Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease.
BACKGROUND
Muscle wasting and decreased muscle oxidative capacity commonly occur in patients with chronic obstructive pulmonary disease (COPD). Polyunsaturated fatty acids (PUFA) have been shown to mediate several inflammatory and metabolic pathways which may be involved in the pathogenesis of muscle impairment in COPD. The aim of this study was to investigate the effect of PUFA modulation on systemic inflammation, reversal of muscle wasting, and functional status in COPD.


METHODS
Eighty patients with COPD (57 men) with forced expiratory volume in 1 second (FEV1) 37.3 (13.8)% predicted received 9 g PUFA or placebo daily in a double blind randomised fashion during an 8 week rehabilitation programme. Body composition (bioelectrical impedance), functional capacity (lung function, incremental cycle ergometry test, submaximal cycle test, isokinetic quadriceps strength) and inflammatory markers (C-reactive protein (CRP), interleukin (IL)-6 and tumour necrosis factor (TNF)-alpha) were assessed at baseline and after 8 weeks.


RESULTS
Both groups had similar increases in weight, fat-free mass (FFM), and muscle strength. The peak load of the incremental exercise test increased more in the PUFA group than in the placebo group (difference in increase 9.7 W (95% CI 2.5 to 17.0), p = 0.009) even after adjustment for FFM. The duration of the constant work rate test also increased more in patients receiving PUFA (difference in increase 4.3 min (95% CI 0.6 to 7.9), p = 0.023). The positive effects of PUFA could not be attributed to a decrease in systemic levels of CRP, IL-6 and TNF-alpha.


CONCLUSIONS
This is the first study to show beneficial effects of PUFA on exercise capacity in patients with COPD.
Broekhuizen
R
R
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands. r.broekhuizen@pul.unimaas.nl
Wouters
E F M
EF
Creutzberg
E C
EC
Weling-Scheepers
C A P M
CA
Schols
A M W J
AM
D002097:C-Reactive Protein / Q000378:metabolism; D004311:Double-Blind Method; D017079:Exercise Tolerance; D005231:Fatty Acids, Unsaturated / Q000627:therapeutic use*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009135:Muscular Diseases / Q000503:physiopathology / Q000534:rehabilitation; D011014:Pneumonia / Q000188:drug therapy* / Q000503:physiopathology; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000534:rehabilitation*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism; D014797:Vital Capacity / Q000502:physiology; D019282:Wasting Syndrome / Q000503:physiopathology / Q000534:rehabilitation
D005231:Fatty Acids, Unsaturated; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein