Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease

OBJECTIVE: Weight loss and muscle wasting adversely affect morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). Maintenance systemic glucocorticosteroids, prescribed in a substantial number of patients, further contribute to muscle weakness. We investigated the efficacy of oral nutritional supplementation therapy in depleted patients with COPD. METHODS: The therapy consisted of daily two to three oral liquid nutritional supplements (mean +/- standard deviation: 2812 +/- 523 kJ/24 h) incorporated into an 8-wk inpatient pulmonary rehabilitation program in 64 (49 men) depleted patients with COPD. Endpoints were body weight, fat-free mass by bioelectrical impedance analysis, respiratory and peripheral muscle function (maximal inspiratory mouth pressure and handgrip strength, respectively), exercise performance (incremental bicycle ergometry), and disease-specific health status by St. George's Respiratory Questionnaire. Forty-eight percent of the patients were treated with low-dose oral glucocorticosteroids as maintenance medication (dose equivalent to 7.6 +/- 2.5 mg of methylprednisolone per day). RESULTS: Increases in body weight (2.1 +/- 2.1 kg, P < 0.001) and fat-free mass (1.1 +/- 2.0 kg, P < 0.001) were seen. Further, maximal inspiratory mouth pressure (4 +/- 10 cm of H(2)O, P = 0.001), handgrip strength (1.2 +/- 3.1 kg, P = 0.004), and peak workload (7 +/- 11 W, P = 0.001) significantly improved. Clinically significant improvements in the items symptoms (9 +/- 16 points, P < 0.001) and impact (4 +/- 15 points, P = 0.043) of St. George's Respiratory Questionnaire were achieved. Oral glucocorticosteroid treatment significantly impaired the response to nutritional supplementation therapy with respect to maximal inspiratory mouth pressure, peak workload, and St. George's Respiratory Questionnaire symptom score. CONCLUSIONS: Nutritional supplementation therapy implemented in a pulmonary rehabilitation program was effective in depleted patients with COPD. However, oral glucocorticosteroid treatment attenuated the anabolic response to nutritional supplementation.     

The pulmonary cachexia syndrome: aspects of energy balance.

The present paper reviews current knowledge of the pulmonary cachexia syndrome with reference to chronic obstructive pulmonary disease (COPD). Aspects of incidence, aetiology and management are discussed. Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD. Both fat mass and fat-free mass become depleted. Loss of fat-free mass is the more important and appears to be due to a depression of protein synthesis. Weight loss is an independent prognostic indicator of mortality, and is associated with increased morbidity and decreased health-related quality of life. The aetiology of malnutrition in COPD is not well understood. Reduced food intake does not seem to be the primary cause. Resting energy expenditure (REE) is elevated in a proportion of patients and probably contributes to negative energy balance. Measurement of actual REE is helpful when considering the adequacy of nutritional supplementation. The underlying reason for a hypermetabolic state is not known. Although weight-losing COPD patients are not catabolic, nutritional supplementation alone does not appear to reverse the loss of fat-free mass. Strategies involving nutritional supplementation in combination with a second intervention are being explored, and there are some encouraging results using anabolic hormones.     

Interventions pour restaurer la masse musculaire du sujet âgé

Resistance exercice training is the most efficient intervention to prevent or limit sarcopenia in elderly. Studies with anabolic treatments have poor results. Because old persons have low energy and protein intakes, increased protein intakes over 0.8–1.0 g/kg of body weight per day could enhance exercice efficacy.     

Composition corporelle des patients atteints de BPCO et son impact sur la fonction respiratoire

Introduction:

Despite fat-free mass index (FFMI) is one of the strongest predictive factors of survival during chronic obstructive pulmonary disease (COPD), there is a considerable lack of information regarding body composition in Tunisian patients with COPD.   Aim: Describe the body composition of Tunisian patients followed for COPD and examine the relationship between body composition and the severity of the disease.

Methods:

Cross-sectional study of patients with stable COPD. Body composition was assessed by bioelectrical impedance analysis. Pulmonary function tests (PFT) included spirometry with plethysmography and the six-minute walking test. The severity of dyspnea was assessed by the mMRC scale.

Results:

During the study period, 104 patients with stable COPD were included (average age= 65.9 years and average FEV1= 49.3%). Fifty-four percent of patients were GOLD D stage. According to the IMM, malnutrition was identified in 20.2% of cases. Patients with low FFMI were the most symptomatic, had a more severe air flow limitation and a more severe disease. The walking distance was lower in malnourished patients. However, FFMI was not significantly associated with exercise capacity.

Conclusions:

Malnutrition is highly prevalent in COPD patients and is correlated to the severity of the disease. Thus, body composition analysis should be considered in COPD patient management.     

Pulmonary Rehabilitation Programs

Effective management of chronic obstructive pulmonary disease (COPD) is aimed at prevention of disease progression, relief of symptoms, improvement in exercise tolerance, improvement in health status, prevention of complications, prevention of exacerbations and reduction in mortality. Pulmonary rehabilitation, aimed at restoring patients with disabling disease to an optimally functioning state, is a relatively recent practice in pulmonary medicine and is classically described as a multidisciplinary program of ‘care’ for patients with chronic respiratory impairment.Health status assessment is a central feature of studies of COPD, since treatments for this condition, other than smoking cessation and long-term oxygen therapy, are largely symptomatic. Health status measurement quantifies the impact of disease on patients’ daily life, health and well-being. General health- and disease-specific questionnaires have been designed to measure health status as well as health-related quality of life (HR-QOL).Published results provide a scientific basis for the overall pulmonary rehabilitation programs and, although with a lesser degree of evidence, for the specific components of these programs. The benefits of pulmonary rehabilitation include improvements in exercise tolerance, dyspnea and HR-QOL, and, to some extent, a decrease in healthcare usage. Pulmonary rehabilitation is effective in all settings including hospital inpatient, hospital outpatient, the community and home. However, more information is needed to ensure that the appropriate rehabilitation is given to the increasing number of patients with chronic respiratory diseases.Pulmonary rehabilitation is a costly process and patients should be carefully selected in order to save resources and obtain the maximum benefit. Although several questions remain unresolved, pulmonary rehabilitation programs should be included in the comprehensive treatment of patients with COPD.     

Évaluation de l'état nutritionnel du patient BPCO

Chronic obstructive pulmonary disease (COPD) is associated with a high prevalence of malnutrition. Malnutrition is a predictive factor of overall mortality in COPD, independently of respiratory function. Although a low body mass index is associated with a high mortality rate, population-based studies have shown that the strongest predictive factor of survival in COPD was the fat-free mass. The determination of body composition therefore constitutes a pivotal step in the clinical assessment of COPD patients. Single-frequency bioelectrical impedance analysis appears to be the most convenient tool for the assessment of body composition, because it is an easy, inexpensive, and highly reproducible method. Nevertheless it has been suggested that dual energy X-ray absorptiometry (DEXA) and computed tomography could be useful methods for the assessment of muscle mass in COPD. Despite the associated pitfalls, determination of weight, body mass index and anthropometric measurements remain essential parameters of nutritional assessment of patients with COPD.     

Malnutrition According to GLIM Criteria Is Associated with Mortality and Hospitalizations in Rehabilitation Patients with Stable Chronic Obstructive Pulmonary Disease

Malnutrition has a negative impact on patients with chronic pulmonary obstructive disease (COPD). The purpose of this study was to assess the prevalence of malnutrition, defined by the Global Leadership Initiative for Malnutrition (GLIM), in stable COPD patients referred to pulmonary rehabilitation, and to explore potential associations of malnutrition according to GLIM, and its components, with increased risk of mortality and hospitalizations in 2 years. In a post-hoc analysis of a prospective cohort of 200 rehabilitation patients with stable COPD, main outcome variables were hospital admissions, length of stay, and mortality during a 2-year follow-up. Covariates were malnutrition according to GLIM and its phenotypic criteria: unintentional weight loss, low body mass index (BMI), and low fat-free mass (FFM). Univariate and multivariate analysis were performed using logistic and proportional hazard Cox regression. Malnutrition according to GLIM showed 45% prevalence and was associated with increased mortality risk. Low age-related BMI and FFM were independently associated with mortality, which persisted after adjustment for age and lung function. Malnutrition and low BMI were also associated with increased risk of hospitalization. Malnutrition according to GLIM criteria was highly prevalent in rehabilitation patients with COPD and was associated with nearly 3 times greater mortality and hospitalization risk.     

Oxidative Stress and Total Phenolics Concentration in COPD Patients—The Effect of Exercises: A Randomized Controlled Trial

Patients with chronic obstructive pulmonary disease (COPD) suffer from exercise intolerance, the sensation of dyspnea, and fatigue, which are the main reasons for limiting their physical activity. In addition to changes in the respiratory and circulatory systems in patients with COPD, peripheral muscle dysfunction, with numerous metabolic dysfunctions, is observed. One of the symptoms of the described anomalies, among others, is an antioxidative and prooxidative imbalance. The aim of the study was to demonstrate the impact of endurance training, carried out in the extended pulmonary rehabilitation program in COPD patients, on the imbalance between prooxidants and antioxidants in their bodies. Methods: The tests were carried out on a group of patients (n = 32) with COPD; 20 randomly selected people underwent a modified rehabilitation program during their rehabilitation stay, and the obtained results were compared with the results of 12 patients (control group) who were treated without endurance training. At the beginning and at the end of the study, spirometry and cardiopulmonary exercise tests (CPET) were performed. Oxidative stress (allantoin (All) and substances which react with thiobarbituric acid) and antioxidant (ferric reducing ability of plasma and total phenolics) parameters’ concentrations were determined in the venous blood. Results: In the study group, greater post-training increases of VO_2max (p = 0.0702) and FEV₁/FVC (p < 0.05; ES: 0.436) were reported. The applied CPET at each time caused an increase in the All concentration (p < 0.05) in the study and control groups. Conclusions: Endurance training applied as a part of the rehabilitation process did not cause the additional aggravation of oxidative stress and blood total phenolics concentration.     

Réhabilitation respiratoire dans la broncho-pneumopathie chronique obstructive (BPCO) : l’androgénothérapie,pourquoi ? Pour qui ? Comment ?

Chronic obstructive pulmonary disease (COPD) combines the deleterious effects of chronic hypoxia, chronic inflammation, insulin-resistance, increased energy expenditure, muscle wasting, and exercise deconditioning. As for other chronic disorders, loss of fat-free mass decreased survival. The preservation of muscle mass and function, through the protection of the mitochondrial oxidative metabolism, is an important challenge in the management of COPD patients. As the prevalence of the disease is increasing and the medical advances make COPD patients live longer, the prevalence of COPD-associated nutritional disorders is expected to augmentation in future decades. Androgenopenia, or hypogonadism, defined by free testosterone plasma concentrations below 50 pg/mL, is observed in 40% of COPD patients. Due to the stimulating effects of androgens on muscle anabolism, androgenopenia favors loss of muscle mass. Studies, including one recent meta-analysis, indicate that androgen substitution could improve body mass index and fat-free mass as well as quality of life in COPD patients, but, alone, was insufficient to improve lung function. Two multicentric randomized clinical trials have shown that the association of androgen therapy with physical exercise and oral nutritional supplements containing omega-3 polyinsaturated fatty acids in the context of pulmonary rehabilitation, during at least three months, is associated with an improved clinical outcome and survival. These approaches are optimized in the field of pulmonary rehabilitation, which is the reference therapy of COPD-associated undernutrition.     

Nutritional depletion and its relationship to respiratory impairment in patients with chronic respiratory failure due to COPD or restrictive thoracic diseases

OBJECTIVE: While malnutrition, especially fat-free mass index (FFMI), is a predictor for mortality in chronic obstructive pulmonary disease (COPD), less information on prevalence and mechanisms is available in patients with chronic respiratory failure (CRF) due to restrictive thoracic diseases (RTD). DESIGN AND SETTING: Cross-sectional study of patients consecutively admitted to an in-patient primary pulmonary centre. SUBJECTS: One hundred and thirty-two patients (30% RTD; 70% COPD) with CRF and intermittent non-invasive positive pressure ventilation. INTERVENTIONS: Malnutrition was quantified by bioelectrical impedance analysis or body mass index (BMI), and its relationship to laboratory, lung function, inspiratory muscle and blood gas parameters and 6-min walking distance (6-MWD) was assessed. RESULTS: Malnutrition in terms of BMI<20 kg/m(2) occurred in 16.1% of patients with COPD but none of those with RTD. FFMI<17.4 (<15.0 in female patients) kg/m(2) was found in 35.4 and 30.7%, respectively. FFMI was correlated with airway obstruction (sR(aw), r = -0.50; FEV(1)/VC, r = -0.28; P< or = 0.01 each) and lung hyperinflation (intrathoracic gas volume, r = -0.41; total lung capacity (TLC), r = -0.50; P< or = 0.001 each) in COPD, and with lung restriction in RTD (TLC, r=0.40; P=0.011). Furthermore, malnourished patients showed a higher inspiratory load (P (0.1)) and reduced 6-MWD in both groups. In COPD, only hyperinflation and P (0.1) were independently related to FFMI. CONCLUSIONS: Malnutrition as indicated by low FFMI was similarly prevalent in patients with CRF and COPD or RTD, but inadequately represented by BMI. The correlations between lung function impairments specific for the disease and FFMI emphasized the link between malnutrition and respiratory mechanical load irrespective of its aetiology.     

Nutritional management of the patient with chronic obstructive pulmonary disease.

The prevalence and prognostic importance of malnutrition in chronic obstructive pulmonary disease (COPD), the factors that contribute to development of nutritional depletion, and the available evidence regarding effects of nutrition support in these patients are the subjects of this review. Nutritional depletion, as indicated by weight loss and loss of lean body mass, is a common complication of advanced COPD (particularly, but not limited to, the emphysematous type). Low body weight or recent weight loss and in particular depleted lean body mass in patients with COPD have been shown to be independent predictors of mortality, outcomes after acute exacerbations, hospital admission rates, and need for mechanical ventilation. The factors thought to contribute to nutritional depletion in these patients include elevated resting and activity-related energy expenditure, reduced dietary intake relative to resting energy expenditure, accelerated negative nitrogen balance, particularly during acute exacerbations of COPD, medication effects, and perhaps most importantly an elevated systemic inflammatory response. Studies to date suggest that, although it can help limit weight loss and negative energy balance in these patients, the effect of nutritional supplementation alone on clinically significant outcomes such as pulmonary function and exercise capacity is minimal. However, nutritional supplementation may have a role in the management of COPD when provided as part of an integrated rehabilitation program incorporating a structured exercise component as an anabolic stimulus.     

Body composition and mortality in chronic obstructive pulmonary disease

BACKGROUND: Survival studies have consistently shown significantly greater mortality rates in underweight and normal-weight patients with chronic obstructive pulmonary disease (COPD) than in overweight and obese COPD patients. OBJECTIVE: To compare the contributions of low fat-free mass and low fat mass to mortality, we assessed the association between body composition and mortality in COPD. DESIGN: We studied 412 patients with moderate-to-severe COPD [Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) stages II-IV, forced expiratory volume in 1 s of 36 +/- 14% of predicted (range: 19-70%). Body composition was assessed by using single-frequency bioelectrical impedance. Body mass index, fat-free mass index, fat mass index, and skeletal muscle index were calculated and related to recently developed reference values. COPD patients were stratified into defined categories of tissue-depletion pattern. Overall mortality was assessed at the end of follow-up. RESULTS: Semistarvation and muscle atrophy were equally distributed among disease stages, but the highest prevalence of cachexia was seen in GOLD stage IV. Forty-six percent of the patients (n = 189) died during a maximum follow-up of 5 y. Cox regression models, with and without adjustment for disease severity, showed that fat-free mass index (relative risk: 0.90; 95% CI: 0.84, 0.96; P = 0.003) was an independent predictor of survival, but fat mass index was not. Kaplan-Meier and Cox regression plots for cachexia and muscle atrophy did not differ significantly. CONCLUSIONS: Fat-free mass is an independent predictor of mortality irrespective of fat mass. This study supports the inclusion of body-composition assessment as a systemic marker of disease severity in COPD staging.     

Pulmonary Rehabilitation Programs

Pulmonary rehabilitation programs aim to improve the health of elderly patients disabled by lung disease. Despite the widespread application of these programs limited scientific data is available on the subject, except in chronic obstructive pulmonary disease (COPD). This review presents an overview on outcomes of pulmonary rehabilitation programs in elderly patients with COPD. Statistically significant improvements can be found for functional and maximal exercise capacity, as well as for health-related quality of life (HR-QOL). However, clinically relevant improvements are mainly found for functional exercise capacity and especially for HR-QOL. Rehabilitation programs including elderly patients with COPD also showed clinically relevant improvements in dyspnea and fatigue and an enhancement of the patient’s control over their condition. Therefore, rehabilitation is an important form of treatment and one of the main components of the management of COPD in elderly patients.     

Creatine Enhances the Effects of Cluster-Set Resistance Training on Lower-Limb Body Composition and Strength in Resistance-Trained Men: A Pilot Study

Creatine monohydrate (CrM) supplementation has been shown to improve body composition and muscle strength when combined with resistance training (RT); however, no study has evaluated the combination of this nutritional strategy with cluster-set resistance training (CS-RT). The purpose of this pilot study was to evaluate the effects of CrM supplementation during a high-protein diet and a CS-RT program on lower-limb fat-free mass (LL-FFM) and muscular strength. Twenty-three resistance-trained men (>2 years of training experience, 26.6 ± 8.1 years, 176.3 ± 6.8 cm, 75.6 ± 8.9 kg) participated in this study. Subjects were randomly allocated to a CS-RT+CrM (n = 8), a CS-RT (n = 8), or a control group (n = 7). The CS-RT+CrM group followed a CrM supplementation protocol with 0.1 g·kg⁻¹·day⁻¹ over eight weeks. Two sessions per week of lower-limb CS-RT were performed. LL-FFM corrected for fat-free adipose tissue (dual-energy X-ray absorptiometry) and muscle strength (back squat 1 repetition maximum (SQ-1RM) and countermovement jump (CMJ)) were measured pre- and post-intervention. Significant improvements were found in whole-body fat mass, fat percentage, LL-fat mass, LL-FFM, and SQ-1RM in the CS-RT+CrM and CS-RT groups; however, larger effect sizes were obtained in the CS-RT+CrM group regarding whole body FFM (0.64 versus 0.16), lower-limb FFM (0.62 versus 0.18), and SQ-1RM (1.23 versus 0.75) when compared to the CS-RT group. CMJ showed a significant improvement in the CS-RT+CrM group with no significant changes in CS-RT or control groups. No significant differences were found between groups. Eight weeks of CrM supplementation plus a high-protein diet during a CS-RT program has a higher clinical meaningfulness on lower-limb body composition and strength-related variables in trained males than CS-RT alone. Further research might study the potential health and therapeutic effects of this nutrition and exercise strategy.     

Acute L-Citrulline Supplementation Increases Nitric Oxide Bioavailability but Not Inspiratory Muscle Oxygenation and Respiratory Performance

The present study aimed to investigate whether acute L-citrulline supplementation would affect inspiratory muscle oxygenation and respiratory performance. Twelve healthy males received 6 g of L-citrulline or placebo in a double-blind crossover design. Pulmonary function (i.e., forced expired volume in 1 s, forced vital capacity and their ratio), maximal inspiratory pressure (MIP), fractional exhaled nitric oxide (NO^•), and sternocleidomastoid muscle oxygenation were measured at baseline, one hour post supplementation, and after an incremental resistive breathing protocol to task failure of the respiratory muscles. The resistive breathing task consisted of 30 inspirations at 70% and 80% of MIP followed by continuous inspirations at 90% of MIP until task failure. Sternocleidomastoid muscle oxygenation was assessed using near-infrared spectroscopy. One-hour post-L-citrulline supplementation, exhaled NO^• was significantly increased (19.2%; p < 0.05), and this increase was preserved until the end of the resistive breathing (16.4%; p < 0.05). In contrast, no difference was observed in the placebo condition. Pulmonary function and MIP were not affected by the L-citrulline supplementation. During resistive breathing, sternocleidomastoid muscle oxygenation was significantly reduced, with no difference noted between the two supplementation conditions. In conclusion, a single ingestion of 6 g L-citrulline increased NO^• bioavailability but not the respiratory performance and inspiratory muscle oxygenation.     

Normal Weight but Low Muscle Mass and Abdominally Obese: Implications for the Cardiometabolic Risk Profile in Chronic Obstructive Pulmonary Disease

Background

It is well established that low muscle mass affects physical performance in chronic obstructive pulmonary disease (COPD). We hypothesize that combined low muscle mass and abdominal obesity may also adversely influence the cardiometabolic risk profile in COPD, even in those with normal weight. The cardiometabolic risk profile and the responsiveness to 4 months high-intensity exercise training was assessed in normal-weight patients with COPD with low muscle mass stratified by abdominal obesity.

The impact of nutritional supplementation and resistance training on the health functioning of free-living Chilean elders: results of 18 months of follow-up

Body composition changes and loss of functionality in the elderly are related to substandard diets and progressive sedentariness. The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders. Healthy elders aged > or = 70 y were studied. Half of the subjects received a nutritional supplement. Half of the supplemented and nonsupplemented subjects were randomly assigned to a resistance exercise training program. Every 6 mo, a full assessment was performed. A total of 149 subjects were considered eligible for the study and 98 (31 supplemented and trained, 26 supplemented, 16 trained and 25 without supplementation or training) completed 18 mo of follow-up. Compliance with the supplement was 48%, and trained subjects attended 56% of programmed sessions. Activities of daily living remained constant in the supplemented subjects and decreased in the other groups. Body weight and fat-free mass did not change. Fat mass increased from 22.2 +/- 7.6 to 24.1 +/- 7.7 kg in all groups. Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups (ANOVA, P < 0.01). Serum cholesterol remained constant in both supplemented groups and in the trained groups, but it increased in the control group (ANOVA, P < 0.05). Upper and lower limb strength, walking capacity and maximal inspiratory pressure increased in trained subjects. In conclusion, patients who were receiving nutritional supplementation and resistance training maintained functionality, bone mineral density and serum cholesterol levels and improved their muscle strength.     

Body Composition in 995 Acutely ill or Chronically ill Patients at Hospital Admission: A controlled population Study

Objective To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile.Subjects/Setting 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjectsDesign Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI <20 kg/m² or fat-free mass in the 10th percentile.Statistical Analysis Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups.Results Fat-free mass was significantly lower in patients than controls (P<.05), and the difference with age in fat-free mass in patients was greater than the age-related difference in the controls. A higher percentage fat mass was found in spite of lower BMI in chronically ill patients older than 55 years. Among participants, 25% of acutely ill and 37.3% of chronically ill patients fell below fat-free mass in the 10th percentile, compared with 15.6% of acutely ill and 18.9% of chronically ill patients falling below BMI ≤20 kg/m².Applications/Conclusion Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass. J Am Diet Assoc. 2002;102:944-948,953-955.     

Body Mass Index and Waist-to-Height Changes During Teen Years in Girls Are Influenced by Childhood Body Mass Index

PurposeThis study examined longitudinal changes in waist-to-height ratio and components of body mass index (BMI) among young and adolescent girls of black and white race/ethnicity.MethodsGirls were recruited at age 9 years through the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS) and were followed annually over 10 years. Girls were grouped into low (<20^th percentile), middle, and high (>80^th percentile) BMI on the basis of race-specific BMI percentile rankings at age 9, and low, middle, and high waist-to-height ratio, on the basis of waist-to-height ratio at age 11. BMI was partitioned into fat mass index (FM) and fat-free mass index (FMI).ResultsGirls accrued fat mass at a greater rate than fat-free mass, and the ratio of fat mass to fat-free mass increased from ages 9 through 18. There was a significant increase in this ratio after age at peak height velocity. Participants with elevated BMI and waist-to-height ratios at age 18 tended to have been elevated at ages 9 and 11, respectively. There were strong correlations between BMI at age 9 with several outcomes at age 18: BMI (.76) and FMI (.72), weaker but significant with FFMI (.37), and ratio of fat mass to fat-free mass (.53). In addition, there was significant tracking of elevated BMI from ages 9 through 18.ConclusionsIn girls, higher BMI levels during childhood lead to greater waist-to-height ratios and greater than expected changes in BMI by age 18, with disproportionate increases in fat mass. These changes are especially evident in adolescent girls of black race/ethnicity and after the pubertal growth spurt.     

Effect of complex sanatorium treatment on some dyspnea indices in patients with chronic obstructive pulmonary disease.

The complex treatment of patients with chronic obstructive pulmonary disease (COPD) administered in a sanatorium environment is an effective therapeutic option for this condition as it involves conduction of a combination of climatic, therapeutic and rehabilitation procedures for a longer period of time. We studied the effect of this therapeutic modality on the dyspnea indices of COPD patients and the implication these indices have for the outcome of the treatment. The study was performed in the sanatorium of the State Hospital for Lung Diseases in Raduntzi, Bulgaria. It included 75 patients (65 men, 11 women) with different forms of stable COPD (mean age, 56.8 +/- 1.0 years, mean +/- SEM, FEV1% predicted--37.3 +/- 1.6%, mean duration of sanatorium stay 14 +/- 0.4 days). During the stay the patients received anti-obstructive and anti-inflammatory therapy based on the clinical discretion of the attending physician. All patients attended a rehabilitation programme according to their conditions; oxygen therapy was used in three patients. Of the 75 patients, 50 (66.7%) showed improvement at discharge, 21 (28%) had no improvement, and 4 (5.3%) were discharged in deteriorated condition. The complex treatment resulted in a minimal but statistically significant improvement of the basic spirographic and dyspnea parameters. This improvement depended not so much on the type of therapy administered as on the initial dyspnea and blood gas parameters. The body mass index (BMI) can also be used as a prognostic indicator especially if it is lower than 20 kg/m2. The lower this index is the lower the basic functional parameters are--in spite of using all available treatments, our patients with low body mass index rarely showed any noticeable improvement.