1&#37;&#44; respectivamente&#46; Entre los pacientes con normopeso&#44; el 62&#44;9&#37; presentaba p&#201;rdida de masa muscular&#46; La proporci&#243;n de casos con &#237;ndice de masa corporal igual o menor del percentil 25 o &#225;rea muscular del brazo igual o inferior al percentil 25 aument&#243; de forma significativa a medida que empeora-ba el grado de obstrucci&#243;n bronquial &#40;p &#60; 0&#44;001 y p &#61; 0&#44;015&#44; respectivamente&#41;&#46; No obstante&#44; hasta un 35&#44;7&#37; de los pacientes con EPOC leve tambi&#201;n mostraron depleci&#243;n proteica muscular&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">La desnutrici&#243;n en pacientes con EPOC estable es un problema frecuente&#44; que aumenta con la gravedad de la enfermedad&#46; La depleci&#243;n afecta tanto al compartimiento graso como al proteico muscular y visceral&#46; No obstante&#44; existe un cierto efecto preferencial sobre la p&#201;rdida de masa muscular&#46; Una proporci&#243;n significativa de pacientes con normopeso tambi&#201;n sufre desnutrici&#243;n proteica muscular&#46; Pese a que las alteraciones en la composici&#243;n corporal son frecuentes&#44; nuestros resultados reflejan una prevalencia de bajo peso corporal menor que la de diversas series publicadas en pa&#237;ses de nuestro entorno social y econ&#243;mico&#46;</p>"
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Vol. 40. Issue 6.
Pages 250-258 (June 2004)
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Vol. 40. Issue 6.
Pages 250-258 (June 2004)
Original Articles
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Prevalence of Malnutrition in Outpatients With Stable Chronic Obstructive Pulmonary Disease
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J.J. Solera,
Corresponding author
soler_juacat@gra.es

Correspondence: Dr. J.J. Soler Cataluña. Unidad de Neumología. Servicio de Medicina Interna. Hospital General de Requena. Paraje Casablanca, s/n. 46430 Requena. Valencia. España
, L. Sánchezb, P. Románb, M.A. Martíneza, M. Perpiñác
a Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Requena, Valencia, Spain
b Servicio de Medicina Interna, Hospital General de Requena, Requena, Valencia, Spain
c Servicio de Neumología, Hospital Universitari La Fe, Valencia. Spain
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Objective

To determine the prevalence of malnutrition in outpatients with stable chronic obstructive pulmonary disease (COPD) followed at a respiratory clinic.

Material and method

In this prospective study, we assessed the nutritional status of consecutive outpatients with stable COPD by investigating various anthropometric parameters. Patients were malnourished (low body weight) if their body mass index was within the bottom quartile of a reference population. Muscle mass was determined from the midarm muscle area and if this mass was at or within the bottom quartile, muscle wasting was present. Albumin and transferrin plasma concentrations were used as a measure of visceral protein stores. Fat stores were assessed from body fat and if this value was at or within the bottom quartile, calorific malnutrition was present. All patients underwent arterial blood gas sampling at rest and spirometry.

Results

A total of 178 patients—one woman (0.6%) and 177 men (99.4%)—were enrolled in the study, with a mean (SD) age of 69 (9) years. We found low body weight in 19.1% of the patients, muscle wasting in 47.2%, visceral protein depletion in 17.4%, and fat depletion in 19.1%. Of the patients with normal weight, 62.9% showed muscle wasting. The proportion of patients with a body mass index or midarm muscle area at or within the bottom quartile increased significantly with increased bronchial obstruction (P <.001 and P=.015, respectively), though 35.7% of the patients showed muscle wasting even when COPD was mild.

Conclusions

Many patients with stable COPD suffer malnutrition. Nutritional state is worse with more severe COPD. Depletion involves both fat stores and muscle and visceral protein stores, but the greatest effect is seen in muscle wasting. A significant number of patients with normal weight also suffer muscle wasting. Although changes in body composition were common in our patients, low body weight was less prevalent than has been reported for populations in countries that are socially and economically similar to Spain.

Key words:
Chronic obstructive pulmonary disease (COPD)
Malnutrition
Anthropometric measures
Objetivo

Determinar la prevalencia de la desnutrición en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable, controlados en una consulta especializada de neumología.

Material Y Métodos

Se realizó un estudio prospectivo y con-secutivo en pacientes con EPOC estable controlados de forma ambulatoria. Para valorar el estado nutricional empleamos diversos parámetros antropomÉtricos. Se definió desnutrición global (bajo peso corporal) como la presencia de un índice de masa corporal inferior al percentil 25 del valor de referencia. Para valorar el compartimiento proteico muscular se determinó el área muscular del brazo y se definió la depleción muscular como un valor de área muscular del brazo igual o inferior al percentil 25. Como valoración de la proteína visceral se midieron las concen-traciones plasmáticas de albúmina y transferrina. El compartimiento graso se estudió mediante la determinación de la grasa corporal total. Un valor de Ésta igual o inferior al percentil 25 se utilizó como criterio de desnutrición calórica. Se realizaron a to-dos los pacientes espirometría y gasometría arterial en reposo.

Resultados

Se incluyó en el estudio a 178 pacientes -una mujer (0,6%) y 177 varones (99,4%)-, con una edad media de 69 ± 9 años. Las prevalencias de bajo peso corporal, desnutrición proteica, muscular o visceral y depleción grasa fueron del 19,1, el 47,2, el 17,4 y el 19,1%, respectivamente. Entre los pacientes con normopeso, el 62,9% presentaba pÉrdida de masa muscular. La proporción de casos con índice de masa corporal igual o menor del percentil 25 o área muscular del brazo igual o inferior al percentil 25 aumentó de forma significativa a medida que empeora-ba el grado de obstrucción bronquial (p < 0,001 y p = 0,015, respectivamente). No obstante, hasta un 35,7% de los pacientes con EPOC leve tambiÉn mostraron depleción proteica muscular.

Conclusions

La desnutrición en pacientes con EPOC estable es un problema frecuente, que aumenta con la gravedad de la enfermedad. La depleción afecta tanto al compartimiento graso como al proteico muscular y visceral. No obstante, existe un cierto efecto preferencial sobre la pÉrdida de masa muscular. Una proporción significativa de pacientes con normopeso tambiÉn sufre desnutrición proteica muscular. Pese a que las alteraciones en la composición corporal son frecuentes, nuestros resultados reflejan una prevalencia de bajo peso corporal menor que la de diversas series publicadas en países de nuestro entorno social y económico.

Palabras clave:
Enfermedad pulmonar obstructiva crónica (EPOC)
Desnutrición
Medidas antropomÉtricas
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