Effect of nutritional status in individuals with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation

Abstract

Background and objective: Chronic obstructive pulmonary disease (COPD) is considered a worldwide major public health problem. Weight loss, muscle and fat mass depletion are common nutritional problems in COPD patients and are determinant factors in pulmonary function, health status, disability and mortality. We aimed to assess the relationships between nutritional status and perception of dyspnoea, pulmonary function tests (PFT), exercise capacity and health-related quality of life (HRQoL) using the subjective global assessment (SGA) in COPD patients who were referred for pulmonary rehabilitation programme.

Methods: A total of 163 patients with stable COPD who are candidates for outpatient pulmonary rehabilitation programme were included in this study. Nutritional status for all patients was assessed by SGA. Association of SGA scores (A, B and C) and anthropometric measurements, PFT, dyspnoea scales (Medical Research Council and resting BORG scale), HRQoL (St. George Respiratory Questionnaire and Chronic Respiratory Diseases Questionnaire) and exercise testing (shuttle walking test) were studied for statistical significance.

Results: Based on SGA, 9.2% of patients were severely malnourished (SGA-C). There were significant decreases in forced expiratory volume in the first second (FEV1 ) (P = 0.009), Medical Research Council scales (P < 0.001) and exercise capacity (incremental shuttle walking test (P = 0.001) and endurance shuttle walking test (P = 0.009)) in SGA-C. Deterioration in anthropometric measurements and HRQoL measures were observed in malnourished patients.

Conclusions: Identifying the nutritional status and determining any requirement for nutritional supplement is an important component of comprehensive pulmonary rehabilitation programme. SGA is an easy and practical method to assess nutritional status in pulmonary rehabilitation candidate patients with stable COPD.

Keywords: chronic obstructive pulmonary disease; malnutrition; pulmonary rehabilitation; subjective global assessment.