A validated disease specific prediction equation for resting metabolic rate in underweight patients with COPD

Malnutrition is a serious condition in chronic obstructive pulmonary disease (COPD). Successful dietary intervention calls for calculations of resting metabolic rate (RMR). One disease-specific prediction equation for RMR exists based on mainly male patients. To construct a disease-specific equation for RMR based on measurements in underweight or weight-losing women and men with COPD, RMR was measured by indirect calorimetry in 30 women and 11 men with a diagnosis of COPD and body mass index <21 kg/m2. The following variables, possibly influencing RMR were measured: length, weight, middle upper arm circumference, triceps skinfold, body composition by dual energy x-ray absorptiometry and bioelectrical impedance, lung function, and markers of inflammation. Relations between RMR and measured variables were studied using univariate analysis according to Pearson. Gender and variables that were associated with RMR with a P value <0.15 were included in a forward multiple regression analysis. The best-fit multiple regression equation included only fat-free mass (FFM): RMR (kJ/day) = 1856 + 76.0 FFM (kg). To conclude, FFM is the dominating factor influencing RMR. The developed equation can be used for prediction of RMR in underweight COPD patients

Knowledge and practice among dietitians in four Western European countries regarding malnutrition, starvation, cachexia and sarcopenia

Adequate distinction between malnutrition, starvation, cachexia and sarcopenia is important in clinical care. Despite the overlap in physical characteristics, differences in etiology have therapeutical and prognostic implications. We aimed to determine whether dietitians in selected European countries have ‘proper knowledge’ of malnutrition, starvation, cachexia and sarcopenia, and use terminology accordingly

Body composition in male elite athletes, comparison of bioelectrical impedance spectroscopy with dual energy X-ray absorptiometry

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to compare body composition results from bioelectrical spectroscopy (BIS) with results from dual energy X-ray absorptiometry (DXA) in a population of male elite athletes. Body composition was assessed using DXA (Lunar Prodigy, GE Lunar Corp., Madison, USA) and BIS (Hydra 4200, Xitron Technologies Inc, San Diego, California, USA) at the same occasion. Agreement between methods was assessed using paired t-tests and agreement-plots.</p> <p>Results</p> <p>Thirty-three male elite athletes (soccer and ice hockey) were included in the study. The results showed that BIS underestimates the proportion of fat mass by 4.6% points in the ice hockey players. In soccer players the BIS resulted in a lower mean fat mass by 1.1% points. Agreement between the methods at the individual level was highly variable.</p> <p>Conclusion</p> <p>Body composition results assessed by BIS in elite athletes should be interpreted with caution, especially in individual subjects. BIS may present values of fat mass that is either higher or lower than fat mass assessed by DXA, independent of true fat content of the individual.</p

Body composition and energy expenditure in patients with chronic obstructive pulmonary disease

The prevalence of chronic obstructive pulmonary disease (COPD) is increasing in Sweden as well as worldwide. The main cause of the disease is cigarette smoking. Almost 50 % of all COPD patients become underweight. The questions addressed in this thesis are: (1) Does body composition measured by bioelectrical impedance predict mortality in patients with COPD?(2) How large variation can be seen in humans body composition measured by bioelectrical impedance during 24 hours?(3) How much energy do underweight patients with COPD expend when they are living their normal lives at home and during a physiotherapy program? Methods used in this thesis were bioelectrical impedance analysis and dual-energy X-ray absorptiometry to assess body composition, doubly labelled water to measure total daily energy expenditure, indirect calorimetry to measure basal metabolic rate, and seven-day dietary registrations to measure energy intake. This thesis shows that within a sample of COPD patients, who have been included in a one-year multidisciplinary rehabilitation program, those patients with a high proportion of fat-free mass measured by bioelectrical impedance lived longer than those with a low proportion of fat-free mass. This thesis also shows that standardization of the measurements of body composition by bioelectrical impedance is of importance. Measurements should be done in the fasting state after the subject has been in the supine position for ten minutes. Additionally, underweight COPD patients were found to have a large variation in energy expenditure. A variation in total daily energy expenditure from 1.2 to 1.8 times basal metabolic rate is reported. Some patients increased their total daily energy expenditure during two weeks of training with a physiotherapist, whilst others decreased their total daily energy expenditure. Energy intake of the patients can not be used as a measure of their energy expenditure, since in most cases these two do not agree.Conclusions: This thesis shows that bioelectrical impedance might be a prognostic tool in COPD, but the measurements need to be standardized. COPD patients at the same level of disease and body weight may have totally different levels of energy expenditure. The energy requirement of underweight COPD patients should therefore be assessed individually. New methods for assessing energy requirement/expenditure are needed to be developed for use in COPD patients. These methods need to be able to be used in the clinical setting, since the main conclusion is that calculation or prediction of energy requirements in COPD patients with current methods has limited value