Zusammenfassung:
In den letzten Jahren ist zunehmend die Erkenntnis gewonnen worden, dass bei COPD
viele Faktoren für die beobachtete Unterernährung eine Rolle spielen. Hierbei wurde
klar, dass eine komplexe Veränderung des Metabolismus bei COPD-Patienten vorliegt,
die durch eine reine Ernährungstherapie wenig zu beeinflussen ist. In dem Übersichtsartikel
wird anhand der aktuellen Literatur auf die Malnutrition und den veränderten Metabolismus
bei COPD-Patienten eingegangen und die Ernährungsintervention bei diesen Patienten
diskutiert.
Unser Blickfeld bezüglich der Therapie muss sich dahin richten, dass wir bei der COPD
nicht eine lokale Erkrankung des Bronchialbaumes haben, sondern eher eine systemische
Erkrankung, die von der Lunge ausgeht und dort die Hauptsymptome verursacht, aber
auch andere Systeme mit einbezieht. Ziel weiterer Studien muss es daher sein, die
Muskelfunktion und die Veränderungen in diesem Bereich bei COPD-Patienten noch besser
zu verstehen, um dann hierauf Einfluss nehmen zu können. Zukünftige Therapien sollten
sich daher nicht nur auf die Behandlung der Inflammation und Dilatation der Bronchien
beschränken, sondern darauf ausgerichtet sein, den veränderten Metabolismus bei COPD-Patienten
zu beeinflussen, um so die Belastbarkeit der Patienten und vielleicht auch die Prognose
zu verbessern.
Malnutrition in COPD:
During the last years our knowledge about the malnutrition of patients with COPD has
grown. Weight loss is a problem of some patients with COPD, but, as we know today
by techniques of body composition measurement much more patients have reduced muscle
mass. The reason for this is complex and involves many body systems. Nutritional intervention
alone is not successful in many patients. We have to accept that COPD is a kind of
systemic disease which does not only involve the lung. Thus, future therapies have
to include not only treatment of the bronchial system.
Literatur
- 1
Arora N S, Rochester D F.
Effect of body weight and muscularity on human diaphragm muscle mass, thickness, and
area.
J Appl Physiol.
1982;
52 (1)
64-70
- 2
Baarends E M, Schols A M, Mostert R. et al .
Peak exercise response in relation to tissue depletion in patients with chronic obstructive
pulmonary disease.
Eur Respir J.
1997;
10 (12)
2807-2813
- 3
Bernard S, LeBlanc P, Whittom F. et al .
Peripheral muscle weakness in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
1998;
158 (2)
629-634
- 4
Braun S R, Keim N L, Dixon R M. et al .
The prevalence and determinants of nutritional changes in chronic obstructive pulmonary
disease.
Chest.
1984;
86 (4)
558-563
- 5
Chailleux E, Fauroux B, Binet F. et al .
Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical
ventilation. A 10-year analysis of ANTADIR observatory.
Chest.
1996;
109 (3)
741-749
- 6
Creutzberg E C, Wouters E F, Vanderhoven-Augustin I M, Dentener M A, Schols A M.
Disturbances in leptin metabolism are related to energy imbalance during acute exacerbations
of chronic obstructive lung disease.
Am J Respir Crit Care Med.
2000;
162 (4)
1239-1245
- 7
d'A Semple P, Watson W S, Beastall G H. et al .
Diet, absorption and hormone studies in relation to body weight in obstructive airways
disease.
Thorax.
1979;
34 (6)
783-788
- 8
Decramer M, Lacquet L M, Fagard R. et al .
Corticosteroids contribute to muscle weakness in chronic airflow obstruction.
Am J Respir Crit Care Med.
1994;
150 (1)
11-16
- 9
Di Francia M, Barbier D, Mege J L, Orehek J.
Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary
disease.
Am J Respir Crit Care Med.
1994;
150
1453-1355
- 10
Donahoe M, Rogers R M, Wilson D O. et al .
Oxygen consumption of the respiratory muscles in normal and in malnourished patients
with chronic obstructive pulmonary disease.
Am Rev Respir Dis.
1989;
140 (2)
385-391
- 11
Efthimiou J, Fleming J, Gomes C. et al .
The effect of supplementary oral nutrition in poorly nourished patients with chronic
obstructive pulmonary disease.
Am Rev Respir Dis.
1988;
137 (5)
1075-1082
- 12
Engelen M P, Schols A M, Baken W C. et al .
Nutritional depletion in relation to respiratory and peripheral skeletal muscle function
in out-patients with COPD.
Eur Respir J.
1994;
7 (10)
1793-1797
- 13
Engelen M P, Schols A M, Does J D. et al .
Altered glutamate metabolism is associated with reduced muscle glutathione levels
in patients with emphysema.
Am J Respir Crit Care Med.
Jan 2000;
161 (1)
98-103
- 14
Engelen M P, Schols A M, Lamers R J. et al .
Different patterns of chronic tissue wasting among patients with chronic obstructive
pulmonary disease.
Clinical Nutrition.
1999;
18 (5)
275-280
- 15
Engelen M PKJ, Deutz N EP, Wouters E FM. et al .
Enhanced levels of whole-body protein turnover in patients with chronic obstructive
pulmonary disease.
Am J Respir Crit Care Med.
2000;
162
1488-1492
- 16
Engelen M PKJ, Wouters E FM, Deutz N EP. et al .
Effects of exercise on amino acid metabolism in patients with chronic obstructive
pulmonary disease.
Am J Respir Crit Care Med.
2001;
163
859-864
- 17
Engelen M PKJ, Wouters E FM, Deutz N EP. et al .
Factors contributing to alterations in skeletal muscle and plasma amino acid profiles
in patients with chronic obstructive pulmonary disease.
Am J Clin Nutr.
2000;
72
1480-1487
- 18
Ferreira I M, Brooks D, Lacasse Y. et al .
Nutritional support for individuals with COPD. A meta-analysis.
Chest.
2000;
117
672-678
- 19
Fiaccadori E, Del Canale S, Coffrini E. et al .
Hypercapnic-hypoxemic chronic obstructive pulmonary disease (COPD): influence of severity
of COPD on nutritional status.
Am J Clin Nutr.
1988;
48 (3)
680-685
- 20
Fiatarone M A, O&Neill E F, Ryan N D. et al .
Exercise training and nutritional supplementation for physical frailty in very elderly
people.
N Engl J Med.
1994;
330 (25)
1769-1775
- 21
Gray-Donald K, Gibbons L, Shapiro S H. et al .
Effect of nutritional status on exercise performance in patients with chronic obstructive
pulmonary disease.
Am Rev Respir Dis.
1989;
140 (6)
1544-1548
- 22 Harris J A, Benedict F G. Standard basal metabolism constants for physiologists
and clinicians: a biometric study of basal metabolism in man;. Lippincott: in Anonymous
Philadelphia 1919
- 23
Hofford J M, Milakofsky L, Vogel W H. et al .
The nutritional status in advanced emphysema associated with chronic bronchitis. A
study of amino acid and catecholamine levels.
Am Rev Respir Dis.
1990;
141
902-908
- 24
Hunter A M, Carey M A, Larsh H W.
The nutritional status of patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis.
1981;
124 (4)
376-381
- 25
Kelsen S G.
The effects of undernutrition on the respiratory muscles.
Clin Chest Med.
1986;
7 (1)
101-110
- 26
Knowles J B, Fairbarn M S, Wiggs B J. et al .
Dietary supplementation and respiratory muscle performance in patients with COPD.
Chest.
1988;
93
977-983
- 27
Maltais F, Simard A A, Simard C. et al .
Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise
in normal subjects and in patients with COPD.
Am J Respir Crit Care Med.
1996;
153
288-293
- 28
Martin T R, Altman L C, Alvares O F.
The effects of severe protein-calorie malnutrition on bacterial defense mechanisms
in the rat lung.
Am Rev Respir Dis.
1983;
128 (6)
1013-1019
- 29
Moore J A, Angelillo V A.
Equations for the prediction of resting energy expenditure in chronic obstructive
lunge disease.
Chest.
1988;
94
1260-1263
- 30
Mostert R, Goris A, Weling-Scheepers C. et al .
Tissue depletion and health related quality of life in patients with chronic obstructive
pulmonary disease.
Respir Med.
Sep 2000;
94 (9)
859-867
- 31
Nguyen L T, Bedu M, Caillaud D, Beaufrere B, Beaujon G, Vasson M, Coudert J, Ritz P.
Increased resting energy expenditure is related to plasma TNF-alpha concentration
in stable COPD patients.
Nutrition.
1999;
18 (5)
255-257
- 32
Pouw E M, Schols A M, Deutz N E. et al .
Plasma and muscle amino acid levels in relation to resting energy expenditure and
inflammation in stable chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
1998;
158
797-801
- 33
Rogers R M, Donahoe M, Costantino J.
Physiologic effects of oral supplemental feeding in malnourished patients with chronic
obstructive pulmonary disease.
Am Rev Respir Dis.
1992;
146
1511-1517
- 34
Sahebjami H, Doers J T, Render M L. et al .
Anthropometric and pulmonary function test profiles of outpatients with stable chronic
obstructive pulmonary disease.
Am J Med.
1993;
94 (5)
469-474
- 35
Satta A, Migliori G B, Spanevello A. et al .
Fibre types in skeletal muscles of chronic obstructive pulmonary disease patients
related to respiratory function and exercise tolerance.
Eur Respir J.
1997;
10
2853-2860
- 36
Schols A M, Creutzberg E C, Buurman W A. et al .
Plasma leptin is related to proinflammatory status and dietary intake in patients
with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
1999;
160 (4)
1220-1226
- 37
Schols A M, Mostert R, Soeters P B. et al .
Body composition and exercise performance in patients with chronic obstructive pulmonary
disease.
Thorax.
1991;
46
695-699
- 38
Schols A M, Soeters P B, Dingemans A M. et al .
Prevalence and characteristics of nutritional depletion in patients with stable COPD
eligible for pulmonary rehabilitation.
Am Rev Respir Dis.
1993;
147 (5)
1151-1156
- 39
Shennib H, Chiu R C, Mulder D S. et al .
Depression and delayed recovery of alveolar macrophage function during starvation
and refeeding.
Surg Gynecol Obstet.
1984;
158 (6)
535-540
- 40
Shoup R, Dalsky G, Warner S. et al .
Body composition and health-related quality of life in patients with obstructive airways
disease.
Eur Respir J.
1997;
10 (7)
1576-1580
- 41
Skerrett S J, Henderson W R, Martin T R.
Alveolar macrophage function in rats with severe protein calorie malnutrition. Arachidonic
acid metabolism, cytokine release, and antimicrobial activity.
J Immunol.
1990;
144 (3)
1052-1061
- 42
Smeenk F WJM, Creutzberg E C, Fokkens B. et al .
COPD and seretide: a multi-center intervention and characterisation (COSMIC) study:
prevalence of nutritional depletion in patients with COPD stratified by disease stage.
Am J Respir Crit Care Med.
2001;
163
A 502
- 43
Tabak C, Smit H A, Rasanen L. et al .
Dietary factors and pulmonary function: a cross sectional study in middle aged men
from three European countries.
Thorax.
1999;
54
1021-1026
- 44
Takabatake N, Nakamura H, Abe S. et al .
Circulating leptin in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
1999;
159 (4 Pt 1)
1215-1219
- 45
Takabatake N, Nakamura H, Abe S, Inoue H, Hino T, Saito H, Yuki H, Kato S, Tomoike H.
The relationship between chronic hypoxemia and activation of the tumor necrosis factor-alpha
system in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med.
2001;
161 (4)
1179-1184
- 46
Vaismann N, Hahn T.
Tumor necrosis factor-alpha and anorexia - cause or effect?.
Metabolism.
1991;
40 (7)
720-723
- 47
Van Duyn M A, Pivonka E.
Overview of the health benefits of fruit and vegetable consumption for the dietetics
professional: selected literature.
J Am Diet Assoc.
Dec 2000;
100 (12)
1511-1521
- 48
Vermeeren M AP, Wouters E F, Nelissen L H, van Lier A, Hofmann Z, Schols A M.
Acute effects of different nutritional supplements on symptoms and functional capacity
in patients with chronic obstructive pulmonary disease.
Am J Clin Nutr.
2001;
73
295-301
- 49
Wang Y M, Zintel T, Vasquez A. et al .
Corticosteroid therapy and respiratory muscle function in humans.
Am Rev Respir Dis.
1991;
144 (1)
108-112
- 50
Watson L, Margetts B M, Howarth P, Dorward M A, Thompson R, Little P S.
Do dietary factors protect against chronic pulmonary disease: a case control study.
Am J Respir Crit Med.
2001;
163
A40
- 51
Weiner P, Azgad Y, Weiner M.
The effect of corticosteroid on inspiratory muscle performance in humans.
Chest.
1993;
104 (6)
1788-1791
- 52
Whittaker J S, Ryan C F, Buckley P A. et al .
The effects of refeeding on peripheral and respiratory muscle function in malnourished
chronic obstructive pulmonary disease patients.
Am Rev Respir Dis.
1990;
142 (2)
283-288
- 53
Wilson D O, Rogers R M, Sanders M H. et al .
Nutritional intervention in malnourished patients with emphysema.
Am Rev Respir Dis.
1986;
134
672-677
- 54
Wilson D O, Rogers R M, Wright E C. et al .
Body weight in chronic obstructive pulmonary disease. The national institutes of health
intermittent positive-pressure breathing trial.
Am Rev Respir Dis.
1989;
139 (6)
1435-1438
- 55
Yoshikawa M, Yoneda T, Kobayashi A. et al .
Body composition analysis by dual energy X-ray absorptiometry and exercise performance
in underweight patients with COPD.
Chest.
1999;
115
371-375
- 56
Zu Wallack R L, Shoup R, Warner S. et al .
Alterations in total and regional body composition in patients with moderate to severe
obstructive lung disease.
Monaldi Arch Chest Dis.
1996;
51
507-509
PD Dr. J. Bargon
Leiter der Abteilung Pneumologie/Allergologie
St. Elisabethenkrankenhaus
Ginnheimer Straße 3
60487 Frankfurt am Main
Email: E-mail: bargon@em.uni-frankfurt.de
