Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease.
OBJECTIVE
Weight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD.


METHODS
The therapy consisted of daily two to three oral liquid nutritional supplements (mean +/- standard deviation: 2812 +/- 523 kJ/24 h) incorporated into an 8-wk inpatient pulmonary rehabilitation program in 64 (49 men) depleted patients with COPD. Endpoints were body weight, fat-free mass by bioelectrical impedance analysis, respiratory and peripheral muscle function (maximal inspiratory mouth pressure and handgrip strength, respectively), exercise performance (incremental bicycle ergometry), and disease-specific health status by St. George's Respiratory Questionnaire. Forty-eight percent of the patients were treated with low-dose oral glucocorticosteroids as maintenance medication (dose equivalent to 7.6 +/- 2.5 mg of methylprednisolone per day).


RESULTS
Increases in body weight (2.1 +/- 2.1 kg, P < 0.001) and fat-free mass (1.1 +/- 2.0 kg, P < 0.001) were seen. Further, maximal inspiratory mouth pressure (4 +/- 10 cm of H(2)O, P = 0.001), handgrip strength (1.2 +/- 3.1 kg, P = 0.004), and peak workload (7 +/- 11 W, P = 0.001) significantly improved. Clinically significant improvements in the items symptoms (9 +/- 16 points, P < 0.001) and impact (4 +/- 15 points, P = 0.043) of St. George's Respiratory Questionnaire were achieved. Oral glucocorticosteroid treatment significantly impaired the response to nutritional supplementation therapy with respect to maximal inspiratory mouth pressure, peak workload, and St. George's Respiratory Questionnaire symptom score.


CONCLUSIONS
Nutritional supplementation therapy implemented in a pulmonary rehabilitation program was effective in depleted patients with COPD. However, oral glucocorticosteroid treatment attenuated the anabolic response to nutritional supplementation.
Creutzberg
Eva C
EC
Department of Pulmonology, University Hospital Maastricht, Maastricht, The Netherlands. e.creutzberg@pul.unimaas.nl
Wouters
Emiel F M
EF
Mostert
Rob
R
Weling-Scheepers
Clarie A P M
CA
Schols
Annemie M W J
AM
D000368:Aged; D001798:Blood Proteins; D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D019587:Dietary Supplements / Q000706:statistics & numerical data*; D002149:Energy Intake / Q000187:drug effects; D004734:Energy Metabolism / Q000187:drug effects; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006304:Health Status; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000178:diet therapy* / Q000209:etiology; D009043:Motor Activity / Q000187:drug effects; D018482:Muscle, Skeletal / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology / Q000534:rehabilitation; D012132:Respiratory Muscles / Q000503:physiopathology; D012143:Respiratory Physiological Phenomena
D001798:Blood Proteins; D005938:Glucocorticoids