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 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.

http://rc.rcjournal.com/content/respcare/61/5/680.full.pdf

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

The aim of this study was to determine the efficacy of an energy restriction intermittent fasting diet in metabolic biomarkers and weight management among adults with metabolic syndrome. This randomized controlled study was performed with metabolic syndrome patients, aged 18-65 years, at an academic institution in Istanbul, Turkey (n = 70). All participants were randomized to the Intermittent Energy Restriction (IER) intervention group and Continuous Energy Restriction (CER) control group. Biochemical tests including lipid profile, fasting plasma glucose, insulin, glycosylated hemoglobin Type A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), blood pressure, and body composition were evaluated at baseline and at the 12th week in diet interviews. Dietary intake was measured with the 24-h dietary recall method and dietary quality was evaluated with the Healthy Eating Index-2010. Changes in body weight (≈7% weight loss) and composition were similar in both groups. Blood pressure, total cholesterol, triglyceride, low-density lipoprotein (LDL), fasting glucose, and insulin at the 12th week decreased in both groups (p < 0.05). No significant differences were observed in metabolic syndrome biomarkers between the IER and CER groups. The energy-restricted intermittent fasting diet did not cause any deficiencies in macronutrient and fiber intake in the subjects. Healthy Eating Index (HEI) index scores were achieved similarly in both groups, and subjects' dietary intakes were close to daily reference nutritional intake values. The technique used to achieve energy restriction, whether intermittent or continuous, appears to alleviate the metabolic syndrome biomarkers activated by weight loss.

https://www.mdpi.com/2072-6643/12/10/3213/pdf

Does the Energy Restriction Intermittent Fasting Diet Alleviate Metabolic Syndrome Biomarkers? A Randomized Controlled Trial.

Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease

Although loss of fat-free mass (FFM) and reduced muscle strength are highly prevalent in chronic obstructive pulmonary disease (COPD), only few data are available on the relationships of handgrip strength (HGS) and respiratory muscle strength with body composition in such disease. In particular, we aimed to assess whether raw bioelectrical impedance (BIA) variables were independent predictors of muscle strength in COPD patients, possibly more significant than anthropometric variables and BIA-based estimates of FFM. Two hundred and thirty-seven COPD patients (161 males and 76 females) underwent respiratory, anthropometric, BIA, HGS and respiratory muscle strength (maximum inspiratory or expiratory pressure=MIP and MEP) measurements. Bioimpedance index (BI index=height square/whole-body impedance) and phase angle (PhA) were considered as raw BIA variables. FFM was estimated using three disease-specific BIA equations. In COPD patients a stronger correlation was observed between HGS and PhA compared to the ones with anthropometric variables or FFM estimates. Multiple regression analysis showed that combining BI index and PhA (plus age in male patients) accounted for 50.2% and 42.6% of the variance in HGS in male and female patients, respectively. Similarly, BI index and PhA emerged as predictors of both MIP and MEP in males, while in females MIP was related only to PhA and MEP only to BI index. Raw BIA variables are independent and valuable predictors of HGS and respiratory muscle strength in COPD patients. BI index and PhA could provide useful information for evaluating body composition and better assessing muscle strength and physical fitness in COPD.

Raw BIA variables are predictors of muscle strength in patients with chronic obstructive pulmonary disease

This study aimed to investigate whether there was any difference in eating pattern, abnormal eating behaviour, obesity and the number of food addiction symptoms according to food addiction presence. A total sample of 851 healthy subjects living in Ankara (n = 360 male, n = 491 female) aged 19-65 years were included in this cross-sectional survey. Data on demographic information, 24-hour dietary recalls, Yale Food Addiction Scale (YFAS), Eating Attitudes Test-26 (EAT-26), and anthropometric measurements were collected through face-to-face interviews. Overall, 11.4% of participants were identified as "food addicted" (F: 13.0%; M: 9.2%). Subjects meeting criteria for 'food addiction' had higher body mass index (35.1% were obese and 3.1% were underweight), compared to subjects without food addiction (13.1% were obese and 10.2% were underweight) (p<0.05). Abnormal eating attitudes estimated with EAT-26 were determined as 45.5% in males, 37.5% in females and 40.2% in total, among subjects with food addiction. Daily energy, protein and fat intakes were significantly higher in food addicted females, compared to non-addicted females (p<0.05). Participants with food addiction reported significantly more problems with foods, which contain high amounts of fat and sugar, compared to the participants without food addiction. Food addiction behaviour should be considered as a part of efforts towards reducing food related problems involving obesity.

/pdf/how-does-food-addiction-influence-dietary-intake-profile-1f5tx10a6w.pdf

How does food addiction influence dietary intake profile

Fat-free mass (FFM) depletion has been shown to be a better predictor of mortality than BMI in chronic obstructive pulmonary disease (COPD) patients. The specific aim of the current study was to assess the nutritional status of stable COPD patients in relation to fat free mass index profiles. We investigated 65 male moderate-to-severe stable COPD patients. A self-reported questionnaire was applied about general characteristics and smoking history. Nutritional intake was assessed by using a 54–item quantitative food frequency questionnaire. Weight, height, mid-upper arm circumference (MUAC), waist circumference (WC), handgrip strength and body composition measurements were taken by a trained dietitian. The data were analyzed with SPSS 15.0 software. The mean age of the patients was 62.1 ± 8.9 years. Among all of the patients 13.8% was underweight (BMI < 21 kg/m2) and 18.5% had a low fat-free mass index (FFMI < 16 kg/m2). The percentages of the patients who did not meet the daily recommended intakes (RNI) were highest for magnesium (93.8%) and calcium (92.3%). Mean daily consumptions of milk-yogurt, red meat and fruits were significantly low in the low FFMI group compared to normal FFMI group (for all; p < 0.05). Patients with normal FFMI had significantly higher weight, height, WC, MUAC, handgrip strength, fat and fat-free mass than the patients with low FFMI (for all; p < 0.05). Dieticians should be aware of COPD patients with low FFMI in order to evaluate the nutritional intake and therefore plan nutritional strategies to improve prognosis of the disease.

/pdf/dietary-intake-of-patients-with-moderate-to-severe-copd-in-1b6uuxk4dk.pdf

Dietary intake of patients with moderate to severe COPD in relation to fat-free mass index: a cross-sectional study

Aim: The objective of this paper is to present a baseline data on the national prevalence and distribution of overweight and obesity in adults, derived from the results of Turkey National Nutrition and Health Survey (TNHS)-2010. Methods: Prevalence data for adults (9820 adults, aged 19–65 years) were the customised data from the nationally representative National Nutrition and Health Survey (2010). Body weight, height, waist and hip circumferences were measured and body mass index (BMI), waist to hip ratio were calculated. BMI (weight-kg/height-m2), waist circumference (cm) and waist to hip ratio were classified and evaluated according to WHO criteria and recommendations. Results:  Mean BMI for all age groups were 26.4±4.5 kg /m2 in men and 28.9±6.4 kg/m2 in women. Overall, prevalence of overweight and obese adults were 34.6% (39.1% in men, 29.7% in women) and 30.3% (20.5% in men, 41.0% in women) respectively.  While the adults aged 51–64 years old were more likely to be obese (30.7% in men and 64.4% in women), adults aged 65 years and over were found to be more overweight (46.0% in men and 30.4% in women). High waist circumference and high waist-to-hip ratio were identified as 24.8% and 54.2% in men, as 53.9% and 40.4% in women, respectively. Conclusions: Obesity and overweight are major public health problems in Turkey. Preventive public measures have started to be implemented by the Turkish government and other bodies to control the increasing trends in obesity.

Population based study of obesity in Turkey: results of the Turkey Nutrition and Health Survey (TNHS)-2010

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Dietary intake of patients with moderate to severe COPD in relation to fat-free mass index: a cross-sectional study

Population based study of obesity in Turkey: results of the Turkey Nutrition and Health Survey (TNHS)-2010