AnneMarie Grönberg

Vitamin and mineral status in elderly patients with chronic obstructive pulmonary disease

Introduction:  Eating problems are common in patients with chronic obstructive pulmonary disease (COPD), and intake of micronutrients might be lower than recommended.

Nutrition impact symptoms and body composition in patients with COPD

Background/objectives:Anorexia or lack of appetite is common in chronic obstructive pulmonary disease (COPD) and may be caused or augmented by several symptoms affecting appetite and eating. We aimed to investigate and quantify the extent of nutrition impact symptoms (NIS) in patients with COPD and to explore relationships between NIS and fat-free mass depletion.Subjects/methods:The results in this cross-sectional study are based on 169 COPD patients (62% female subjects). Body composition was assessed using bioelectrical impedance spectroscopy and the patients reported NIS by two newly developed questionnaires: the Eating Symptoms Questionnaire (ESQ) and the Disease-Related Appetite Questionnaire (DRAQ).Results:Symptoms with the highest prevalence were dry mouth (71%), stomach ache (39%), pain or aches affecting appetite (36%) and constipation (35%). Problems with diarrhoea and feeling affected by smells were more severe among women compared with men (P<0.05). Thirty-six percent of the patients were depleted (fat-free mass index (FFMI) <15 kg/m2 for women and FFMI<16 kg/m2 for men). Depleted patients had more NIS (P<0.05) and also rated appetite and taste of food as worse compared with non-depleted patients (P<0.05).Conclusions:NIS are common in patients with COPD, and depleted patients have more severe symptoms. To investigate how these symptoms are best prevented and/or managed and whether NIS prevention/treatment can affect development of malnutrition in patients with COPD is a challenge for the future.

Energy expenditure in underweight chronic obstructive pulmonary disease patients before and during a physiotherapy programme

Objective:To investigate how total daily energy expenditure (TEE) changes when underweight patients with chronic obstructive pulmonary disease (COPD) enters a physiotherapy programme.Design:Prospective intervention study.Setting:Sahlgrenska University Hospital, Göteborg, Sweden.Subjects:Fifteen patients with severe COPD and BMI<21 kg/m2 were recruited consecutively at the outpatient COPD unit at the Department of Respiratory Medicine. Fourteen patients completed the whole study.Intervention:TEE was assessed by the doubly labelled water method in a 2-week control period and during 2 weeks of physiotherapy. Energy intake was assessed using 7-day dietary record during control and physiotherapy period.Results:Mean TEE during physiotherapy period was 500 kJ (6%) lower than during control period but the difference was not statistically significant. Ten of the 14 patients had lower and four had higher TEE. Mean energy intake during the physiotherapy period did not change from the control period (7700 vs 7600 kJ/day).Conclusions:Since underweight patients with COPD may show variable TEE during physiotherapy compared to a control period, an assessment of individual energy requirements is recommended.Sponsorship:The Swedish Heart Lung Foundation, The Swedish Heart and Lung Association, The Swedish Nutrition Foundation, The Ingabritt and Arne Lundberg Foundation.

Energy expenditure in chronic obstructive pulmonary disease—evaluation of simple measures

Background/Objectives:Almost 50% of all chronic obstructive pulmonary disease (COPD) patients become underweight. One possible reason for nutritional treatment to fail could be miscalculation of patients’ energy requirements. The aim of this study was, therefore, to evaluate simple measures that may be used to assess the energy requirement of COPD patients.Subjects/Methods:This cross-sectional evaluation study includes 68 COPD patients (42 women). Resting metabolic rate (RMR) was assessed by indirect calorimetry, while total energy expenditure (TEE) was assessed by a 7-day monitoring using the ActiReg. Simple measures to evaluate was body weight (kg) multiplied by 125 kJ (30 kcal), predicted RMR multiplied by 1.7 and two simple questionnaires.Results:Mean physical activity level (PAL) from the ActiReg was 1.46. Calculation of energy expenditure multiplying body weight with 125 kJ resulted in a TEE of 8614 kJ compared with ActiReg 8317 kJ (P=0.10). To multiply predicted RMR by 1.7 resulted in a statistically significant overestimation of 1335 kJ (P<0.01). Both questionnaires showed a clear ‘dose-response’ regarding PAL from ActiReg in the different activity categories.Conclusions:This study shows that simple measures of energy expenditure could, on group level, assess COPD patients energy needs. However, for individual assessment of energy need, more thorough procedures are necessary.

PP168-SUN: Nutrition Impact Symptoms and Body Composition in Patients with COPD

airflow, T and RH were continuously monitored to assess the stability of the system over time. Results: Reproducibility of the measurements was <4.5% for VO2 and VCO2, and 1.2% for RER (n = 6). Recovery, measured by comparing to pure ethanol burning, was 9.8% for VO2, 15.6% for VCO2, and 6.5% for RER (n = 6). Moreover, a high stability was maintained during the experimental period for the measured outcomes (VO2: ±0.31ml/min, VCO2 ±0.24ml/min, RER ±0.03), as well as for the experimental conditions inside the chamber (airflow ±0.43ml/min, T ±1.04oC, RH = 0.39%, SE, n = 6). Conclusion: The new whole-body calorimetry chamber provides stable and reproducible data, as the variability remains below the intra-subject variability. Poor recovery (mainly for VCO2) is attributed to metabolic cart technical limitations and can be improved. In conclusion, our system is a new suitable device for adequately measuring human REE and TEF over several hours in clinical trials.