Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-26T09:32:16.109Z Has data issue: false hasContentIssue false
  • English
  • Français

The pulmonary cachexia syndrome: aspects of energy balance

Published online by Cambridge University Press:  28 February 2007

Jo Congleton
Jo Congleton*
Affiliation:
Respiratory Medicine Division, Hammersmith Hospital, Du Cane Road, London W12, UK
*
Corresponding author: Dr Jo Congleton, present address Worthing General Hospital, Lyndhurst Road, Worthing BN11 2HR, UK, fax +44 (0)1903 285045, email 101503.1514@compuserve.com
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 present paper reviews current knowledge of the pulmonary cachexia syndrome with reference to chronic obstructive pulmonary disease (COPD). Aspects of incidence, aetiology and management are discussed. Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD. Both fat mass and fat-free mass become depleted. Loss of fat-free mass is the more important and appears to be due to a depression of protein synthesis. Weight loss is an independent prognostic indicator of mortality, and is associated with increased morbidity and decreased health-related quality of life. The aetiology of malnutrition in COPD is not well understood. Reduced food intake does not seem to be the primary cause. Resting energy expenditure (REE) is elevated in a proportion of patients and probably contributes to negative energy balance. Measurement of actual REE is helpful when considering the adequacy of nutritional supplementation. The underlying reason for a hypermetabolic state is not known. Although weight-losing COPD patients are not catabolic, nutritional supplementation alone does not appear to reverse the loss of fat-free mass. Strategies involving nutritional supplementation in combination with a second intervention are being explored, and there are some encouraging results using anabolic hormones.

Keywords

Pulmonary cachexia syndromeChronic obstructive pulmonary diseaseEnergy balanceBody-weight lossMalnutrition
Type
Clinical Nutrition and Metabolism Group Symposium on ‘Nutrition and lung health’
Information
Proceedings of the Nutrition Society , Volume 58 , Issue 2 , May 1999 , pp. 321 - 328
Copyright
Copyright © The Nutrition Society 1999

References

Arora, NS & Rochester, DF (1982) Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. American Review of Respiratory Disease 126, 5–8.Google ScholarPubMed
Brandstetter, RD, Zakkay, Y, Gutherz, P & Goldberg, RJ (1988) Effect of nasogastric feeding on arterial oxygen saturation in patients with symptomatic chronic obstructive pulmonary disease. Heart and Lung 17, 170–172.Google Scholar
Braun, SR, Dixon, RM, Keim, NL, Luby, M, Anderegg, A & Shrago, E (1984) Predictive clinical value of nutritional assessment factors in COPD. Chest 85, 353–357.CrossRefGoogle ScholarPubMed
Chandra, RK (1980) Cell-mediated immunity in nutritional imbalance. Federation Proceedings 39, 3088–3092.Google ScholarPubMed
Cherniak, RM (1958) The oxygen consumption and efficency of the respiratory muscles in health and emphysema. Journal of Clinical Investigation 38, 494–499.CrossRefGoogle Scholar
Congleton, J (1998) Investigations into resting energy expenditure and weight loss in chronic lung disease. MD Thesis, University of Cambridge.Google Scholar
Congleton, J, Green, JH & Muers, MF (1993) Basal metabolic rate, weight loss and decline in FEV1. Monaldi Archives of Chest Disease 48, 539–540.Google ScholarPubMed
Congleton, J & Muers, MF (1995) Relation of nutritional indices to quality of life in COPD. European Respiratory Journal 8, Suppl. 19, 172s Abstr.Google Scholar
Congleton, J & Muers, MF (1998) Effect of regular use of high dose nebulised β2 agonists on resting energy expenditure, weight, and hand grip strength in patients with chronic airflow limitation. Chest 113, 1588–1594.CrossRefGoogle ScholarPubMed
Donahoe, M, Mancino, J, Costantino, J, Lebow, H & Rogers, RM (1994) The effect of an aggressive nutritional support regimen on body composition in patients with severe COPD and weight loss. American Journal of Respiratory and Critical Care Medicine 149, A313 Abstr.Google Scholar
Donahoe, M, Rogers, RM, Wilson, DO & Pennock, BE (1989) Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 140, 385–391.CrossRefGoogle ScholarPubMed
Driver, AG, McAlevy, MT & Smith, JL (1982) Nutritional assessment of patients with chronic obstructive pulmonary disease and acute respiratory failure. Chest 5, 568–571.Google Scholar
Efthimiou, J, Flemming, J, Gomes, C & Spiro, SG (1988) The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 137, 1075–1082.CrossRefGoogle ScholarPubMed
Falconer, J, Fearon, KCH, Plester, CE, Ross, JA & Carter, DC (1994) Cytokines, the acute phase response and energy expenditure in weight-losing patients with pancreatic cancer. Annals of Surgery 219, 325–331.Google Scholar
Fitting, JW (1992) Nutritional support in chronic obstructive lung disease. Thorax 47, 141–143.CrossRefGoogle ScholarPubMed
Fitting, JW, Frascarolo, P, Jequier, E & Leuenberger, P (1989) Energy expenditure and rib cage-abdominal motion in chronic obstructive pulmonary disease. European Respiratory Journal 2, 840–845.CrossRefGoogle ScholarPubMed
Gibson, JNA, Morrison, WL & Halliday, D (1987) Decrease in human quadriceps muscle protein turnover consequent on leg immobilisation. Clinical Science 72, 503–509.CrossRefGoogle Scholar
Goldstein, SA, Askanazi, J, Weissman, C, Thomashow, BM & Kinney, JM (1987) Energy expenditure in patients with chronic obstructive pulmonary disease. Chest 91, 221–224.CrossRefGoogle ScholarPubMed
Goldstein, SA, Thomashow, BM, Kvetan, V, Askanazi, J, Kinney, JM & Elwyn, DH (1988) Nitrogen and energy relationships in malnourished patients with emphysema. American Review of Respiratory Disease 138, 636–644.CrossRefGoogle ScholarPubMed
Gray-Donald, K, Gibbons, L, Shapiro, SH & Martin, JG (1989) Effects of nutritional state on exercise performance in patients with chronic obsructive pulmonary disease. American Review of Respiratory Disease 140, 1544–1548.CrossRefGoogle Scholar
Green, JH, Bramley, PN & Lowsowsky, MS (1991) Are patients with primary biliary cirrhosis hypermetabolic? A comparison between patients before and after liver transplantation and controls. Hepatology 14, 464–472.Google ScholarPubMed
Green, JH & Muers, MF (1991) The thermic effect of food in underweight patients with emphysematous chronic obstructive pulmonary disease. European Respiratory Journal 4, 813–819.Google Scholar
Green, JH & Muers, MF (1992) Comparisons between basal metabolic rate and diet-induced thermogenesis in different types of chronic obstructive pulmonary disease. Clinical Science 83, 109–116.CrossRefGoogle ScholarPubMed
Harris, JA & Benedict, FG (1919) A Biometric Study of Basal Metabolism in Man. Washington, DC: Carnegie Institute of Washington.Google Scholar
Hoffard, JM, Milakofsky, L, Vogel, WH, Sacher, RS, Savage, G & Pell, S (1990) The nutritional status in advanced emphysema associated with chronic bronchitis. American Review of Respiratory Disease 141, 902–908.CrossRefGoogle Scholar
Holt, LE, Snyderman, SE, Norton, PM, Roitman, E & Finch, J (1963) The plasma aminogram in kwashiorkor. Lancet ii, 1343–1348.CrossRefGoogle Scholar
Hugli, O, Frascaralo, P, Schutz, Y, Jequier, E, Leuenberger, P & Fitting, J (1993) Diet-induced thermogenesis in chronic obstructive pulmonary disease. American Review of Respiratory Disease 148, 1479–1483.CrossRefGoogle ScholarPubMed
Hugli, O, Schutz, Y & Fitting, J (1996) The daily energy expenditure in stable chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 153, 294–300.CrossRefGoogle ScholarPubMed
Hunter, AB, Carey, MA & Larsh, HW (1981) The nutritional status of patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 124, 376–381.Google ScholarPubMed
Jones, PW, Quirk, FH, Baveystock, CM & Littlejohns, P (1992) A self complete measure of health status for chronic airflow limitation. American Review of Respiratory Disease 145, 1321–1327.Google Scholar
Knowles, JB, Fairburn, MS, Wiggs, BJ, Chan-Yan, C & Pardy, R (1988) Dietary supplementation and respiratory muscle performance in COPD. Chest 93, 977–983.CrossRefGoogle Scholar
Lavine, B, Kalman, J, Mayer, L, Fillit, H & Packer, M (1990) Elevated circulating levels of tumour necrosis factor in severe chronic heart failure. New England Journal of Medicine 323, 236–241.Google Scholar
Lewis, MI, Belman, MJ & Dorr-Uyemura, L (1987) Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 135, 1062–1068.Google Scholar
Lewis, MI, Sieck, GC, Fournier, M & Belman, MJ (1986) Effect of nutritional deprivation on diaphragm contractility and muscle fibre size. Journal of Applied Physiology 60, 596–603.Google Scholar
Morrison, WL & Edwards, RHT (1991) Cardiac cachexia. British Medical Journal 302, 301–302.CrossRefGoogle ScholarPubMed
Morrison, WL, Gibson, JNA, Scrimgeour, C & Rennie, MJ (1988) Muscle wasting in emphysema. Clinical Science 75, 415–420.CrossRefGoogle ScholarPubMed
Pape, GS, Friedman, M, Underwood, LE & Clemmons, DR (1991) The effect of growth hormone on weight gain and pulmonary function in patients with chronic obstructive lung disease. Chest 99, 1495–1500.CrossRefGoogle ScholarPubMed
Pugh, LGCE (1962) Physiological and medical aspects of the Himalayan Scientific and Mountaineering Expedition 1960–1961. British Medical Journal ii, 621–627.Google Scholar
Rennie, MJ, Babij, P, Sutton, JR, Tonkins, WJ, Read, WW, Ford, C & Halliday, D (1983) Effects of acute hypoxia on forearm leucine metabolism. In Hypoxia, Exercise and Altitude: Proceedings of the Third Banff International Hypoxia Symposium, pp. 317–323. New York: Alan R. Liss.Google Scholar
Sargeant, AJ, Davies, CTM, Edwards, RHT, Maunder, C & Young, A (1977) Functional and structural changes after disuse of human muscle. Clinical Science and Molecular Medicine 52, 337–342.Google ScholarPubMed
Schols, AMWJ, Buurman, WA, Staal-van den Brekel, AJ, Dentener, MA & Wouters, EFM (1996) Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease. Thorax 51, 819–824.Google Scholar
Schols, AMWJ, Mostert, R, Soeters, PB & Wouters, EFM (1991 a) Body composition and exercise performance in patients with chronic obstructive pulmonary disease. Thorax 46, 695–699.CrossRefGoogle ScholarPubMed
Schols, AMWJ, Soeters, P, Dingemans, AMC, Mostert, R, Frantzen, PJ & Wouters, EFM (1993) Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. American Review of Respiratory Disease 147, 1151–1156.Google Scholar
Schols, AMWJ, Soeters, PB, Mostert, R, Pluymers, RJ & Wouters, EFM (1995) Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 152, 1268–1274.CrossRefGoogle ScholarPubMed
Schols, AMWJ, Soeters, PB, Mostert, R & Wouters, EFM (1991 b) Energy balance in chronic obstructive pulmonary disease. American Review of Respiratory Disease 143, 1248–1252.Google Scholar
Schols, AMWJ, Soeters, PB, Mostert, R & Wouters, EFM (1991 c) Energy balance in chronic obstructive pulmonary disease. American Review of Respiratory Disease 143, 1248–1252.Google Scholar
Semple, PD, Watson, WS, Beastall, GH, Bethel, MIF, Grant, JK & Hume, R (1979) Diet, absorption, and hormone studies in relation to body weight in obstructive airways disease. Thorax 34, 783–788.Google Scholar
Sridhar, MK, Lean, MJ, Beastall, G & Banham, SW (1993) Insulin like growth factor-1 as a marker of malnutrition in patients with emphysematous chronic obstructive pulmonary disease (COPD). European Respiratory Journal 6, Suppl. 17, 427s Abstr.Google Scholar
Sukumalchantra, Y & Williams, H (1965) Serial studies of pulmonary function in patients with chronic obstructive pulmonary disease. American Journal of Medicine 39, 941–945.Google Scholar
Thurlbeck, WM (1978) Diaphragm and body weight in emphysema. Thorax 33, 483–487.CrossRefGoogle ScholarPubMed
Vandenbergh, E, VandeWoestijne, K & Gyselen, A (1967) Weight changes on the terminal stages of COPD. American Review of Respiratory Disease 95, 556–566.Google Scholar
Whittaker, JS, Ryan, CF, Buckley, PA & Road, JD (1990) The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive pulmonary disease patients. American Review of Respiratory Disease 142, 283–288.Google Scholar
Wilson, DO, Rogers, RM & Hoffman, RM (1985) Nutrition and chronic lung disease. American Review of Respiratory Disease 132, 1347–1365.Google Scholar
Wilson, DO, Rogers, RM, Sanders, MH, Pennock, BE & Reilly, JJ (1986) Nutritional intervention in malnourished patients with emphysema. American Review of Respiratory Disease 134, 672–677.Google Scholar
Wilson, DO, Rogers, RM, Wright, EC & Anthonisen, NR (1989) Body weight in chronic obstructive pulmonary disease. American Review of Respiratory Disease 139, 1435–1438.Google Scholar
Wouters, EFM & Schols, A (1993) Prevalence and pathophysiology of nutritional depletion in chronic obstructive pulmonary disease. Repiratory Medicine 87, Suppl. B, 45–47.Google Scholar
Yang, YT & McElligott, MA (1989) Multiple actions of β-adrenergic agonists on skeletal muscle and adipose tissue. Biochemical Journal 261, 1–10.Google Scholar