The Relationship between GOLD Grouping and Nutritional Status in Patients with Chronic Obstructive Pulmonary Disease
Date Issued
2014
Date
2014
Author(s)
Chen, Ying-Yu
Abstract
Background: Malnutrition is a common and serious problem among patients with chronic obstructive pulmonary disease (COPD), one which causes body weight loss and the depletion of free-fat mass (FFM). The Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy for the assessment of COPD was revised in 2014, and COPD patients are classified into groups A, B, C, and D. The GOLD ABCD groups help the treatment for COPD patients more efficient, but malnutrition was often neglected in the managements of patients with COPD. Aim: This study examined the nutritional status of patients with COPD, and explored the relationship between the GOLD grouping and nutritional status. Methods: A cross-sectional research design was used in this study. A total of 116 subjects were recruited at a medical center in northern Taiwan. For the combined COPD assessment, we selected the COPD assessment test (CAT) scale for assessing symptom, and used lung function and the history of exacerbation to assess the risk of exacerbation. The nutritional status was evaluated using the Mini Nutritional Assessment (MNA) questionnaire and body composition was measured with a body fat analyzer (Tanita BC-565-WH, Japan). Data were analyzed with SPSS version 20.0 for Windows. Independent t-test and one-way ANOVA were used to compare the values for the different groups. Multiple linear regression analysis was used to test which variables were associated with the indicators of nutritional status. A p-value of less than 0.05 was considered statistically significant. Results: The subjects were mostly men (96.6%) and had a mean age of 70.6 (SD=10.9) years. Underweight (BMI<20kg/m2) occurred in 15.5% of the COPD patients. The nutritional status indicators of the elderly patients (>75years old) were worse than in younger patients, particularly in terms of BMI, FFM and fat-free mass index (FFMI). Patients who did not work had worse FFM and FFMI result, because most of them were older retirees. The nutritional statuses of COPD patients with comorbidities were unnecessarily worse. This was due to the fact that many COPD patients may also have metabolic syndrome. Exacerbation frequency was significantly associated with the MNA scores (p<0.001). FEV1/FVC% of lung function was positively correlated with FFM (r=0.229, p=0.014). In terms of the GOLD grouping, 32.8% of the subjects were classified in group A, 25.9% were classified in group B, 17.2% were classified in group C, and 24.1% were classified in group D. Close to seventy percent of the patients in groups C and, D were malnourished and at risk for malnutrition (68.8% according to the MNA and 66.7% according to the MNA-T1). The MNA scores were generally lower with increasing COPD severity according to GOLD grouping (p<0.001). In multiple linear regression analysis, the MNA scores were related to the severity of COPD base on GOLD grouping. The severer the COPD, the less the MNA scores. For the other indicators of nutritional status (BMI, fat%, FFM and FFMI), the COPD severity according to GOLD grouping was not a significant predicator. Conclusions: We used the MNA questionnaire and body composition measurements to assess the nutritional status of COPD patients in this study. After determining which patients might be at risk of malnutrition, we needed to provide nutritional support and follow-up. The GOLD grouping were significantly associated with MNA scores, so we suggested that nutritional assessments and dietary health education should be conducted for COPD patients classified in groups C and D of the GOLD grouping in order to improve the health status and prognosis for each of these patients.
Subjects
chronic obstructive pulmonary disease(COPD)
malnutrition
nutritional status
ABCD groups
mini nutritional assessment(MNA)
body composition
Type
thesis
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