Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-27T10:53:27.741Z Has data issue: false hasContentIssue false
  • English
  • Français

Body composition in patients with chronic obstructive pulmonary disease: which method to use in clinical practice?

Published online by Cambridge University Press:  08 March 2007

M. C. Lerario ,
A. Sachs ,
M. Lazaretti-Castro ,
L. G. Saraiva  and
J. R. Jardim
M. C. Lerario*
Affiliation:
Respiratory Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
A. Sachs
Affiliation:
Nutrition Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
M. Lazaretti-Castro
Affiliation:
Endocrinology Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
L. G. Saraiva
Affiliation:
Endocrinology Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
J. R. Jardim
Affiliation:
Respiratory Division, Pulmonary Rehabilitation Center, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
*
*Corresponding author: Dr M. C. Lerario, fax + 55 11 5052 5715, email clerario@terra.com.br
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The objective of the present study was to compare anthropometry with bioelectrical impedance (BIA) in relation to densitometry (dual-energy X-ray absorptiometry; DEXA) as methods of nutritional assessment and body composition in out-patients with chronic pulmonary obstructive disease (COPD). We conducted a cross-sectional clinical study with sixty-one patients with COPD (forty-two men and nineteen women), mean age of 66·5 (sd 7·9) years and forced expiratory volume in 1s of 1·3 (sd 0·6) litres (52·2 (sd 19·8) % predicted), referred to the Pulmonary Rehabilitation Center. The patients were evaluated regarding nutrition status and body composition as determined by anthropometry, BIA and DEXA. In the results, 34·4% showed mild obstruction, 31·2%, moderate and 34·4%, severe obstruction. According to the BMI (mean 24·5 (sd 4·5) kg/m2), 45·9% of the patients exhibited normal weight, while 27·9% were underweight and 26·2% were obese. Related to fat-free mass (FFM), anthropometry and BIA compared with DEXA presented high correlations (r 0·96 and 0·95 respectively; p<0·001) and high reliability between the methods (α 0·98; p<0·001). Agreement analysis between the methods shows that anthropometry overestimates (0·62 (sd of the difference 2·89) kg) while BIA underestimates FFM (0·61 (sd of the difference 2·82) kg) compared with DEXA. We concluded that according to the nutritional diagnosis, half of our population of patients with COPD showed normal weight, while the other half comprised equal parts obese and underweight patients. Body composition estimated by BIA and anthropometry presented good reliability and correlation with DEXA; the three methods presented satisfactory clinical accuracy despite the great disparity of the limits of agreement.

Keywords

Chronic pulmonary obstructive diseaseNutritional assessmentAnthropometryElectrical bioimpedanceDual-energy X-ray absorptiometry
Type
Research Article
Information
British Journal of Nutrition , Volume 96 , Issue 1 , January 2006 , pp. 86 - 92
Copyright
Copyright © The Nutrition Society 2006

References

Anonymous Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med (1995) 152, Suppl., 77–120.Google Scholar
Baarends, EM, Schols, AM, van Marken Lichtenbelt, WD & Wouters, EFAnalysis of body water compartments in relation to tissue depletion in clinically stable patients with chronic obstructive pulmonary disease. Am J Clin Nutr (1997) 65, 88–94.CrossRefGoogle ScholarPubMed
Bland, MJ & Altman, GDStatistical methods for assessing agreement between two methods of clinical measurement. Lancet i (1986) 307–310.CrossRefGoogle ScholarPubMed
Celli, BR, Cote, CG, Marin, JM, Casanova, C, Oca, MM, Mendez, RA, Plata, VP & Cabral, JHThe body-mass-index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl Med (2004) 350, 1005–1012.CrossRefGoogle ScholarPubMed
Consenso Nacional de Saúde Resoluçã CNS 196/96. Normas de pesquisa envolvendo seres humanos (Resolution CNS 196/96. Norms of research involving human beings). Bioética (1996) 4, Suppl., 7–27.Google Scholar
Donahoe, MNutritional support in advanced lung disease. The pulmonary cachexia syndrome. Clin Chest Med (1997) 18, 547–561.CrossRefGoogle ScholarPubMed
Douglas, NJ, Calverley, PM, Leggett, RG, Brash, HM, Flenley, DC & Brezinova, VTransenient hypoxemia during sleep in chronic bronchitis and emphysema. Lancet i (1979) 1–4.CrossRefGoogle Scholar
Durnin, JVGA & Wormersley, JBody fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. Br J Nutr (1974) 32, 77–97.CrossRefGoogle ScholarPubMed
Engelen, MPKJ, Schols, AMWJ, Baken, WC, Wesseling, GJ & Wouters, EFMNutritional depletion in relation to respiratory and peripheral skeletal muscle function in out patients with COPD. Eur Respir J (1994) 7, 1793–1797.CrossRefGoogle ScholarPubMed
Engelen, MPKJ, Schols, AMWJ, Heidendal, GAK & Wouters, EFMDual-energy X-ray absorptiometry in the clinical evaluation of body composition and bone mineral density in patients with chronic obstructive pulmonary disease. Am J Clin Nutr (1998) 68, 1298–1303.CrossRefGoogle ScholarPubMed
Gosker, HR, Wouters, EFM, van de Vusse, GJ & Schols, AMWJSkeletal muscle dysfunction in chronic failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr (2000) 71, 1033–1047.CrossRefGoogle ScholarPubMed
Harmon-Weiss, SNutritional strategies efficacious in the prevention or treatment of chronic obstructive pulmonary disease. In The Role of Nutrition in Chronic Disease Care. Nutrition Screening Initiative Project. American Academy of Family Physicians, pp 22–31, Washington, DC. 1999Google Scholar
Heyward, VH & Stolarczyk, LMApplied Body Composition Assessment. Champaign, IL: Human Kinetics Publishers. 1996Google Scholar
Hugli, O, Schutz, Y & Fitting, J-WThe daily energy expenditure in stable chronic obstructive pulmonary disease. Am J Respir Crit Care Med (1996) 153, 294–300.CrossRefGoogle ScholarPubMed
Jardim, JR, Farkas, G, Prefaut, C, Thomas, D, Macklem, PT & Roussos, CThe failing inspiratory muscles under normoxic and hypoxic conditions. Am Rev Respir Dis (1981) 124, 274–279.Google ScholarPubMed
Kyle, UG, Pichard, C, Rochat, T, Slosman, DO, Fitting, WJ & Thiebaud, DNew bioelectrical impedance formula for patients with respiratory insufficiency: comparison to dual-energy X-ray absorptiometry. Eur Respir J (1998) 12, 960–966.CrossRefGoogle ScholarPubMed
Landbo, C, Prescott, E, Lange, P, Vestbo, J & Almdal, PTPrognostic value of nutritional status in chronic obstructive pulmonary disease. Am J Respir Crit Care Med (1999) 160, 1856–1861.CrossRefGoogle ScholarPubMed
Lipschitz, DAScreening for nutritional status in the elderly. Primary Care (1994) 21, 55–67.CrossRefGoogle ScholarPubMed
Lohman, TG, Roche, AF & Martorell, RAnthropometric Standardization – Reference Manual. Champaign, IL: Human Kinetics Publishers. 1988Google Scholar
Marquis, K, Debigaré, R, Lacasse, Y, LeBlanc, P, Jobin, J, Carrier, G & Maltais, FMidthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med (2002) 166, 809–813.CrossRefGoogle ScholarPubMed
Mostert, R, Goris, A, Weling-Scheepers, C, Wouters, EFM & Schols, AMWJTissue depletion and health related quality of life in patients with chronic obstructive pulmonary disease. Respir Med (2000) 94, 859–867.CrossRefGoogle ScholarPubMed
Neder, JA, Andreoni, S, Lerario, MC & Nery, LEReference values for lung function test. II Maximal respiratory pressures and voluntary ventilation Braz J Med Biol Res (1999a) 32, 719–727.CrossRefGoogle Scholar
Neder, JA, Lerario, MC, Castro, ML, Sachs, A & Nery, LEPeak VO2 correction for fat-free mass estimated by anthropometry and DEXA. Med Sci Sports Exerc (2001) 33, 1968–1975.CrossRefGoogle ScholarPubMed
Neder, JA, Nery, LE, Castelo, A, Lerario, MC, Sachs, A, Silva, AC & Whipp, BJPrediction of metabolic and cardiopulmonary responses to maximum cycle ergometry: a randomised study. Eur Respir J (1999b) 14, 1304–1313.CrossRefGoogle ScholarPubMed
Paiva, SAR, Campana, AO & Godoy, INutrition support for the patient with chronic obstructive pulmonary disease. Nutr Clin Care (2000) 3, 44–50.CrossRefGoogle Scholar
Pichard, C, Kyle, GU, Janssens, JP et al. Body composition by X-ray absorptiometry and bioelectrical impedance in chronic respiratory insufficiency patients. Nutrition (1997) 13, 952–958.CrossRefGoogle ScholarPubMed
Rochester, DFRespiratory muscles and ventilatory failure: 1993 perspective. Am J Med Sci (1993) 305, 394–402.CrossRefGoogle ScholarPubMed
Schols, AMWJPulmonary cachexia. Int J Cardiol (2002) 85, 101–110.CrossRefGoogle ScholarPubMed
Schols, AMWJ, Slangen, J, Volovics, L & Wouters, EFMWeight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med (1998) 157, 1791–1797.CrossRefGoogle ScholarPubMed
Schols, AMWJ, Soeters, PB, Dingemans, AMC, Mostert, R, Frantzen, PJ & Wouters, EFMPrevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis (1993) 147, 1151–1156.CrossRefGoogle ScholarPubMed
Schols, AMWJ, Soeters, PB, Mostert, R, Saris, WHM & Wouters, EFMEnergy balance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis (1991a) 143, 1248–1252.CrossRefGoogle ScholarPubMed
Schols, AMWJ & Wouters, EFMNutritional abnormalities and supplementation in chronic obstructive pulmonary disease. Clin Chest Med (2000) 21, 753–762.CrossRefGoogle ScholarPubMed
Schols, AMWJ, Wouters, EFM, Soeters, PB & Westertep, KRBody composition by bioelectrical-impedance analysis compared with deuterium dilution and skinfold anthropometry in patients with chronic obstructive pulmonary disease. Am J Clin Nutr (1991b) 53, 421–424.CrossRefGoogle ScholarPubMed
Serres, I, Hayot, M, Préfaut, C & Mercier, JSkeletal muscle abnormalities in patients with COPD: contribution to exercise intolerance. Med Sci Sports Exerc (1998) 7, 1019–1027.CrossRefGoogle Scholar
Steiner, MC, Barton, RL, Singh, SJ & Morgan, MDLBedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD. Eur Respir J (2002) 19, 626–631.CrossRefGoogle ScholarPubMed
van Loan, MDIs dual-energy X-ray absorptiometry ready for prime time in the clinical evaluation of body composition?. Am J Clin Nutr (1998) 68, 1155–1156.CrossRefGoogle ScholarPubMed
Vermeeren, MAP, Schols, AMWJ & Wouters, EFMEffects of an acute exacerbation on nutritional metabolic profile of patients with COPD. Eur Respir J (1997) 10, 2264–2269.CrossRefGoogle ScholarPubMed
Wouters, EFMNutrition and metabolism. Chest (2000) 117, Suppl., S274–S280.CrossRefGoogle ScholarPubMed
Wouters, EFM & Schols, AMWJPrevalence and pathophysiology of nutritional depletion in chronic obstructive pulmonary disease. Respir Med (1993) 87, Suppl. B, S45–S47.CrossRefGoogle ScholarPubMed