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Chung AC, Chang CJ, Liu JF, Hung MS, Fang TP, Lin HL. The short- and long-term effects of lower limb endurance training on outpatients with chronic obstructive pulmonary disease. Clin Rehabil 2024; 38:85-97. [PMID: 37574917 DOI: 10.1177/02692155231192453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To explore the short- and long-term effects of lower-limb endurance training on chronic obstructive pulmonary disease outpatients. DESIGN Prospective quasi-experimental study. SETTING 1383-bed teaching hospital in Taiwan. PARTICIPANTS Overall, 69 outpatients diagnosed with chronic obstructive pulmonary disease were enrolled. A total of 60 patients completed the study. INTERVENTION Training group: Lower-limb endurance training; control group: Education only. MAIN MEASURES The modified medical research council score, chronic obstructive pulmonary disease assessment test score, pulmonary function test, and number of acute exacerbation within a year. RESULTS The training group showed significant improvement in the chronic obstructive pulmonary disease assessment test total score, modified medical research council score (both P < 0.001) at third month sustaining to 12th month (P < 0.001) and presented less events of acute exacerbation (P = 0.011) at 12th month. The chronic obstructive pulmonary disease assessment test decreased by 8 points sustaining to 12th month. The training group presented significant post-training functional capacity improvements in 6-min walking distance, lowest oxygen saturation during 6-min walking test, peak workload, maximum inspiratory/ expiratory pressures, and calf circumference. CONCLUSIONS The lower-limb endurance training improved perceived dyspnea in daily activity and health status after completion of training and sustaining for a year. The lower-limb endurance training alleviated disease impacted on reduced acute exacerbations.
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Affiliation(s)
- An-Chi Chung
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Physical Education, Health & Recreation, National Chiayi University-Minhsiung Campus, Chiayi, Taiwan
| | - Chun-Jung Chang
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Jui-Fang Liu
- Department of Respiratory Care, Chang Gung University and Technology, Chiayi, Taiwan
- Chronic Diseases and Health Promotion Research Centre, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Ming-Szu Hung
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tien-Pei Fang
- Department of Respiratory Therapy, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Respiratory Care, Chang Gung University and Technology, Chiayi, Taiwan
| | - Hui-Ling Lin
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
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2
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Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr 2023; 42:848-858. [PMID: 37084471 DOI: 10.1016/j.clnu.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Malnutrition is a significant comorbidity among chronic obstructive pulmonary disease (COPD), but it has been often ignored. To date, the prevalence of malnutrition and its association with clinical parameters in the patients with COPD have not been well described. We aimed to investigate the prevalence of malnutrition and the prevalence of at-risk for malnutrition among COPD and the clinical impact of malnutrition on patients with COPD in a systematic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched for articles describing the prevalence of malnutrition and/or at-risk for malnutrition from January 2010 to December 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine the prevalence of malnutrition and at-risk for malnutrition and the clinical impact of malnutrition on patients with COPD. Meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Comparisons were made between individuals with and without malnutrition according to pulmonary function, degree of dyspnea, exercise capacity, and mortality risk. RESULTS Out of the 4156 references identified, 101 were read full-text, of which 36 studies were included. The total number of involved patients included in this meta-analysis was 5289. The prevalence of malnutrition was 30.0% (95% CI 20.3 to 40.6), compared with an at-risk prevalence of 50.0% (95% CI 40.8 to 59.2). Both prevalences were associated with regions and measurement tools. The prevalence of malnutrition was associated with COPD phase (acute exacerbations and stable). COPD with malnutrition showed lower forced expiratory volume 1 s % predicted (mean difference (MD) -7.19, 95% CI -11.86 to -2.52), higher modified Medical Research Council dyspnea scores (MD 0.38, 95% CI 0.12 to 0.64), poorer exercise tolerance (standardized mean difference -0.29, 95% CI -0.54 to -0.05), and higher mortality risk (hazard ratio 2.24, 95% CI 1.23 to 4.06) compared to COPD without malnutrition. CONCLUSION Malnutrition and at-risk for malnutrition are common among COPD. Malnutrition negatively impacts important clinical outcomes of COPD.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Ye Lu
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Zhou
- Respiratory Department, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
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3
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Pradelli L, Zaniolo O, Sanfilippo A, Lezo A, Riso S, Zanetti M. Prevalence and economic cost of malnutrition in Italy: A systematic review and metanalysis from the Italian Society of Artificial Nutrition and Metabolism (SINPE). Nutrition 2023; 108:111943. [PMID: 36669368 DOI: 10.1016/j.nut.2022.111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/14/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Disease-related malnutrition (DRM) is a major public health issue with dramatic consequences on outcomes. However, in Italy a comprehensive and updated overview on national prevalence, in both the adult and pediatric populations, and its burden on the health care environment, is missing. The aim of this systematic literature review and meta-analysis was to identify and summarize the available evidence regarding the prevalence of DRM in Italy from pediatric to adult and older ages, and to project its global costs on the health care system. METHODS We performed a systematic literature search for articles on epidemiology of DRM in Italy published up to June 2021. Studies reporting data on the prevalence of DRM in community-dwelling individuals with chronic diseases, nursing home patients, and hospitalized patients (medical, surgery, and oncology patients), were selected for inclusion. Methodological quality of the studies was assessed by two independent reviewers using published criteria. An epidemiologic meta-analysis to obtain an aggregate estimate of prevalence of DRM was performed and a model for estimating the cost of illness, based on the application of epidemiologic results to official national hospitalization data, and attribution of relevant unit costs in the national context was constructed. RESULTS Sixty-seven studies reporting on the prevalence of DRM in Italian populations were included in the final selection; meta-analytical pooling yields mean prevalence estimates of about 50% and 30% in adult and pediatric hospitalized populations, respectively, with even higher findings for residents of long-term care facilities. Modeled projections of DRM-attributable yearly economic effects on the Italian health care system exceed 10 billion € in base case analysis, with the most optimistic estimate still exceeding 2.5 billion €. CONCLUSION Although comparable in magnitude to data from previous studies in analogous international settings, the diffusion and effects of DRM in the Italian setting is impressive. Increased awareness of these data and proactive fostering of clinical nutrition services are warranted, as prompt identification and treatment of malnutrition have been shown to effectively improve clinical and economic results.
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Affiliation(s)
| | | | | | - Antonella Lezo
- Clinical Nutrition Unit, Children's Hospital "Regina Margherita," AOU Città della Salute e della Scienza, Turin, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit - "Maggiore della Carità" University Hospital, Novara, Italy
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy
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Bernardes S, Silva FM, da Costa CC, de Souza RM, Teixeira PJZ. Reduced calf circumference is an independent predictor of worse quality of life, severity of disease, frequent exacerbation, and death in patients with chronic obstructive pulmonary disease admitted to a pulmonary rehabilitation program: A historic cohort study. JPEN J Parenter Enteral Nutr 2021; 46:546-555. [PMID: 34173982 DOI: 10.1002/jpen.2214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Muscle wasting is associated with worse outcomes in chronic obstructive pulmonary disease (COPD) patients. We assessed the association of calf circumference (CC) measurements with clinical outcomes in COPD patients referred to an outpatient pulmonary rehabilitation program (PRP). METHODS In this single-center, retrospective study, we analyzed demographic and clinical data ( spirometry tests, comorbidities, COPD exacerbations, dyspnea scoring, exercise capacity, quality-of-life scores, BMI, CC measurements, and all-cause deaths [for 2 years]) from COPD patients PRP medical records. Patients were grouped according to CC into reduced CC (male, ≤34 cm; female, ≤33 cm) or adequate CC groups. RESULTS We evaluated 144 patients (aged 64.6 ± 8.5 years; mostly males; forced expiratory volume in 1 s, 40.3% ± 15.8%, predicted). Eighteen patients (12.5%) died during the 2 years of follow-up. Logistic regression showed that patients with reduced CC were more likely to present worse outcomes compared with COPD patients with adequate CC: more advanced disease severity (odds ratio [OR] = 5.09; 95% CI, 2.00-12.96), COPD frequent exacerbators (OR = 2.34; 95% CI, 1.11-4.91), worse total quality-of-life score (OR = 2.70, 95% CI, 1.22-6.00), and higher mortality (OR = 3.69; 95% CI, 1.06-12.87). CONCLUSION Reduced CC in COPD patients under initial assessment for PRP admission was associated with disease severity, frequent exacerbation, poor health status, and higher mortality in 2 years of follow-up. Considering its clinical applicability, CC measurement should be introduced in the nutrition assessment of COPD patients admitted to the PRP.
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Affiliation(s)
- Simone Bernardes
- Postgraduate Program in Health Sciences, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Flávia Moraes Silva
- Nutrition Department and Nutrition Science, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | | | - Paulo José Zimermann Teixeira
- Postgraduate Program in Health Sciences, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Clinical Medicine, Federal University of Health Science of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Hospital Pavilhão Pereira Filho, Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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5
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Jerng JS, Tang CH, Cheng RWY, Wang MYH, Hung KY. Healthcare utilization, medical costs and mortality associated with malnutrition in patients with chronic obstructive pulmonary disease: a matched cohort study. Curr Med Res Opin 2019; 35:1265-1273. [PMID: 30676096 DOI: 10.1080/03007995.2019.1574460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions. Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls. Results: The prevalence of malnutrition was 3.8% overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p < .01), and higher mortality (HR = 2.26, 95% CI 2.18-2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p < .001) and lower mortality (HR = 0.85, 95% CI 0.80-0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75% higher than controls (p < .001), whereas malnourished ventilator-dependent patients had total costs 7% lower than controls (p < .001). Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs.
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Affiliation(s)
- Jih-Shuin Jerng
- a Department of Internal Medicine , National Taiwan University Hospital , Taipei , Taiwan
| | - Chao-Hsiun Tang
- b School of Health Care Administration, College of Management , Taipei Medical University , Taipei , Taiwan
| | | | | | - Kuan-Yu Hung
- d Department of Internal Medicine , National Taiwan University Hospital Hsin-Chu Branch , Hsinchu , Taiwan
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Dubé BP, Laveneziana P. Effects of aging and comorbidities on nutritional status and muscle dysfunction in patients with COPD. J Thorac Dis 2018; 10:S1355-S1366. [PMID: 29928518 DOI: 10.21037/jtd.2018.02.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a prevalent, complex and debilitating disease which imposes a formidable burden on patients and the healthcare system. The recognition that COPD is a multifaceted disease is not new, and increasing evidence have outlined the importance of its extra-pulmonary manifestations and its relation to other comorbid conditions in the clinical course of the disease and its societal cost. The relationship between aging, COPD and its comorbidities on skeletal muscle function and nutritional status is complex, multidirectional and incompletely understood. Despite this, the current body of knowledge allows the identification of various, seemingly partially independent factors related both to the normal aging process and to the independent deleterious effects of chronic diseases on muscle function and body composition. There is a dire need of studies evaluating the relative contribution of each of these factors, and their potential synergistic effects in patients with COPD and advanced age/comorbid conditions, in order to delineate the best course of therapeutic action in this increasingly prevalent population.
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Affiliation(s)
- Bruno-Pierre Dubé
- Département de Médecine, Service de Pneumologie, Centre Hospitalier de l'Université de Montréal (CHUM) Montréal, Québec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) - Carrefour de l'Innovation et de l'Évaluation en Santé, Montréal, Québec, Canada
| | - Pierantonio Laveneziana
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée du Département R3S, Paris, France
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7
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Martinez CH, Diaz AA, Meldrum CA, McDonald MLN, Murray S, Kinney GL, Hokanson JE, Curtis JL, Bowler RP, Han MK, Washko GR. Handgrip Strength in Chronic Obstructive Pulmonary Disease. Associations with Acute Exacerbations and Body Composition. Ann Am Thorac Soc 2017; 14:1638-1645. [PMID: 29090990 PMCID: PMC5711268 DOI: 10.1513/annalsats.201610-821oc] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/24/2017] [Indexed: 01/26/2023] Open
Abstract
RATIONALE Handgrip strength (HGS) predicts mortality in the elderly, but its determinants and clinical significance in chronic obstructive pulmonary disease (COPD) has not been defined. OBJECTIVES We tested associations of HGS with pectoralis muscle area (PMA), subcutaneous adipose tissue (SAT), imaging characteristics, and lung function in smokers with COPD, and evaluated the cross-sectional and longitudinal associations of HGS with acute respiratory events. METHODS We analyzed demographic, clinical, spirometry, HGS, and imaging data of 272 subjects with COPD, obtaining measures of airway thickness, emphysema, PMA, and SAT from chest computed tomography scans. We tested associations of lung function and imaging characteristics with HGS, using linear models. HGS association to acute respiratory events at enrollment and during follow-up (mean, 2.6 years) was analyzed using adjusted logistic models. RESULTS HGS correlated with PMA, SAT, forced expiratory volume, and airway thickness, but not with body mass index or emphysema severity. In adjusted regression models, HGS was directly (β, 1.5; 95% confidence interval [CI], 0.1-3.0) and inversely (β, -3.3; 95% CI, -5.1 to -0.9) associated with one standard deviation of PMA and SAT, respectively, independent of body mass index and emphysema. In regression models adjusted for age, sex, body mass index, race, pack-years smoked, current smoking, chronic bronchitis, FEV1% predicted, emphysema, and airway metrics, HGS was associated with exacerbation risk; in cross-sectional analyses, there was an increment of 5% in the risk of exacerbations for each 1-kg decrement in HGS (risk ratio, 1.05; 95% CI, 1.01-1.08), and there was a similar risk during follow-up (risk ratio, 1.04; 95% CI, 1.01-1,07). CONCLUSIONS In ever-smokers with COPD, HGS is associated with computed tomography markers of body composition and airway thickness, independent of body mass index and emphysema. Higher HGS is associated with lower exacerbation frequency.
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Affiliation(s)
- Carlos H. Martinez
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Catherine A. Meldrum
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Merry-Lynn N. McDonald
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Murray
- School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - John E. Hokanson
- School of Public Health, University of Colorado, Aurora, Colorado
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and
| | - Jeffrey L. Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Russell P. Bowler
- Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado
| | - MeiLan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - for the COPDGene Investigators
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
- Division of Pulmonary and Critical Care Medicine, and
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- School of Public Health, University of Colorado, Aurora, Colorado
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and
- Division of Pulmonary Medicine, National Jewish Health, Denver, Colorado
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8
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Faramawy MAE, Korraa EEA, Dwedar IA, Riad NM, Nada MAM. Assessment of fitness and exercise tolerance of chronic obstructive pulmonary disease patients in correlation with their lifestyle. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.176664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Salama SS, Mohamed-Hussein AA, Khalil MA, Abd El-Gayed Eid S. Lean BMIs as markers of malnutrition in chronic obstructive pulmonary disease patients. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2016. [DOI: 10.4103/1687-8426.176663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Laudisio A, Costanzo L, Di Gioia C, Delussu AS, Traballesi M, Gemma A, Antonelli Incalzi R. Dietary intake of elderly outpatients with chronic obstructive pulmonary disease. Arch Gerontol Geriatr 2016; 64:75-81. [PMID: 26952380 DOI: 10.1016/j.archger.2016.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/30/2015] [Accepted: 01/07/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Chronic obstructive pulmonary disease (COPD) is often associated with malnutrition, which is in turn associated with poor outcomes. Accordingly, in COPD patients adequate nutrition might improve several clinical and functional outcomes. Nevertheless, information about nutrient intake of older populations with COPD is still scanty. MATERIALS AND METHODS We analysed data of 523 elderly attending a geriatric ambulatory. Of these, 165 had a diagnosis of COPD, while 358 were control participants, matched for demographic characteristics and free from respiratory diseases. COPD was diagnosed according to the global initiative for chronic obstructive lung disease (GOLD) criteria. The intake of micro and macronutrients was recorded using the European prospective investigation into cancer and nutrition (EPIC) questionnaire. Nutrient intake of COPD patients was compared with that of the control group and with recommended dietary allowances RDA. RESULTS COPD patients had a lower energy intake, as compared with control participants (29.4 vs 34.4 kcal/kg of ideal weight; P<.0001), due to reduced intake of carbohydrates and proteins. Accordingly, in the energy intake was lower than recommended in 52% of COPD patients, vs 30% of controls (P<.0001). The intake of calcium, potassium, folate, cholecalciferol, retinol, and thiamine was lower than RDA in over 75% of COPD patients. CONCLUSIONS The diet of elderly COPD outpatients does not provide the recommended energy intake, nor does it meet the RDA for many micronutrients. Such deficits are more severe than in age matched non- respiratory subjects.
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Affiliation(s)
- Alice Laudisio
- Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200-00128 Rome, Italy.
| | - Luisa Costanzo
- Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200-00128 Rome, Italy
| | - Claudia Di Gioia
- Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200-00128 Rome, Italy
| | | | | | - Antonella Gemma
- UOS Accesso e Presa in Carico Assistenziale, Azienda Sanitaria Locale Roma E, Borgo S. Spirito, 3 Rome, Italy
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11
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Matsumura T, Mitani Y, Oki Y, Fujimoto Y, Ohira M, Kaneko H, Kawashima T, Nishio M, Ishikawa A. Comparison of Geriatric Nutritional Risk Index scores on physical performance among elderly patients with chronic obstructive pulmonary disease. Heart Lung 2015; 44:534-8. [DOI: 10.1016/j.hrtlng.2015.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/21/2015] [Accepted: 08/24/2015] [Indexed: 01/18/2023]
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12
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Shimizu K, Okita R, Saisho S, Maeda A, Nojima Y, Nakata M. Preoperative neutrophil/lymphocyte ratio and prognostic nutritional index predict survival in patients with non-small cell lung cancer. World J Surg Oncol 2015; 13:291. [PMID: 26424708 PMCID: PMC4590710 DOI: 10.1186/s12957-015-0710-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/22/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The immunological status, consisting of "inflammation status" and "nutritional condition," is important for the survival of patients with various cancers, including non-small cell lung cancer (NSCLC). The neutrophil/lymphocyte ratio (NLR) reflects the inflammation status, and the prognostic nutritional index (PNI) reflects the immunological nutritional condition. In the present study, the correlation between the NLR and the PNI as well as the consistency and magnitude of the prognostic impact of the NLR and the PNI were investigated. METHODS We conducted a retrospective review of data from 334 patients who had undergone a curative resection for NSCLC. The NLR and the PNI were calculated, which was routinely performed before surgery. The correlations between the NLR and the PNI and survival were then evaluated. RESULTS A clear inverse correlation was observed between the NLR and the PNI. The NLR was associated with sex, smoking history, the CEA level, tumor size, and vascular invasion. The PNI was associated with sex, age, smoking history, tumor size, histological type, tumor differentiation, and vascular invasion. Patients with NLR ≥2.5 had a significantly poorer survival outcome, and patients with PNI <50 had a significantly poorer survival outcome. A multivariate analysis demonstrated that age, nodal metastasis, tumor differentiation, NLR, and PNI were independent predictors of disease-free and overall survival. CONCLUSIONS Our study demonstrated a significant inverse correlation between the NLR and the PNI, and a high NLR and a low PNI were significantly associated with a poor survival among patients who had undergone a complete resection for NSCLC.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/analysis
- Carcinoma, Large Cell/mortality
- Carcinoma, Large Cell/pathology
- Carcinoma, Large Cell/surgery
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Female
- Follow-Up Studies
- Humans
- Lung Neoplasms/mortality
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymphocytes/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Neutrophils/pathology
- Nutrition Assessment
- Preoperative Care
- Prognosis
- Retrospective Studies
- Survival Rate
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Affiliation(s)
- Katsuhiko Shimizu
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Riki Okita
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Ai Maeda
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Yuji Nojima
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Masao Nakata
- Department of General Thoracic Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
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13
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Kim SR, Chung SJ, Yoo SH. Factors contributing to malnutrition in patients with Parkinson's disease. Int J Nurs Pract 2014; 22:129-37. [DOI: 10.1111/ijn.12377] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Sung R Kim
- College of Nursing; Chonbuk National University; Jeonju Korea
| | - Sun J Chung
- Department of Neurology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - Sung-Hee Yoo
- College of Nursing; Chonnam National University; Gwangju Korea
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Anaemia in chronic obstructive pulmonary disease: an insight into its prevalence and pathophysiology. Clin Sci (Lond) 2014; 128:283-95. [DOI: 10.1042/cs20140344] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major health problem, with increasing morbidity and mortality. There is a growing literature regarding the extra-pulmonary manifestations of COPD, which can have a significant impact on symptom burden and disease progression. Anaemia is one of the more recently identified co-morbidities, with a prevalence that varies between 4.9% and 38% depending on patient characteristics and the diagnostic criteria used. Systemic inflammation seems to be an important factor for its establishment and repeated bursts of inflammatory mediators during COPD exacerbations could further inhibit erythropoiesis. However, renal impairment, malnutrition, low testosterone levels, growth hormone level abnormalities, oxygen supplementation, theophylline treatment, inhibition of angiotensin-converting enzyme and aging itself are additional factors that could be associated with the development of anaemia. The present review evaluates the published literature on the prevalence and significance of anaemia in COPD. Moreover, it attempts to elucidate the reasons for the high variability reported and investigates the complex pathophysiology underlying the development of anaemia in these patients.
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Yoshikawa M, Fujita Y, Yamamoto Y, Yamauchi M, Tomoda K, Koyama N, Kimura H. Mini Nutritional Assessment Short-Form predicts exacerbation frequency in patients with chronic obstructive pulmonary disease. Respirology 2014; 19:1198-203. [PMID: 25208631 DOI: 10.1111/resp.12380] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 03/24/2014] [Accepted: 06/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity, mortality and reduced health status. Thus, to predict and prevent exacerbations is essential for the management of COPD. The aims of this study were to determine whether nutritional status as assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) predicts COPD exacerbation and to compare the ability of the MNA-SF to predict COPD exacerbation with that of the COPD Assessment Test (CAT). METHODS Pulmonary function, the modified Medical Research Council (mMRC) scale and body mass index (BMI) were evaluated in 60 stable patients with COPD (mean age, 72 years; mean forced expiratory volume in 1 s (FEV1 ), 51.1% predicted). The MNA-SF and CAT were also completed. Exacerbations were recorded prospectively for 1 year after the initial assessment. RESULTS The mean MNA-SF score was 11.4 ± 2.4 (well nourished, 51%; at risk, 37%; and malnourished, 12%). The mean CAT score was 14.4 ± 7.5 (low impact, 37%; medium impact, 38%; high impact, 20%; and very high impact, 5%). The CAT scores were significantly associated with the mMRC scale and %FEV₁, but were not associated with BMI and the MNA-SF score. The exacerbation frequency was associated with the MNA-SF score but not with the CAT score. CONCLUSIONS The MNA-SF predicts COPD exacerbation independently of the CAT.
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Affiliation(s)
- Masanori Yoshikawa
- Second Department of Internal Medicine, Nara Medical University, Nara, Japan
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Lee H, Kim S, Lim Y, Gwon H, Kim Y, Ahn JJ, Park HK. Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD). Arch Gerontol Geriatr 2013; 56:518-23. [PMID: 23352455 DOI: 10.1016/j.archger.2012.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/13/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to identify the relationship between nutritional status and the severity of the disease in patients with COPD in South Korea. This study used pretest data from a larger intervention study. Data were collected from March to October 2010, and 251 patients diagnosed with COPD from five hospitals in South Korea were included in the analysis. All participants were interviewed face-to-face. Actual dietary intake was measured by a 24-h dietary recall, and the body mass index (BMI), obstruction of the airway (FEV1% predicted), degree of dyspnea (modified Medical Research Council: MMRC), and exercise capacity (6min walking distance: 6MWD) (BODE) index was calculated to estimate the severity of the condition. Lower BODE index scores indicate lower risk of mortality. The data were analyzed by descriptive statistics, a χ(2) test, t-tests, analysis of variance (ANOVA), Pearson correlation, and hierarchical multiple regression using SPSS 18.0. The mean age of the participants was 66.83 years and 92.4% of the participants were men. The mean total energy intake was 1431.65kcal, and the mean BODE index score was 2.89. Total energy intake significantly explained additional variance in BODE, BMI, the severity of the perceived dyspnea, and the length of 6min walk after controlling for age, duration after diagnosed with COPD, and physical activities. The findings of this study emphasized the importance of calorie intake in the disease severity among COPD patients. Further research on the effects of nutritional intervention on the health outcomes of patients with COPD is warranted.
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Affiliation(s)
- Haejung Lee
- College of Nursing, Pusan National University, Beomeo-ri, Mulgeum-eup, Yangsan-si 626-870, South Korea.
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Practical management problems of stable chronic obstructive pulmonary disease in the elderly. Curr Opin Pulm Med 2012; 17 Suppl 1:S43-8. [PMID: 22209930 DOI: 10.1097/01.mcp.0000410747.20958.39] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and increasing health problems in the elderly on a worldwide scale. The management of COPD in older patients presents practical diagnostic and treatment issues, which are reviewed with reference to the stable stage of the disease. RECENT FINDINGS In the diagnostic approach of COPD in the elderly the use of spirometry is recommended, but both patient conditions (such as inability to correctly perform it due to fatigue, lack of coordination, and cognitive impairment) and metrics characteristics should be taken into account for the test performance. It has been demonstrated in population studies that the use of the fixed ratio determines a substantial overdiagnosis of COPD in the oldest patients. Other parameters have been suggested [such as the evaluation of Lower Limit of Normality (LLN) for the FEV1/FVC ratio], which may be useful to guide the diagnosis. Several nonpharmacologic - such as smoking cessation, vaccination, physical activity, and pulmonary rehabilitation, nutrition, and eventually invasive ventilation - and pharmacologic interventions have been shown to improve outcomes and have been reviewed. Effective management of COPD in older adults should always consider the ability of patients to properly use inhalers and the involvement of caregivers or family members as a useful support to care, especially when treating cognitively impaired patients. Especially in the older population, timely identification and treatment of comorbidities are also crucial, but evidence in this area is still lacking and clinical practice guidelines do not take comorbidities into account in their recommendations. SUMMARY The Global Initiative for Obstructive Lung Disease has recommended criteria for diagnosis and management of COPD in the general population. On the contrary, available evidence suggests practical limitations in diagnostic approach and intervention strategies in older patients with stable COPD that need to be further studied for a translation into clinical practice guidelines.
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Abstract
PURPOSE OF REVIEW To summarize recent evidences and advances on the implementation and the use of the Mini Nutritional Assessment (MNA). RECENT FINDINGS Despite being introduced and validated for clinical use about 20 years ago, the MNA has recently received new attention in order to more widely disseminate among healthcare professionals the practice of a systematic nutritional screening and assessment of the old patient. Particularly, the structure has been implemented to face the difficulties in having the patients contributing to the assessment and to reduce further the time required to complete the evaluation. Recent data also confirm that in older populations prevalence of malnutrition by this tool is associated with the level of dependence. The rationale of nutritional assessment is to identify patients candidate to nutritional support. However, the sensitivity of the MNA is still debated because it has been associated with a high-risk 'overdiagnosis' and the advantages of a positive screening need to be assessed both in terms of outcome and money saving. SUMMARY The MNA is a simple and highly sensitive tool for nutritional screening and assessment. The large mass of data collected and the diffusion among healthcare professionals clearly support its use. However, the cost-effectiveness of interventions based on its scoring deserves investigation.
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Affiliation(s)
- Emanuele Cereda
- Nutrition and Dietetics Service, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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Benedik B, Farkas J, Kosnik M, Kadivec S, Lainscak M. Mini nutritional assessment, body composition, and hospitalisations in patients with chronic obstructive pulmonary disease. Respir Med 2011; 105 Suppl 1:S38-43. [DOI: 10.1016/s0954-6111(11)70009-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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