Unintended Weight Loss in Outpatients With Chronic Obstructive Pulmonary Disease

In outpatients with chronic obstructive pulmonary disease (COPD), a high prevalence of unintended weight loss (UWL) has been reported, with nutrition impact symptoms (NIS) and reduced food intake (RFI) reported as UWL-associated characteristics, according to the results of a recent analysis published in the journal Clinical Nutrition ESPEN.

“Malnutrition is commonly seen in [COPD] and has been associated with negative outcomes,” noted authors of the current study. Because unintended weight loss is a potential indicator of COPD-related malnutrition, study investigators conducted a cross-sectional study to identify the prevalence of UWL and its associated characteristics in outpatients with COPD. Data from all patients who visited a COPD outpatient clinic at a Danish University Hospital between November 2020 and May 2021 were obtained via medical records and a patient questionnaire administered by the researchers.

Study inclusion criteria were age ≥18 years and the willingness to sign an informed consent after written and oral information was presented in Danish or English. Any patients who did not wish to be weighed and measured, and had not had their weight measured within the past week and their height measured within the past year, were excluded from the study.

A total of 200 patients were included in the study. The mean participant age was 68.7±11.2 years. Overall, 55.5% of the patients were women. UWL was observed in 21.5% of the participants, with a median weight loss of 3.5 kg (range, 2 to 16 kg). An underweight state (ie, BMI <18.5 kg/m²) was seen among 13.5% of the patients, whereas 34.5% were obese (ie, BMI >30 kg/m²). RFI within the prior week was reported in 22.0% of the participants.

The most common NIS included shortness of breath, nausea, and reduced appetite.
NIS, RFI, and BMI of <18.5 kg/m² were all shown to be associated with UWL. A significant association was found between RFI and UWL (P <.05). In contrast, comorbidities, recent COPD exacerbations, and hospitalization within the prior 3 months all demonstrated no association with UWL.

A major limitation of the current study is the fact that some data are missing because of the possibility that sufficient data could not be found in all patients’ medical records. Thus, some associations related to UWL were not calculated in all participants, which might have impacted the results.

The researchers concluded that the findings from this study demonstrate the importance of nutritional screening and guidance both for patients with COPD who are underweight and for those who are obese. “Underweight as well as sarcopenic obesity may have significant negative consequences for the patient as well as for the community.” A broader perspective on malnutrition-associated health issues, including obesity and physical function, is warranted among patients with COPD. Referral to a clinical dietitian is recommended in these individuals.

Reference  

Christensen T, Mikkelsen S, Geisler L, Holst M. Chronic obstructive pulmonary disease outpatients bear risks of both unplanned weight loss and obesity. Clin Nutr ESPEN. Published online April 18, 2022. doi:10.1016/j.clnesp.2022.04.010