A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary disease

BACKGROUND: Skeletal muscle depletion is an important complication of chronic obstructive pulmonary disease (COPD) but little prospective data exists about the rate at which it occurs and the factors that promote its development. We therefore prospectively investigated the impact of disease severity, exacerbation frequency and treatment with corticosteroids on change in body composition and maximum isometric quadriceps strength (QMVC) over one year. METHODS: 64 patients with stable COPD (FEV(1 )mean (SD) 35.8(18.4) %predicted) were recruited from clinic and studied on two occasions one year apart. Fat free mass was determined using bioelectrical impedance analysis and a disease specific regression equation. RESULTS: QMVC fell from 34.8(1.5) kg to 33.3(1.5) kg (p = 0.04). The decline in quadriceps strength was greatest in those with the highest strength at baseline (R -0.28 p = 0.02) and was not correlated with lung function, exacerbation frequency or steroid treatment. Decline in fat free mass was similarly higher in those with largest FFM at baseline (R = -0.31 p = 0.01) but was more strongly correlated with greater gas trapping (R = -0.4 p = 0.001). Patients with frequent exacerbations (>1 per year) (n = 36) experienced a greater decline in fat free mass compared to infrequent exacerbators (n = 28) -1.3(3.7)kg vs. +1.2(3.1)kg (p = 0.005), as did patients on maintenance oral steroids (n = 8) -2.8(3.3) kg vs. +0.2(3.5) kg (p = 0.024) whereas in those who stopped smoking (n = 7) fat free mass increased; +2.7(3.1) kg vs. -0.51(3.5) kg (p = 0.026). CONCLUSION: Decline in fat free mass in COPD is associated with worse lung function, continued cigarette consumption and frequent exacerbations. Factors predicting progression of quadriceps weakness could not be identified from the present cohort

Inuit housing and homelessness: Results from the International Polar Year Inuit Health Survey 2007-2008

Objectives. Evaluate housing characteristics across Inuit regions in Canada that participated in the 2007-2008 International Polar Year (IPY) Inuit Health Survey. Study design. A cross-sectional Inuit Health Survey. Methods. Housing characteristics were ascertained as part of the IPY Inuit Health Survey through interviews conducted in 33 coastal and 3 inland communities, representing all communities in the Inuvialuit Settlement Region (ISR) of NWT, Nunavut and Nunatsiavut of northern Labrador. Variable descriptive statistics were weighted and presented by region and by whether children were present or not in each household. Results. A total of 2,796 Inuit households were approached, of which 68% participated (n=1,901 households). In ISR and Nunavut, approximately 20% of homes provided shelter to the homeless compared to 12% in Nunatsiavut (p≤0.05). The prevalence of public housing and household crowding also varied by region, with Nunavut having a statistically significantly higher prevalence of crowding (30%) than Nunatsiavut (12%) and ISR (12%). Household crowding was more prevalent among homes with children. Overall, 40% of homes were in need of major repairs and problems with mould were reported in 20% of households. Conclusions. Adequate shelter is a basic human need and an essential foundation for thriving population health. The results indicate that improvements in housing indicators are needed. Of utmost concern is the high prevalence of overcrowding in Inuit homes with children, which poses potential consequences for children's health and well-being. Further, the high percentage of homes providing shelter to the homeless suggests that hidden homelessness needs to be addressed by further research and program implementation