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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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REFERENCES
[1]
AGN Agustí, A Noguera, J Sauleda, E Sala, J Pons, X Busquets.
Systemic effects of chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 347-360
[2]
C Landbo, E Prescott, 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
[3]
K Gray-Donald, L Gibbons, SH Shapiro, PT Maclem, JG Martín.
Nutritional status and mortality in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 153 (1996), pp. 961-966
[4]
MPKJ Engelen, AMWJ Schols, WC Baken, GJ Wesseling, EFM Wouters.
Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in an out-patient population with chronic obstructive pulmonary disease.
Eur Respir J, 7 (1994), pp. 1793-1797
[5]
Y Nishimura, N Tsutsumi, H Nakata, T Tsunenari, H Maeda, M Yokoyama.
Relationship between respiratory muscle strength and lean body mass in men with COPD.
Chest, 107 (1995), pp. 1232-1236
[6]
EM Baarends, AMWJ Schols, R Mostert, EFM Wouters.
Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease.
Eur Respir J, 10 (1997), pp. 2807-2813
[7]
AMWJ Schols, R Mostert, PB Soeters, EFM Wouters.
Body composition and exercise performance in patients with chronic obstructive pulmonary disease.
Thorax, 46 (1991), pp. 695-699
[8]
H Sahebjami, E Sathianpitayakul.
Influence of body weight on the severity of dyspnea in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 161 (2000), pp. 886-890
[9]
R Shoup, G Dalsky, S Warner, M Davies, M Connors, M Khan, et al.
Body composition and health-related quality of life in patients with obstructive airways disease.
Eur Respir J, 10 (1997), pp. 1576-1580
[10]
R Mostert, A Goris, C Weling-Sheepers, EF Wouters, AM Schols.
Tissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease.
Respir Med, 94 (2000), pp. 859-867
[11]
SR Braun, NL Keim, RM Dixon, P Clagnaz, A Anderegg, ES Shrago.
The prevalence and determinants of nutritional changes in chronic obstructive pulmonary disease.
Chest, 86 (1984), pp. 558-563
[12]
RS Mitchell, GF Filley.
Chronic obstructive bronchopulmonary disease. I. Clinical features.
Am Rev Respir Dis, 89 (1964), pp. 360-371
[13]
AMB Hunter, MA Carey, HW Larsh.
The nutritional status of patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 96 (1981), pp. 556-565
[14]
Metropolitan Life Insurance Company.
New weight standards for men and women.
Stat Bull Metrop Life Found, 64 (1983), pp. 1-4
[15]
WPT James, A Ferro-Luzzi, JC Waterlow.
Definition of chronic energy deficiency in adults.
Eur J Clin Nutr, 42 (1988), pp. 969-981
[16]
DO Wilson, RM Rogers, EC Wright, NR Anthonisen.
Body weight in chronic obstructive pulmonary disease. The National Institutes of Health Intermittent Positive-Pressure Breathing Trial.
Am Rev Respir Dis, 139 (1989), pp. 1435-1438
[17]
AMWJ Schols, PB Soeters, AMC Dingemans, R Mostert, PJ Frantzen, EFM Wouters.
Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation.
Am Rev Respir Dis, 147 (1993), pp. 1151-1156
[18]
H Sahebjami, JT Doers, ML Render, TL Bond.
Anthropometric and pulmonary function test profiles of outpatients with stable chronic obstructive pulmonary disease.
Am J Med, 94 (1993), pp. 469-474
[19]
T Montemayor, I Alfageme, C Escudero, J Morera, L Sánchez Agudo.
Grupo de Trabajo de la SEPAR. Normativa sobre el diagnóstico y el tratamiento de la enfermedad pulmonar obstructiva crónica.
Arch Bronconeumol, 32 (1996), pp. 285-301
[20]
JVGA Durnin, J Womersley.
Body fat assessed from total body density and its estimation from skin-fold thickness: measurements on 481 men and women aged from 16 to 72 years.
Br J Nutr, 32 (1974), pp. 77-97
[21]
DB Jellife.
Assessment of the nutritional status of the community, WHO, (1966),
[22]
W Ricart, F González-Huix, V Conde, Grup per l´Evaluacio de la Composició Corporal de la Població de Catalunya.
Valoración del estado de nutrición a través de la determinación de los parámetros antropométricos: nuevas tablas en la población laboral de Cataluña.
Med Clin (Barc), 100 (1993), pp. 681-691
[23]
M Esquius, S Schwart, J López Hellín, AL Andreu, E García.
Parámetros antropométricos de referencia de la población anciana.
Med Clin (Barc), 100 (1993), pp. 692-698
[24]
A Alastrué, M Rull, I Camps, C Ginesta, MR Melus, JA Salvá.
Nuevas normas y consejos en la valoración de los parámetros antropométricos en nuestra población: índice adiposomuscular, índices ponderales y tablas de percentiles de los datos antropométricos útiles en una valoración nutricional.
Med Clin (Barc), 91 (1988), pp. 223-236
[25]
J Sanchis, P Casan, J Castillo, N González, L Palenciano, J Roca.
Normativa para la práctica de la espirometría forzada.
Arch Bronconeumol, 25 (1989), pp. 132-142
[26]
J Roca, J Sanchis, A Agustí-Vidal, F Segarra, D Navajas, R Rodríguez, et al.
Spirometric reference values for a Mediterranean population.
Bull Eur Physiopathol Respir, 22 (1986), pp. 217-224
[27]
Grupo de Trabajo de la SEPAR para la práctica de la gasometría arterial.
Normativa sobre la gasometría arterial.
Arch Bronconeumol, 34 (1998), pp. 142-153
[28]
JM Pascual, F Carrión, C Sánchez, B Sánchez, C González.
Alteraciones nutricionales en pacientes con enfermedad pulmonar obstructiva crónica avanzada.
Med Clin (Barc), 107 (1996), pp. 486-489
[29]
C Coronell, 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
[30]
C Coronell, M Orozco-Levi, J Gea.
COPD and body weight in a Mediterranean population.
Clin Nutr, 21 (2002), pp. 437
[31]
F Franssen, E Wouters, A Schols.
Reply to Dr Coronell et al.
Clin Nutr, 21 (2002), pp. 437-438
[32]
S Bernard, P LeBlanc, F Whitthom, G Carrier, J Jobin, R Belleau, et al.
Peripheral muscle weakness in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 158 (1998), pp. 629-634
[33]
K Marquis, R Debigaré, Y Lacasse, P LeBlanc, J Jobin, G Carrier, et al.
Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 166 (2002), pp. 809-813
[34]
EFM Wouters.
Nutrition and metabolism in COPD.
Chest, 117 (2000), pp. 274S-280S
[35]
L Auwerx, B Staels.
Leptin.
[36]
G Lord, G Matarese, J Howard, RJ Baker, SR Bloom, RJ Lechler.
Leptin modulates the T-cell immune response and reverses starvation-induced immunosuppression.
Nature, 394 (1998), pp. 897-901
[37]
AMWJ Schols, EFM Wouters, PB Soeters, KP Westerterp.
Body composition by bioelectrical impedance analysis compared to deuterium dilution and skinfold anthropometry in patients with chronic obstructive pulmonary disease.
Am J Clin Nutr, 53 (1991), pp. 421-424
[38]
SB Heymsfield, C McManus, J Smith, V Stevens, DW Nixon.
Anthropometric measurements of muscle mass: revised equations for calculating bone-free arm muscle-area.
Am J Clin Nutr, 36 (1982), pp. 680-690
[39]
O Hugli, JW Fitting.
Alterations in metabolism and body composition in chronic respiratory diseases.
Eur Respir Mon, 24 (2003), pp. 11-22
[40]
MC Steiner, RL Barton, SJ Singh, MD Morgan.
Bedside methods versus dual energy x-ray absorptiometry for body composition measurement in COPD.
Eur Respir J, 19 (2002), pp. 626-631
[41]
A Alastrué, A Sitges Serra, E Jaurrieta, A Sitges Creus.
Valoración de los parámetros antropométricos en nuestra población.
Med Clin (Barc), 78 (1982), pp. 407-415
[42]
MP Engelen, AM Schols, RJ Lamers, EF Wouters.
Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease.
Clin Nutr, 18 (1999), pp. 275-280
Copyright © 2004. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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