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1 Service de Gastroentérologie et Nutrition, Clinique Résidence du Parc, Marseille, 2 Dépt de Médecine Aiguë Spécialisée, Centre Hospitalier Universitaire (CHU), Grenoble, 3 Service de Pneumologie, CHU, Saint-Etienne, 4 Service de Biochimie A and 5 Service de Pneumologie et de Réanimation Respiratoire, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôtel-Dieu, Paris, 6 Service de Réanimation Médicale et d'Assistance Respiratoire, Hospices Civils de Lyon, Lyon, 7 Service de Pneumologie, CHU, Rouen, and 8 Service des Maladies Infectieuses, 9 Service de Réanimation Médicale, AP-HP, Hôpital Raymond Poincaré, Garches, France, 10 Dépt de Nutrition Clinique, Hôpital Cantonal Universitaire, Genève, Suisse
CORRESPONDENCE: C.M. Pison, Dépt de Médecine Aiguë Spécialisée, Pneumologie, Hôpital A. Michallon, Centre Hospitalier Universitaire de Grenoble, BP217X 38043, Grenoble Cedex 9, France. Fax: 33 476765617. E-mail: CPison@chu-grenoble.fr
Keywords: bioelectric impedance, fat-free mass, hypoxaemia, long-term oxygen therapy, malnutrition, smoking
Received: October 10, 2001
Accepted January 17, 2002
The present study was supported by the Société Francophone de Nutrition Entérale et Parentérale and Astra-Zeneca, France.
The purpose of this study was to estimate the prevalence of malnutrition in outpatients on long-term oxygen therapy or home mechanical ventilation, to determine the relationships between malnutrition and impairment/disability and smoking and also to identify relevant tools for routine nutritional assessment.
In 744 patients (M:F 1.68, aged 65±15 yrs) with chronic obstructive pulmonary disease (COPD, 40%), restrictive disorders (27%), mixed respiratory failure (15%), neuromuscular diseases (13%) and bronchiectasis (5%), body mass index (BMI), fat-free mass (FFM), serum albumin, transthyretin, 6-min walking test, forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and blood gases were recorded.
FFM was the most sensitive parameter for detecting malnutrition, being abnormal in 53.6% of patients, while BMI was <20 in 23.2%, serum albumin <35 g·L–1 in 20.7 %, and serum transthyretin <200 mg·L–1 in 20%. FFM depletion predominated in neuromuscular, bronchiectasis and restrictive disorders. BMI and FFM were correlated with FEV1, FVC and 6-min walking test. In multivariate analysis a BMI<20 was related to FEV1 and smoking habits, and a low FFM to smoking, FEV1 and female sex.
Malnutrition is highly prevalent in home-assisted respiratory patients and is related to causal disease, forced expiratory volume in one second, smoking and disability. Fat-free mass appeared to be the most sensitive and relevant nutritional parameter according to impairment and disability.
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