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Nutritional status and physical activity in patients with COPD, and factors associated with malnutrition

Background: Low body mass index (BMI) and reduced physical activity (PA) are predictors of health- care use and mortality in chronic obstructive pulmonary disease (COPD). Aim: To evaluate nutritional status of patients with moderate to very severe COPD, to compare PA of patients in different BMI categories, and to explore the factors associated with malnutrition. Methods: BMI was calculated as weight/height squared (kg/m2). Clinical evaluation included pulmonary function tests, COPD Assessment Test, mMRC dyspnoea scale, EuroQol questionnaire, and Hospital Anxiety and Depression Scale. PA was measured by the StepWatch Activity Monitor®, an ankle-worn accelerometer. Results: In the study population (n=111, male 76, mean age 68 years) 31 patients (28%) had normal weight, 18 (16%) were underweight, 27 (24%) overweight, and 35 (32%) obese. An average daily step count for patients with normal weight was 8074±4701, for underweight 7104±5356, for overweight 9295±5383, and for obese 7582±3909 steps/day. These differences in PA of patients in different BMI categories did not reach statistical significance (p=0.412). Underweight patients had lower lung diffusing capacity (p<0.001) and more severe lung hyperinflation (i.e. higher total lung capacity (TLC), p<0.001 ; higher residual volume (RV), p<0.001 ; and greater RV/TLC ratio, p=0.004). Being underweight was not related to the smoking history, severity of airflow limitation, symptoms severity, exacerbations, psychological status or health-related quality of life. Conclusion: Lung hyperinflation and reduced lung diffusing capacity are associated with malnutrition in COPD. State of nutrition was not related to the PA level.

Body mass index, chronic obstructive pulmonary disease, nutritional status, pulmonary function tests

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