Am. J. Respir. Crit. Care Med., Vol 155, No. 5, 05 1997, 1535-1540.
Role of the thermic effect of food in malnutrition of patients with chronic obstructive pulmonary disease
MF Dore, JP Laaban, E Orvoen-Frija, B Kouchakji, M Joubert and J Rochemaure
Department of Pneumology and Intensive Care, Hotel Dieu, Paris, France.
Malnutrition in patients with chronic obstructive pulmonary disease (COPD)
is classically ascribed to an increased resting energy expenditure (REE)
secondary to high cost of breathing. However, malnutrition correlates only
weakly with the severity of respiratory dysfunction, which suggests other
mechanisms. The aim of the present study was to determine the possible role
of diet-induced thermogenesis (DIT). Therefore, we evaluated the
relationship between DIT and nutritional status, in particular fat-free
mass (FFM) estimated by bioelectrical impedance analysis in 26 patients
with stable COPD (mean FEV1 +/- SEM = 36.5 +/- 3.8% of predicted). Ten
patients were undernourished (weight < 90% of ideal body weight [IBW]
and/or FFM < 69% of IBW), and 16 were normally nourished. Diet-induced
thermogenesis was determined by comparing postprandial energy expenditure
and REE, the latter being measured after an overnight fast and the former
over 4 h after a mixed test meal of 0.4 times REE load. No statistical
difference in DIT was found between undernourished and eutrophic patients.
There was no relationship between DIT and nutritional or functional
parameters, notably FFM. These results suggest that malnutrition is not a
consequence of an increased DIT.
