We examined the effect of nutritional supplementation for 8 wk on respiratory muscle function (RMF) in 21 malnourished patients with COPD. Patients were randomized to a fed group or to a control group. Patients in the fed group were provided with an enteral formula in addition to their usual diet. Daily calorie and protein intake and weekly anthropometric measures were made. Pulmonary function tests were measured on Weeks 1, 4, and 8. Respiratory muscle strength was measured by means of maximal inspiratory and expiratory pressures (MIP), (MEP), and respiratory muscle endurance was measured by the maximal sustained ventilatory capacity (MSVC). The mean weight of the fed group increased from 52.2 +/- 6.4 to 53.3 +/- 6.9 kg (NS). The mean daily caloric intake of the fed group was significantly increased during the study (p less than 0.02). The mean calorie intake during the study of the fed group was 174 +/- 17% of the estimated basal energy expenditure. During the study period, no change was observed in anthropometric measures, pulmonary function studies, or RMF. Because patients tend to decrease their own food intake while receiving enteral formulas, it is difficult to provide sufficient calories and protein needed to effect changes in nutritional status and RMF in an outpatient COPD population. In addition, we compared RMF in 12 poorly nourished male patients (87.6 +/- 6.1% of ideal body weight) and 13 well-nourished male patients with severe COPD. Both groups had comparable degrees of air-flow limitation and hyperinflation. No difference was noted between the groups in either MIP, MEP, or MSVC.(ABSTRACT TRUNCATED AT 250 WORDS)

Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease.

Background and aims: In a geriatric patient, nutritional status (NS), particularly in the case of malnutrition (M), may influence not only clinical results but also achievement of targets expected by geriatric rehabilitation. The aim of this study was to evaluate the effect of nutritional status (NS) on the occurrence of Adverse Clinical Events (ACE) and on mortality in geriatric rehabilitation patients. Methods: We retrospectively examined the clinical records of 278 elderly subjects (154 women, 124 men), admitted to a geriatric hospital between September 2000 and December 2001 and evaluated for clinical, functional, cognitive and NS within the first 48 hours of admission. Clinical outcomes (ACE, mortality) were recorded during follow-up. Logistic regression analysis estimated models having mortality or the occurrence of ACE as outcome variables. Results: Malnutrition was detected upon admission in 56.1% of the sample population. Incidence of ACE in malnourished subjects was higher than that in well-nourished patients (28.2 vs 13.1%). Equally, mortality among malnourished subjects was higher than among those whose NS was normal (23.1 vs 9.8%). The logistic regression models were able to predict: 1) mortality from comorbidity (OR 1.43; 95% CI 1.16–1.78; p=0.001) and NS (OR 2.64; 95% CI 1.29–5.4; p=0.008), and 2) occurrence of ACE from comorbidity (OR 1.69; 95% CI 1.36–2.1; p=0.000), cognitive (OR 1.22; 95% CI 1.11–1.35; p=0.000) and nutritional status (OR 2.38; 95% CI 1.19–4.8; p=0.015). Conclusions: NS emerged as the main independent predictor of both mortality and occurrence of ACE. Although most patients fell into the category of mild/moderate (energy) malnutrition (148/156), a mild deterioration of NS, for instance, reduction in triceps skinfold thickness (TSF) seemed to be sufficient to cause an increase in the incidence of ACE and in mortality.

Effect of nutritional status on clinical outcome in a population of geriatric rehabilitation patients.

Nutrition and the respiratory muscles.

Malnutrition and the respiratory muscles

Cytokines, bone turnover markers and weight change in candidates for lung transplantation

Nutritional Status as an Index of Morbidity in Chronic Airflow Limitation

Introduction: Cardiovascular diseases are common in patients with COPD. Endothelial damage secondary to systemic inflammation may help in explaining this. Aims and objectives: The aim was to determine whether biomarkers of endothelial damage and clot resolution predicted major cardiovascular events (MACE) within 36 months in patients with severe COPD. Methods: Biological samples from the CORTICO-COP trial, which included patients admitted with acute exacerbation of COPD. We assessed von Willebrand factor (vWf)-activated (a), vWF-non-active (n) and a fibrin degradation product (X-FIB) vs. time-to-first MACE within 36 months, using multivariable Cox proportional hazards. Interaction with previous MACE was explored. Results: A total of 299/318 persons in the trial had samples available. 132 had a MACE event. No association were observed between the biomarkers and MACE within 36 months: vWf-a: HR 0.85 [95% CI 0.55–1.28], X-FIB: HR 1.06 [95% CI 0.69–1.62], although vWf-n almost reached significance: HR 1.40 [95% CI 0.93–2.10] (figure). Due to a positive interaction, results for vWf-a and vWf-n were stratified according to previous MACE event. For patients with previous MACE, vWf-a had a HR of 0.48 [95% CI 0.26–0.89]) for future MACE. Conclusion: In COPD patients having an AECOPD, vWf-n seemed associated with future MACE, although this association was not quite significant. Explanations include Type II error hiding a real association and residual confounding.

Biomarkers of coagulative properties in patients admitted with AECOPD.

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Nutritional Status as an Index of Morbidity in Chronic Airflow Limitation

Biomarkers of coagulative properties in patients admitted with AECOPD.