Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Clinical nutrition

Prevalence of sarcopenia and malnutrition during acute exacerbation of COPD and after 6 months recovery

European Journal of Clinical Nutrition volume 74, pages 1556–1564 (2020)Cite this article

Subjects

Abstract

Background/Objectives

Sarcopenia defined by the association of skeletal muscle mass depletion and a decreased physical performance is underdiagnosed in chronic obstructive pulmonary disease (COPD) patients. The objective was to assess prevalence of sarcopenia and malnutrition in hospitalized COPD patients during an acute exacerbation, after 6 months follow-up and the 1-year survival.

Subjects/Methods

Hospitalized COPD patients were recruited for the assessment of body composition, handgrip strength, respiratory function, and maximal inspiratory and expiratory pressures (MIP and MEP), during hospitalization and 6 months later. Sarcopenia was defined according to the criteria of the European Working Group on Sarcopenia in Older Adults, malnutrition was defined according to French criteria 2007. Survival data were collected 12 months after hospitalization.

Results

We analyzed data from 54 patients, aged 68 ± 9 years and BMI 26.9 ± 7.8 kg/m2, with an average FEV1 of 1.13 ± 0.49 l (45 ± 16% predicted value). Sarcopenia and malnutrition prevalence were, respectively, 48% and 52% during hospitalization, 30% and 30% after 6 months. MIP and MEP were lower in sarcopenic patients (p = 0.01 and 0.009, respectively). In multivariate analysis, skeletal muscle mass index and MIP were positively correlated at 6 months’ follow-up (r = 0.40, p = 0.04). The 1-year survival rate was lower in sarcopenic patients (65 vs 86%, p = 0.03), particularly when malnutrition was associated (p = 0.02).

Conclusions

Sarcopenia in COPD patients is highly prevalent during and after recovery of an acute exacerbation, exposing to lower survival. A multimodal management is required to treat sarcopenia and improve prognosis.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2: Prevalence of sarcopenia and malnutrition at inclusion and 6 months later.
Fig. 3: Kaplan–Meier survival curves according to sarcopenic and malnutrition status.

Similar content being viewed by others

References

  1. Soriano JB. An epidemiological overview of chronic obstructive pulmonary disease: what can real-life data tell us about disease management? COPD. 2017;14(suppl 1):S3–7.

    Article  Google Scholar 

  2. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442.

    Article  Google Scholar 

  3. GOLD. Global strategy for the diagnosis, management and prevention of COPD. Global Initiative for Chronic Obstructive Lung Disease—GOLD; 2017. http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/.

  4. Molinari N, Chanez P, Roche N, Ahmed E, Vachier I, Bourdin A. Rising total costs and mortality rates associated with admissions due to COPD exacerbations. Respir Res. 2016;17:149.

    Article  Google Scholar 

  5. Schols AM, Slangen J, Volovics L, Wouters EF. Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1791–7.

    Article  CAS  Google Scholar 

  6. Ehsan M, Khan R, Wakefield D, Qureshi A, Murray L, Zuwallack R, et al. A longitudinal study evaluating the effect of exacerbations on physical activity in patients with chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2013;10:559–64.

    Article  Google Scholar 

  7. Maltais F, Decramer M, Casaburi R, Barreiro E, Burelle Y, Debigaré R, et al. An Official American Thoracic Society/European Respiratory Society Statement: update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2014;189:e15–62.

    Article  Google Scholar 

  8. Schols AM, Ferreira IM, Franssen FM, Gosker HR, Janssens W, Muscaritoli M, et al. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J. 2014;44(Dec):1504–20.

    Article  Google Scholar 

  9. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing. 2010;39:412–23.

    Article  Google Scholar 

  10. Kyle UG, Genton L, Hans D, Pichard C. Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM). Clin Nutr. 2003;22:537–43.

    Article  CAS  Google Scholar 

  11. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, Elia M, Gómez JM, et al. Bioelectrical impedance analysis-part I: review of principles and methods. Clin Nutr. 2004;23:1226–43.

    Article  Google Scholar 

  12. Chien M-Y, Huang T-Y, Wu Y-T. Prevalence of sarcopenia estimated using a bioelectrical impedance analysis prediction equation in community-dwelling elderly people in Taiwan. J Am Geriatr Soc. 2008;56:1710–5.

    Article  Google Scholar 

  13. Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40:423–9.

    Article  Google Scholar 

  14. Lauretani F, Russo CR, Bandinelli S, Bartali B, Cavazzini C, Di Iorio A, et al. Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol. 2003;95:1851–60.

    Article  Google Scholar 

  15. Thibault R, Goujon N, Le Gallic E, Clairand R, Sébille V, Vibert J, et al. Use of 10-point analogue scales to estimate dietary intake: a prospective study in patients nutritionally at-risk. Clin Nutr. 2009;28(Apr):134–40.

    Article  Google Scholar 

  16. Raynaud A, Revel-Delhom C, Alexandre D, Alix E, Ancellin R, et al. Stratégies de prise en charge en cas de dénutrition protéino-énergetique de la personne âgée. Nutr Clin Métabolisme. 2007;21:120–33.

    Article  Google Scholar 

  17. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.

    Article  Google Scholar 

  18. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004;350:1005–12.

    Article  CAS  Google Scholar 

  19. Vestbo J, Prescott E, Almdal T, Dahl M, Nordestgaard BG, Andersen T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med. 2006;173:79–83.

    Google Scholar 

  20. Smoliner C, Sieber CC, Wirth R. Prevalence of sarcopenia in geriatric hospitalized patients. J Am Med Dir Assoc. 2014;15:267–72.

    Article  Google Scholar 

  21. Rossi AP, Fantin F, Micciolo R, Bertocchi M, Bertassello P, Zanandrea V, et al. Identifying sarcopenia in acute care setting patients. J Am Med Dir Assoc. 2014;15:303.e7–12.

    Article  Google Scholar 

  22. Jones SE, Maddocks M, Kon SSC, Canavan JL, Nolan CM, Clark AL, et al. Sarcopenia in COPD: prevalence, clinical correlates and response to pulmonary rehabilitation. Thorax. 2015;70:213–8.

    Article  Google Scholar 

  23. Patel HP, Syddall HE, Jameson K, Robinson S, Denison H, Roberts HC, et al. Prevalence of sarcopenia in community-dwelling older people in the UK using the European Working Group on Sarcopenia in Older People (EWGSOP) definition: findings from the Hertfordshire Cohort Study (HCS). Age Ageing. 2013;42:378–84.

    Article  Google Scholar 

  24. Byun MK, Cho EN, Chang J, Ahn CM, Kim HJ. Sarcopenia correlates with systemic inflammation in COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:669–75.

    Article  CAS  Google Scholar 

  25. Schols AM, Soeters PB, Mostert R, Pluymers RJ, Wouters EF. Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease: a placebo-controlled randomized trial. Am J Respir Crit Care Med. 1995;152:1268–74.

    Article  CAS  Google Scholar 

  26. Creutzberg EC, Wouters EFM, Mostert R, Weling-Scheepers CAPM, Schols AMWJ. Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition. 2003;19:120–7.

    Article  Google Scholar 

  27. Lim S, Kwon S-Y, Yoon JW, Kim SY, Choi SH, Park YJ, et al. Association between body composition and pulmonary function in elderly people: the Korean longitudinal study on health and aging. Obesity. 2011;19:631–8.

    Article  Google Scholar 

  28. Nishimura Y, Tsutsumi M, Nakata H, Tsunenari T, Maeda H, Yokoyama M. Relationship between respiratory muscle strength and lean body mass in men with COPD. Chest. 1995;107:1232–6.

    Article  CAS  Google Scholar 

  29. Shin HI, Kim D-K, Seo KM, Kang SH, Lee SY, Son S. Relation between respiratory muscle strength and skeletal muscle mass and hand grip strength in the healthy elderly. Ann Rehabil Med. 2017;41:686–92.

    Article  Google Scholar 

  30. Ohara DG, Pegorari MS, Oliveira Dos Santos NL, de Fátima Ribeiro Silva C, Monteiro RL, Matos AP, et al. Respiratory muscle strength as a discriminator of sarcopenia in community-dwelling elderly: a cross-sectional study. J Nutr Health Aging. 2018;22:952–8.

    Article  CAS  Google Scholar 

  31. Redelmeier DA, Bayoumi AM, Goldstein RS, Guyatt GH. Interpreting small differences in functional status: the Six Minute Walk test in chronic lung disease patients. Am J Respir Crit Care Med. 1997;155:1278–82.

    Article  CAS  Google Scholar 

  32. Hoogendoorn M, Hoogenveen RT, Rutten-van Mölken MP, Vestbo J, Feenstra TL. Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach. Eur Respir J. 2011;37:508–15.

    Article  CAS  Google Scholar 

  33. Celli BR, Locantore N, Yates J, Tal-Singer R, Miller BE, Bakke P, et al. Inflammatory biomarkers improve clinical prediction of mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2012;185:1065–72.

    Article  CAS  Google Scholar 

  34. Schols AMWJ, Broekhuizen R, Weling-Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr. 2005;82:53–9.

    Article  CAS  Google Scholar 

  35. de Blasio F, Di Gregorio A, de Blasio F, Bianco A, Bellofiore B, Scalfi L. Malnutrition and sarcopenia assessment in patients with chronic obstructive pulmonary disease according to international diagnostic criteria, and evaluation of raw BIA variables. Respir Med. 2018;134:1–5.

    Article  Google Scholar 

  36. Boirie Y, Guillet C. Fast digestive proteins and sarcopenia of aging. Curr Opin Clin Nutr Metab Care. 2018;21:37–41.

    Article  CAS  Google Scholar 

  37. Verlaan S, Maier AB, Bauer JM, Bautmans I, Brandt K, Donini LM, et al. Sufficient levels of 25-hydroxyvitamin D and protein intake required to increase muscle mass in sarcopenic older adults—the PROVIDE study. Clin Nutr. 2018;37:551–7.

    Article  CAS  Google Scholar 

  38. Janssen I, Heymsfield SB, Baumgartner RN, Ross R. Estimation of skeletal muscle mass by bioelectrical impedance analysis. J Appl Physiol. 2000;89:465–71.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors wish to acknowledge the Respiratory and Clinical Nutrition Departments of the University Hospital of Clermont-Ferrand for their assistance in collecting data in this study.

Author information

Author notes

  1. L. Perrot

    Present address: Perrot Loïc, 42 Boulevard Jourdan, 75016, Paris, France

Authors and Affiliations

  1. CHU Clermont-Ferrand, Service de Pneumologie, Clermont-Ferrand, France

    L. Perrot, A. Greil & D. Caillaud

  2. CHU Clermont-Ferrand, Service de Nutrition Clinique, Clermont-Ferrand, France

    Y. Boirie & N. Farigon

  3. Université Clermont Auvergne, INRA, UNH, Unité de Nutrition Humaine, CRNH Auvergne, Clermont-Ferrand, France

    Y. Boirie & F. Costes

  4. CHU Clermont-Ferrand, Délégation à la Recherche Clinique et l’Innovation, Clermont-Ferrand, France

    A. Mulliez

  5. CHU Clermont-Ferrand, Service de Médecine du Sport et explorations fonctionnelles respiratoires, Clermont-Ferrand, France

    F. Costes

Authors
  1. L. Perrot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Greil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Boirie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Farigon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Mulliez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Costes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. Caillaud
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LP, AG, YB, NF, and FC conceived the study; LP carried out the study, managed, and analyzed data; LP and AM performed the statistical analysis; LP drafted the manuscript; AG, YB, FC, and DC reviewed the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to L. Perrot.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Perrot, L., Greil, A., Boirie, Y. et al. Prevalence of sarcopenia and malnutrition during acute exacerbation of COPD and after 6 months recovery. Eur J Clin Nutr 74, 1556–1564 (2020). https://doi.org/10.1038/s41430-020-0623-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41430-020-0623-6

This article is cited by

Search

Advanced search

Quick links