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Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease.

Abstract

OBJECTIVE

Weight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD.

METHODS

The therapy consisted of daily two to three oral liquid nutritional supplements (mean +/- standard deviation: 2812 +/- 523 kJ/24 h) incorporated into an 8-wk inpatient pulmonary rehabilitation program in 64 (49 men) depleted patients with COPD. Endpoints were body weight, fat-free mass by bioelectrical impedance analysis, respiratory and peripheral muscle function (maximal inspiratory mouth pressure and handgrip strength, respectively), exercise performance (incremental bicycle ergometry), and disease-specific health status by St. George's Respiratory Questionnaire. Forty-eight percent of the patients were treated with low-dose oral glucocorticosteroids as maintenance medication (dose equivalent to 7.6 +/- 2.5 mg of methylprednisolone per day).

RESULTS

Increases in body weight (2.1 +/- 2.1 kg, P < 0.001) and fat-free mass (1.1 +/- 2.0 kg, P < 0.001) were seen. Further, maximal inspiratory mouth pressure (4 +/- 10 cm of H(2)O, P = 0.001), handgrip strength (1.2 +/- 3.1 kg, P = 0.004), and peak workload (7 +/- 11 W, P = 0.001) significantly improved. Clinically significant improvements in the items symptoms (9 +/- 16 points, P < 0.001) and impact (4 +/- 15 points, P = 0.043) of St. George's Respiratory Questionnaire were achieved. Oral glucocorticosteroid treatment significantly impaired the response to nutritional supplementation therapy with respect to maximal inspiratory mouth pressure, peak workload, and St. George's Respiratory Questionnaire symptom score.

CONCLUSIONS

Nutritional supplementation therapy implemented in a pulmonary rehabilitation program was effective in depleted patients with COPD. However, oral glucocorticosteroid treatment attenuated the anabolic response to nutritional supplementation.

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  • Authors+Show Affiliations

    ,

    Department of Pulmonology, University Hospital Maastricht, Maastricht, The Netherlands. e.creutzberg@pul.unimaas.nl

    , , ,

    Source

    MeSH

    Aged
    Blood Proteins
    Body Composition
    Body Weight
    Dietary Supplements
    Energy Intake
    Energy Metabolism
    Female
    Glucocorticoids
    Health Status
    Humans
    Male
    Malnutrition
    Motor Activity
    Muscle, Skeletal
    Pulmonary Disease, Chronic Obstructive
    Respiratory Muscles
    Respiratory Physiological Phenomena

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    12591542

    Citation

    Creutzberg, Eva C., et al. "Efficacy of Nutritional Supplementation Therapy in Depleted Patients With Chronic Obstructive Pulmonary Disease." Nutrition (Burbank, Los Angeles County, Calif.), vol. 19, no. 2, 2003, pp. 120-7.
    Creutzberg EC, Wouters EF, Mostert R, et al. Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition. 2003;19(2):120-7.
    Creutzberg, E. C., Wouters, E. F., Mostert, R., Weling-Scheepers, C. A., & Schols, A. M. (2003). Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition (Burbank, Los Angeles County, Calif.), 19(2), pp. 120-7.
    Creutzberg EC, et al. Efficacy of Nutritional Supplementation Therapy in Depleted Patients With Chronic Obstructive Pulmonary Disease. Nutrition. 2003;19(2):120-7. PubMed PMID: 12591542.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. AU - Creutzberg,Eva C, AU - Wouters,Emiel F M, AU - Mostert,Rob, AU - Weling-Scheepers,Clarie A P M, AU - Schols,Annemie M W J, PY - 2003/2/20/pubmed PY - 2003/12/17/medline PY - 2003/2/20/entrez SP - 120 EP - 7 JF - Nutrition (Burbank, Los Angeles County, Calif.) JO - Nutrition VL - 19 IS - 2 N2 - OBJECTIVE: Weight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD. METHODS: The therapy consisted of daily two to three oral liquid nutritional supplements (mean +/- standard deviation: 2812 +/- 523 kJ/24 h) incorporated into an 8-wk inpatient pulmonary rehabilitation program in 64 (49 men) depleted patients with COPD. Endpoints were body weight, fat-free mass by bioelectrical impedance analysis, respiratory and peripheral muscle function (maximal inspiratory mouth pressure and handgrip strength, respectively), exercise performance (incremental bicycle ergometry), and disease-specific health status by St. George's Respiratory Questionnaire. Forty-eight percent of the patients were treated with low-dose oral glucocorticosteroids as maintenance medication (dose equivalent to 7.6 +/- 2.5 mg of methylprednisolone per day). RESULTS: Increases in body weight (2.1 +/- 2.1 kg, P < 0.001) and fat-free mass (1.1 +/- 2.0 kg, P < 0.001) were seen. Further, maximal inspiratory mouth pressure (4 +/- 10 cm of H(2)O, P = 0.001), handgrip strength (1.2 +/- 3.1 kg, P = 0.004), and peak workload (7 +/- 11 W, P = 0.001) significantly improved. Clinically significant improvements in the items symptoms (9 +/- 16 points, P < 0.001) and impact (4 +/- 15 points, P = 0.043) of St. George's Respiratory Questionnaire were achieved. Oral glucocorticosteroid treatment significantly impaired the response to nutritional supplementation therapy with respect to maximal inspiratory mouth pressure, peak workload, and St. George's Respiratory Questionnaire symptom score. CONCLUSIONS: Nutritional supplementation therapy implemented in a pulmonary rehabilitation program was effective in depleted patients with COPD. However, oral glucocorticosteroid treatment attenuated the anabolic response to nutritional supplementation. SN - 0899-9007 UR - https://www.unboundmedicine.com/medline/citation/12591542/Efficacy_of_nutritional_supplementation_therapy_in_depleted_patients_with_chronic_obstructive_pulmonary_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0899900702008419 DB - PRIME DP - Unbound Medicine ER -