KOAH Hastalarında Beslenme Durumunun Hastalık Şiddetine Etkisi

Öz

Amaç: Bu çalışmanın amacı, KOAH hastalarının beslenme durumunu değerlendirmek ve hastalık şiddeti ile olan ilişkisini incelemektir. Yöntemler: Bu çalışmaya, 15 Kasım 2022 ile 1 Mart 2023 tarihleri arasında göğüs hastalıkları polikliniğine başvuran ve KOAH tanısı almış 40 yaş üzeri hastalar dâhil edildi. Bu hastalara antropometrik ölçümler ve BİA (Biyoelektrik İmpedans Analizi) uygulandı. Beslenme durumu, MNA(Mini Nutritional Assessment) ve MUST(Malnutrition Universal Screening Tool) kullanılarak değerlendirildi. KOAH’ın şiddeti; bronkodilatör sonrası FEV₁( Zorlu Ekspiratuar Volüm – 1. Saniye), CAT(KOAH Değerlendirme Testi) ve mMRC(Modifiye Medikal Araştırma Konseyi Dispne Skalası) dispne skoru ile belirlendi. Bulgular: Çalışmaya 129 hasta (ortalama yaş: 63,01 ± 10,12 yıl) dâhil edildi. Ortalama beden kitle indeksi (BKİ) 24,95 ± 5,59, ortalama FFMI(Yağsız Vücut Kitle İndeksi) ise 19,01 ± 2,91 idi. Düşük kilolu ve obez gruplar arasında FEV₁/FVC(Birinci saniyedeki zorlu ekspiratuar hacmin (FEV₁), zorlu vital kapasiteye (FVC)) oranlarında anlamlı fark bulundu (p=0,025). FFMI ile FEV₁ (p=0,019), FEV₁/FVC (p=0,018) ve FEF25–75 (p=0,015) arasında istatistiksel olarak anlamlı ilişkiler gözlendi. MNA ve MUST skorları da akciğer fonksiyon parametreleri ile anlamlı şekilde ilişkiliydi. Sonuç: Düşük BKİ ve FFMI,KOAH’ta bozulmuş akciğer fonksiyonlarıyla ilişkilidir. Beslenme durumu, hastalık şiddetiyle yakından bağlantılıdır. BIA dâhil olmak üzere beslenme durumunun erken değerlendirilmesi ve uygun beslenme desteği, solunumsal sonuçların ve genel prognozun iyileştirilmesine katkıda bulunabilir; KOAH yönetiminde dikkate alınmalıdır.

Anahtar Kelimeler

• vücut kitle indeksi
• beslenme durumu
• akciğer fonksiyon testleri
• yağsız vücut kütle indeksi

The Impact of Nutritional Status on Disease Severity in COPD Patients

Öz

Background: Hypoxia and systemic inflammation observed in chronic obstructive pulmonary disease (COPD) may lead to weight loss, muscle atrophy, and malnutrition. Objective: The objective of this study is to evaluate the nutritional status of patients with COPD and to examine its association with disease severity. Methods: Patients over the age of 40 who attended the pulmonary outpatient clinic between November 15, 2022, and March 1, 2023, and were diagnosed with COPD were included in the study. Anthropometric measurements and bioelectrical impedance analyses were performed for these patients.The nutritional status of the patients was assessed using the Mini Nutritional Assessment (MNA) and the Malnutrition Universal Screening Tool (MUST). The severity of COPD was determined by post-bronchodilator FEV₁, the COPD Assessment Test (CAT), and the modified Medical Research Council (mMRC) dyspnea scale. Results: The study included 129 patients (mean age: 63.01 ± 10.12 years). The mean BMI was 24.95 ± 5.59, and FFMI was 19.01 ± 2.91. Significant differences were found in FEV₁/FVC ratios between underweight and obese groups (p=0.025). Statistically significant associations were observed between FFMI and FEV₁ (p=0.019), FEV₁/FVC (p=0.018), and FEF25–75 (p=0.015).MNA and MUST scores were also significantly associated with pulmonary function parameters. Conclusion: Lower BMI and FFMI are associated with impaired lung function in COPD. Nutritional status is closely linked to disease severity. Early evaluation of nutritional status, including BIA, and provision of appropriate nutritional support may contribute to improved respiratory outcomes and overall prognosis, and should be considered in COPD management

Anahtar Kelimeler

• body mass index
• Nutritional status
• pulmonary function tests
• fat-free mass index

Kaynakça

1. 1.Celli B, Fabbri L, Criner G, et al. Definition andNomenclature of Chronic Obstructive PulmonaryDisease: Time for Its Revision. Am J Respir Crit CareMed. 2022;206(11):1317-1325.doi:10.1164/rccm.202204-0671PP. Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC9746870/
2. 2.Adeloye D, Song P, Zhu Y, et al. Global, regional,and national prevalence of, and risk factors for,chronic obstructive pulmonary disease (COPD) in2019: a systematic review and modelling analysis.Lancet Respir Med. 2022;10(5):447-458.doi:10.1016/s2213-2600(21)00511-7.
3. 3.Boers E, Barrett M, Su JG, et al. Global Burden ofChronic Obstructive Pulmonary Disease Through2050. JAMA Netw Open. 2023;6(12):e2346598.doi:10.1001/jamanetworkopen.2023.46598.
4. 4.Corsonello A, Antonelli Incalzi R, Pistelli R, et al.Comorbidities of chronic obstructive pulmonarydisease. Curr Opin Pulm Med. 2011;17 Suppl 1:S21-S28. doi10.1097/01.mcp.0000410744.75216.d0.
5. 5.Hanson C, Bowser EK, Frankenfield DC, et al.Chronic Obstructive Pulmonary Disease: A 2019Evidence Analysis Center Evidence-Based PracticeGuideline. J Acad Nutr Diet. 2021;121(1):139-165.e15. doi:10.1016/j.jand.2019.12.001. Availablefrom: https://www.jandonline.org/article/S2212-2672(19)31696-X/fulltext
6. 6.Fekete M, Pákó J, Szőllősi G, et al. [Significance ofnutritional status in chronic obstructive pulmonarydisease: a survey]. Orv Hetil. 2020;161(40):1711-1719. doi:10.1556/650.2020.31824. Availablefrom:https://akjournals.com/view/journals/650/161/40/article-p1711.xml
7. 7.Mete B, Pehlivan E, Gülbaş G, et al. Prevalence ofmalnutrition in COPD and its relationship with theparameters related to disease severity. Int J ChronObstruct Pulmon Dis. 2018;13:3307-3312.doi:10.2147/COPD.S179609. Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC6188194/
8. 8.Shen X, Qian R, Wei Y, et al. Prediction model andassessment of malnutrition in patients with stablechronic obstructive pulmonary disease. Sci Rep.2024;14(1):6508. doi:10.1038/s41598-024-56747-2. Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC10948850/

9. 9.Rawal G, Yadav S. Nutrition in chronic obstructivepulmonary disease: A review. J Transl Int Med.2015;3(4):151-154. doi:10.1515/jtim-2015-0021.Available from:https://pmc.ncbi.nlm.nih.gov/articles/PMC4936454/#sec12
10. 10.Remels AH, Gosker HR, Langen RC, et al. Themechanisms of cachexia underlying muscledysfunction in COPD. J Appl Physiol.2013;114(9):1253-1262.doi:10.1152/japplphysiol.00790.2012.
11. 11.Vermeeren MA, Creutzberg EC, Schols AM, et al.Prevalence of nutritional depletion in a large out-patient population of patients with COPD. RespirMed. 2006;100(8):1349-1355.doi:10.1016/j.rmed.2005.11.023. Available from:https://www.sciencedirect.com/science/article/pii/S0954611105005135?via%3Dihub
12. 12.Schols AM, Ferreira IM, Franssen FM, et al.Nutritional assessment and therapy in COPD: aEuropean Respiratory Society statement. Eur RespirJ. 2014;44(6):1504-1520.doi:10.1183/09031936.00070914. Available from:https://publications.ersnet.org//content/erj/44/6/1504.full.pdf
13. 13.Walter-Kroker A, Kroker A, Mattiucci-Guehlke M,et al. A practical guide to bioelectrical impedanceanalysis using the example of chronic obstructivepulmonary disease. Nutr J. 2011;10:35.doi:10.1186/1475-2891-10-35.
14. 14.Kyle UG, Bosaeus I, De Lorenzo AD, et al.Bioelectrical impedance analysis—part II:utilization in clinical practice. Clin Nutr.2004;23(6):1430-1453.doi:10.1016/j.clnu.2004.09.012. Available from:https://doi.org/10.1016/j.clnu.2004.09.012
15. 15. Serón-Arbeloa C, Labarta-Monzón L, Puzo-Foncillas J, et al. Malnutrition Screening and Assessment. Nutrients. 2022;14(12). doi:10.3390/nu14122392. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9228435/#sec4-nutrients-14-02392
16. 16.Zhang X, Zhang Q, Feng LJ, et al. The Applicationof Fat-Free Mass Index for Survival Prediction inCancer Patients With Normal and High Body MassIndex. Front Nutr. 2021;8:714051.doi:10.3389/fnut.2021.714051.
17. 17. Agustí A, Celli BR, Criner GJ, et al. Global Initiativefor Chronic Obstructive Lung Disease 2023 Report:GOLD Executive Summary. Am J Respir Crit CareMed. 2023;207(7):819-837.doi:10.1164/rccm.202301-0106PP.
18. 18. Sarikaya D. Geriatrik hastalarda mini nütrisyoneldeğerlendirme (MNA) testinin uzun ve kısa (MNA-SF) formunun geçerlilik çalışması. 2013.
19. 19.Guigoz Y. The Mini Nutritional Assessment(MNA) review of the literature--What does it tell us?J Nutr Health Aging. 2006;10(6):466-485.
20. 20.Hsu MF, Ho SC, Kuo HP, et al. Mini-nutritionalassessment (MNA) is useful for assessing thenutritional status of patients with chronicobstructive pulmonary disease: a cross-sectionalstudy. COPD. 2014;11(3):325-332.doi:10.3109/15412555.2013.863274.
21. 21.Kaluźniak-Szymanowska A, Krzymińska-Siemaszko R, et al. Optimal Assessment ofNutritional Status in Older Subjects with the Chronic Obstructive Pulmonary Disease. Int J Environ ResPublic Health. 2022;19(3).doi:10.3390/ijerph19031025.
22. 22.Ingadottir AR, Beck AM, Baldwin C, et al. ESPENdiagnostic criteria and lung function in hospitalizedCOPD patients. Clin Nutr. 2018;37(4):1323-1331.doi:10.1016/j.clnu.2017.05.031.
23. 23.Benedik B, Farkas J, Kosnik M, et al. Mininutritional assessment, body composition, andhospitalisations in patients with COPD. Respir Med.2011;105 Suppl 1:S38-S43. doi:10.1016/s0954-6111(11)70009-9.
24. 24.Sharma B, Dabur R. Role of Pro-inflammatoryCytokines in Regulation of Skeletal MuscleMetabolism: A Systematic Review. Curr Med Chem.2020;27(13):2161-2188.doi:10.2174/0929867326666181129095309.
25. 25.Qaisar R, Ustrana S, Muhammad T, et al.Sarcopenia in pulmonary diseases and sarcoplasmicreticulum stress. Histochem Cell Biol.2022;157(1):93-105. doi:10.1007/s00418-021-02043-3.
26. 26.Chai X, Chen Y, Li Y, et al. Lower geriatricnutritional risk index and mortality in COPD. BMJOpen Respir Res. 2023;10(1). doi:10.1136/bmjresp-2022-001518.
27. 27.Nan Y, Zhou Y, Dai Z, et al. Role of nutrition inpatients with COPD and sarcopenia. Front Nutr.2023;10:1214684. doi:10.3389/fnut.2023.1214684.
28. 28.Jin X, Yang Y, Chen G, et al. Correlation betweenbody composition and COPD severity. Front Med.2024;11:1304384.doi:10.3389/fmed.2024.1304384.
29. 29.King DA, Cordova F, Scharf SM. Nutritionalaspects of COPD. Proc Am Thorac Soc.2008;5(4):519-523. doi:10.1513/pats.200707-092ET.
30. 30. Ahmadi A, Mazloom Z, Eftekhari MH, et al. Musclemass and function related to respiratory function inCOPD. Med J Islam Repub Iran. 2021;35:34.doi:10.47176/mjiri.35.34.
31. 31.de Blasio F, Miracco Berlingieri G, Bianco A, et al.Evaluation of body composition in COPD patientsusing multifrequency bioelectrical impedance. Int JChron Obstruct Pulmon Dis. 2016;11:2419- 2426.doi:10.2147/COPD.S110364.
32. 32.Landbo C, Prescott E, Lange P, et al. Prognosticvalue of nutritional status in COPD. Am J Respir CritCare Med. 1999;160(6):1856-1861.doi:10.1164/ajrccm.160.6.9902115.
33. 33.Guo Y, Zhang T, Wang Z, et al. BMI and mortalityin COPD: A dose-response meta-analysis. Medicine.2016;95(28):e4225.doi:10.1097/MD.0000000000004225.
34. 34.Tang X, Lei J, Li W, et al. The RelationshipBetween BMI and Lung Function in China. Int JChron Obstruct Pulmon Dis. 2022;17:2677-2692.doi:10.2147/COPD.S378247.