Eri Miyuki1,2, Yoko Hokotachi1,3, Mari Hasegawa4, Masahiro kaneko5 and Teruyoshi Amagai4*
1Administration Food Sciences and Nutrition Major, Graduate School of Human Environmental Sciences, Mukogawa Women's University, Japan
2Department of Food and Nutrition, Ube Frontier College, Japan
3Department of Clinical Nutrition, Takarazuka Dai-ichi Hospital, Japan
4Department of Human Environmental Sciences, Mukogawa Women's University, Japan
5Department of Respiratory Medicine, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, Japan
Background: Malnutrition is frequently observed in patients with Chronic Obstructive Pulmonary Disease (COPD). However, the effects of decreased caloric consumption on disease severity have not been determined.
Objective: To examine the hypothesis that increased incidence of COPD-related symptoms is associated with lower energy intake in malnourished COPD patients. Design and Setting: A cross-sectional study at a single institute.
Participants: Patients with older than 18 years of age who visited the outpatient COPD clinic at a single institute were eligible. Measurements: Subjects were divided into two groups to categorize high and low Daily Energy Intake (DEI) using three strategies, with daily caloric cutoff thresholds of 25, 30 and 35 kcal/kg to distinguish high-DEI patients from low-DEI patients. All data was compared between higher- DEI and lower-DEI patients using each threshold to examine whether lower energy intake is associated with COPD symptom severity and frequency and to determine the optimal cutoff value to distinguish higher-DEI and lower-DEI patients.
Results: The cutoff value of a DEI of 30 kcal/kg could identify which patients had severe symptoms and malnutrition. COPD patients with DEI ≤ 30 kcal/kg had more severe dyspneic symptoms, as determined by a COPD Assessment Test (CAT). Finally, CAT could be recognized as the determinant of lower DEI in patients with COPD and malnutrition.
Conclusion: Our study proved that DEI ≤ 30 kcal/kg body weights may identify COPD patients with severe dyspnea, as assessed by CAT. In addition, the Food Frequency Questionnaire, known as BDHQ (brief-type self-administered diet history questionnaire), suggested that lower-DEI patients consumed a significantly smaller percentage of fat as a macronutrient in total energy. Increasing DEI to greater than 30 kcal/kg per day and increasing fat intake may improve COPD. However, the adverse events from this nutritional strategy must be monitored long term.
Miyuki E, Hokotachi Y, Hasegawa M, kaneko M, Amagai T. A Dyspnea as Determinant of Lower Energy Intake in Older Adult Patients with Chronic Obstructive Pulmonary Disease (COPD). Clin Surg. 2019; 4: 2410.