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Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD.

Abstract

BACKGROUND

Despite the high prevalence of weight loss in subjects with COPD, the 2011 COPD management guidelines do not include an index measuring nutritional status. Fat-free mass index (FFMI) can accurately determine the nutritional status of subjects and may be closely correlated with COPD severity. We aimed to determine the nutritional status evaluated by FFMI according to the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) levels in stable subjects with COPD and the association between nutritional status and respiratory symptoms, exercise capacity, and respiratory muscle function.

METHODS

We included 235 stable subjects with COPD in this cross-sectional study. All of the subjects were divided into the 2011 GOLD Groups A, B, C, and D. FFMI (measured by bioelectrical impedance), spirometry (FEV1, percent-of-predicted FEV1, and FEV1/FVC), respiratory muscle function (peak inspiratory and peak expiratory pressures), exercise capacity (6-min walk distance), and dyspnea severity (Modified Medical Research Council dyspnea scale) were measured and compared between the GOLD groups.

RESULTS

Malnutrition was identified in 48.5% of subjects and most prevalent in Group D (Group A: 41%, Group B: 41%, Group C: 31%, and Group D: 62%). FFMI was significantly lower in Group D (P < .001), with both sexes considered malnourished. Low FFMI significantly correlated with frequent exacerbation, older age, decreased pulmonary function, 6-min walk distance, peak inspiratory pressure, and worsened dyspnea. FFMI was significantly lower in the emphysema-dominant phenotype and mixed phenotype compared with the normal phenotype and airway-dominant phenotype. A stepwise multiple linear regression analysis identified peak inspiratory pressures and older age as independent predictors of FFMI.

CONCLUSIONS

Malnutrition is highly prevalent in all COPD groups, particularly in Group D subjects, who warrant special attention for nutritional intervention and pulmonary rehabilitation. FFMI significantly correlated with exercise capacity, dyspnea, respiratory muscle function, and pulmonary function and may be a useful predictor of COPD severity.

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  • Authors+Show Affiliations

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

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    State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Disease, Guangzhou Medical University, Guangzhou 510120, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.

    ,

    Department of Respiratory Diseases, SUN Yat-sen Memorial Hospital, SUN Yat-sen University, Guangzhou 510120, China. chen_xin1020@hotmail.com gzchenrui@163.com.

    Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China. chen_xin1020@hotmail.com gzchenrui@163.com.

    Source

    Respiratory care 61:5 2016 May pg 680-8

    MeSH

    Aged
    Body Mass Index
    Cross-Sectional Studies
    Dyspnea
    Electric Impedance
    Exercise Tolerance
    Female
    Humans
    Lung
    Male
    Malnutrition
    Middle Aged
    Nutritional Status
    Prevalence
    Pulmonary Disease, Chronic Obstructive
    Respiratory Muscles
    Severity of Illness Index
    Spirometry
    Tomography, X-Ray Computed

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    26814217

    Citation

    Luo, Yuwen, et al. "Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD." Respiratory Care, vol. 61, no. 5, 2016, pp. 680-8.
    Luo Y, Zhou L, Li Y, et al. Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD. Respir Care. 2016;61(5):680-8.
    Luo, Y., Zhou, L., Li, Y., Guo, S., Li, X., Zheng, J., ... Chen, X. (2016). Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD. Respiratory Care, 61(5), pp. 680-8. doi:10.4187/respcare.04358.
    Luo Y, et al. Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD. Respir Care. 2016;61(5):680-8. PubMed PMID: 26814217.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Fat-Free Mass Index for Evaluating the Nutritional Status and Disease Severity in COPD. AU - Luo,Yuwen, AU - Zhou,Luqian, AU - Li,Yun, AU - Guo,Songwen, AU - Li,Xiuxia, AU - Zheng,Jingjing, AU - Zhu,Zhe, AU - Chen,Yitai, AU - Huang,Yuxia, AU - Chen,Rui, AU - Chen,Xin, Y1 - 2016/01/26/ PY - 2016/1/28/entrez PY - 2016/1/28/pubmed PY - 2017/4/12/medline KW - chronic obstructive pulmonary disease KW - epidemiology KW - free fat mass index KW - malnutrition KW - prognosis KW - pulmonary function SP - 680 EP - 8 JF - Respiratory care JO - Respir Care VL - 61 IS - 5 N2 - BACKGROUND: Despite the high prevalence of weight loss in subjects with COPD, the 2011 COPD management guidelines do not include an index measuring nutritional status. Fat-free mass index (FFMI) can accurately determine the nutritional status of subjects and may be closely correlated with COPD severity. We aimed to determine the nutritional status evaluated by FFMI according to the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) levels in stable subjects with COPD and the association between nutritional status and respiratory symptoms, exercise capacity, and respiratory muscle function. METHODS: We included 235 stable subjects with COPD in this cross-sectional study. All of the subjects were divided into the 2011 GOLD Groups A, B, C, and D. FFMI (measured by bioelectrical impedance), spirometry (FEV1, percent-of-predicted FEV1, and FEV1/FVC), respiratory muscle function (peak inspiratory and peak expiratory pressures), exercise capacity (6-min walk distance), and dyspnea severity (Modified Medical Research Council dyspnea scale) were measured and compared between the GOLD groups. RESULTS: Malnutrition was identified in 48.5% of subjects and most prevalent in Group D (Group A: 41%, Group B: 41%, Group C: 31%, and Group D: 62%). FFMI was significantly lower in Group D (P < .001), with both sexes considered malnourished. Low FFMI significantly correlated with frequent exacerbation, older age, decreased pulmonary function, 6-min walk distance, peak inspiratory pressure, and worsened dyspnea. FFMI was significantly lower in the emphysema-dominant phenotype and mixed phenotype compared with the normal phenotype and airway-dominant phenotype. A stepwise multiple linear regression analysis identified peak inspiratory pressures and older age as independent predictors of FFMI. CONCLUSIONS: Malnutrition is highly prevalent in all COPD groups, particularly in Group D subjects, who warrant special attention for nutritional intervention and pulmonary rehabilitation. FFMI significantly correlated with exercise capacity, dyspnea, respiratory muscle function, and pulmonary function and may be a useful predictor of COPD severity. SN - 1943-3654 UR - https://www.unboundmedicine.com/medline/citation/26814217/Fat_Free_Mass_Index_for_Evaluating_the_Nutritional_Status_and_Disease_Severity_in_COPD_ L2 - http://rc.rcjournal.com/cgi/pmidlookup?view=short&amp;pmid=26814217 DB - PRIME DP - Unbound Medicine ER -