Chronic obstructive pulmonary disease and malnutrition: severity of the disease and controlling nutritional status (CONUT) score

Year 2024, Volume: 7 Issue: 6, 658 - 663, 27.10.2024

Mustafa İlteriş Bardakçı , Gülhan Ayhan Albayrak , Remzi Gediz

Abstract

Aims: The definition for chronic obstructive pulmonary disease (COPD) is abnormalities of the or alveoli, that can cause chronic respiratory symptoms. A significant number of COPD patients have malnutrition. We aimed to demonstrate the correlation between the Control of Nutritional Status (CONUT) score and the severity of the disease, the number of hospitalizations, and emergency department visits due to acute exacerbations of COPD.
Methods: Patients over 65 years of age diagnosed with COPD were included in this study. Smoking habits, systemic and pulmonary comorbidities, Modified British Medical Research Council (mMRC) survey score and COPD assessment test (CAT) score, number of COPD exacerbations, number of hospitalizations due to COPD in the last year were recorded. CONUT score was calculated by looking at blood albumin, total cholesterol and lymphocyte levels.
Results: This study was carried out with 112 COPD patients. The mean age of our patients was 72.28±7.3 (64-96). Of the 112 patients, 26 (23.2%) were female and 86 (76.8%) were male. Forced expiratory volume in 1 second (FEV1%) was 42.31% (13.00-75.00%), CAT 17.83±6.8 (7-34), mMRC 2.19±1.1 (0-4), COPD attack count 2.30±2.1 (0-9) and 35 patients were hospitalized due to COPD attacks. The CONUT score determined as 2.71±2.3 (0-9), 45 (40.1%) patients were normal, 36 (32.1%) were light, 29 (25.9%) were moderate, and 2 (1.8%) patients were severe. There was a statistically significant, correlation between CONUT values and FEV1 (%), CAT and mMRC values. The patients were divided into 2 groups as low (values 4 and below) and high (values 5 and above). A statistically significant difference was found between the CONUTs high and low groups in terms of CAT, mMRC and FEV 1 (%). The number of high CONUT attacks was statistically significantly higher than the number of low CONUT attacks. High CONUTs hospitalization rates are significantly higher than low CONUTs hospitalization rates.
Conclusion: The CONUT score is accepted as a promising tool for the assessment of malnutrition. In our study, CONUT scores were high in COPD patients over 65 years of age with low FEV1%, high CAT and high mMRC values. This high level suggests that the CONUT score may be a new prognostic predictor. And again, we found that the CONUT score was associated with a high number of attacks and hospitalizations. These results suggest that the use of the CONUT score may help adapt patients’ follow-up and treatment strategies.

Keywords

COPD, CONUT, malnutrition

Ethical Statement

This study was approved by the ethics committee of the hospital institution (28.05.2024/2661).

Thanks

all author

References

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report). https://goldcopd.org/2024-gold-report/. Accessed March 2024.
• Barnes PJ, Burney PG, Silverman EK, et al. Chronic obstructive pulmonary disease. Nat Rev Dis Primers. 2015;1:1 5076.
• Scioscia G, Blanco I, Arismendi E, et al. Different dyspnoea perception in COPD patients with frequent and infrequent exacerbations. Thorax. 2017;72(2):117-121.
• Lewis MI, Sieck GC, Fournier M.Effect of nutritional deprivation on diaphragm contractility and muscle size. J Appl Physiol. 1986; 60:96-603.
• Donahoe M, Rogers RM. Nutrition assessment and support in chronic obstructive pulmonary disease. Clin Chest Med. 1990;11:487.
• Braun ST, Keim NL, Dixon RM. The prevalence and determinants KOAH ve beslenme 428 of nutritional changes in chronic obstructive pulmonary disease. Chest. 1984;86:558-563.
• Driver AG, McAlevy MT, Smith JL. Nutritional assessment of patients with chronic obstructive pulmonary disease and respiratory failure. Chest. 1982;82:568-571.
• Wermeeren MA, Schols AM, Wouters EF. Effects of an acute exacerbations on nutritional and metabolic profile of patients with COPD. Eur Respir J. 1997;10:2264-2269.
• Schols AM. Nutrition in chronic obstructive pulmonary disease. Curr Opin Pulm. Med. 2000;6:110-15.
• Hancu, A. Nutritional status as a risk factor in COPD. Maedica. 2019;14(2):140.
• Vermeeren, MA, Creutzberg EC, Schols AM, et al. Prevalence of nutritional depletion in large out-patient population of patients with COPD. Respir Med. 2006;100:1349-1355.
• Ozgen N, Lu Z, Boink GJ, et al. Microtubules and angiotensin II receptors contribute to modulation of repolarization induced by ventricular pacing. Heart Rhythm. 2012;9:1865-1872.
• Plotnikov AN, Yu H, Geller JC, et al. Role of L-type calcium channels in pacing-induced short-term and long-term cardiac memory in canine heart. Circulation. 2003;107:2844-2849.
• Itoh M, Tsuji T, Nemoto K, Nakamura H, Aoshiba K. Undernutrition in patients with COPD and its treatment. Nutrients. 2013;5(4):1316-1335.
• De Ulibarri J, González-Madroño A, de Villar NG, at al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20:38-45.
• Lo Buglio A, Bellanti F, Capurso C, Vendemiale G. Controlling nutritional status (CONUT) score as a predictive marker in hospitalized frail elderly patients. J Personaliz Med. 2023;13(7):1119.
• Rawal G, Yadav S. Nutrition in chronic obstructive pulmonary disease: a review. J Translat Int Med. 2015;3(4):151-154.
• Ingadottir AR, Beck AM, Baldwin C, et al. Two components of the new ESPEN diagnostic criteria for malnutrition are independent predictors of lung function in hospitalized patients with chronic obstructive pulmonary disease (COPD). Clinical Nutrition. 2018;37(4):1323-1331.
• Raad S, Smith C and Allen K. Nutrition status and chronic obstructive pulmonary disease: can we move beyond the body mass index? Nutrition in Clinical Practice. 2019;34(3):330-339.
• Keogh E, Williams EM. Managing malnutrition in COPD: a review. Respirat Med. 2021:176:106248.
• Gea J, Barreiro E. Nutritional abnormalities and chronic obstructive pulmonary disease. Int J Tuberculos Lung Dis. 2019; 23(5):531-532.
• Silvestre CR, Domingues TD, Mateus L, et al. The nutritional status of chronic obstructive pulmonary disease exacerbators. Canadian Respirat J. 2022. doi:10.1155/2022/3101486
• Tomita M, Matsuse H, Hashida R, et al. Impact of energy malnutrition on exacerbation hospitalization in patients with chronic obstructive pulmonary disease: retrospective observational study. J Nutrit Sci Vitaminol. 2024;70(1):44-52.
• Law S, Kumar P, Woods S, Sriram KB. Malnutrition screening in patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease and its association with patient outcomes. Hospital Practice. 2016;44(4):207-212.
• Gattermann Pereira T, Lima J, Silva FM. Undernutrition is associated with mortality, exacerbation, and poorer quality of life in patients with chronic obstructive pulmonary disease: a systematic review with meta‐analysis of observational studies. J Parent Enteral Nutrit. 2022;46(5):977-996.
• Yamaya M, Usami O, Nakayama S, et al. Malnutrition, airflow limitation and severe emphysema are risks for exacerbation of chronic obstructive pulmonary disease in Japanese subjects: a retrospective single-center study. Int J Chronic Obstruct Pulmonar Dis. 2020;857-868.
• Girón R, Matesanz C, García-Río F, et al. Nutritional state during COPD exacerbation: clinical and prognostic implications. Ann Nutrit Metabol. 2009;54(1):52-58.
• Lo Buglio A, Scioscia G, Bellanti F, et al. Controlling nutritional status score as a predictor for chronic obstructive pulmonary disease exacerbation risk in elderly patients. Metabolites. 2023;13(11):1123.