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Am. J. Respir. Crit. Care Med., Volume 160, Number 6, December 1999, 1856-1861

Prognostic Value of Nutritional Status in Chronic Obstructive Pulmonary Disease

CHARLOTTE LANDBO, EVA PRESCOTT, PETER LANGE, JØRGEN VESTBO, and THOMAS P. ALMDAL

Institute of Preventive Medicine, University of Copenhagen, Copenhagen; The Copenhagen City Heart Study, Copenhagen; Department of Respiratory Medicine, Hvidovre Hospital, Copenhagen; and Department of Endocrinology, Herlev Hospital, Copenhagen, Denmark

The association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) is a common clinical observation. We prospectively examined whether BMI is an independent predictor of mortality in subjects with COPD from the Copenhagen City Heart Study. In total, 1,218 men and 914 women, aged 21 to 89 yr, with airway obstruction defined as an FEV1-to-FVC ratio of less than 0.7, were included in the analyses. Spirometric values, BMI, smoking habits, and respiratory symptoms were assessed at the time of study enrollment, and mortality from COPD and from all causes during 17 yr of follow-up was analyzed with multivariate Cox regression models. After adjustment for age, ventilatory function, and smoking habits, low BMI was predictive of a poor prognosis (i.e., higher mortality), with relative risks (RRs) in underweight subjects as compared with that in subjects of normal weight of 1.64 (95% confidence interval [CI]: 1.20 to 2.23) in men and 1.42 (95% CI: 1.07 to 1.89) in women. However, the association between BMI and survival differed significantly with stage of COPD. In mild and moderate COPD there was a nonsignificant U-shaped relationship, with the lowest risk occurring in normal-weight to overweight subjects, whereas in severe COPD, mortality continued to decrease with increasing BMI (test for trend: p < 0.001). Similar results were found for COPD-related deaths, with the strongest associations found in severe COPD (RR for low versus high BMI: 7.11 [95% CI: 2.97 to 17.05]). We conclude that low BMI is an independent risk factor for mortality in subjects with COPD, and that the association is strongest in subjects with severe COPD. Landbo C, Prescott E, Lange P, Vestbo J, Almdal TP. Prognostic value of nutritional status in chronic obstructive pulmonary disease.




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B. R. Celli, C. G. Cote, J. M. Marin, C. Casanova, M. Montes de Oca, R. A. Mendez, V. Pinto Plata, and H. J. Cabral
The Body-Mass Index, Airflow Obstruction, Dyspnea, and Exercise Capacity Index in Chronic Obstructive Pulmonary Disease
N. Engl. J. Med., March 4, 2004; 350(10): 1005 - 1012.
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P A Dawkins, L J Dowson, P J Guest, and R A Stockley
Predictors of mortality in {alpha}1-antitrypsin deficiency
Thorax, December 1, 2003; 58(12): 1020 - 1026.
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E.F.M. Wouters
Introduction: systemic effects in chronic obstructive pulmonary disease
Eur. Respir. J., November 2, 2003; 22(46_suppl): 1s - 1s.
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H. Andreassen and J. Vestbo
Chronic obstructive pulmonary disease as a systemic disease: an epidemiological perspective
Eur. Respir. J., November 2, 2003; 22(46_suppl): 2s - 4s.
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A.W. Boots, G.R.M.M. Haenen, and A. Bast
Oxidant metabolism in chronic obstructive pulmonary disease
Eur. Respir. J., November 2, 2003; 22(46_suppl): 14s - 27s.
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A.M.W.J. Schols
Nutritional and metabolic modulation in chronic obstructive pulmonary disease management
Eur. Respir. J., November 2, 2003; 22(46_suppl): 81s - 86s.
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R. I. Cohen, K. Marzouk, P. Berkoski, C. P. O'Donnell, V. Y. Polotsky, and S. M. Scharf
Body Composition and Resting Energy Expenditure in Clinically Stable, Non-Weight-Losing Patients With Severe Emphysema
Chest, October 1, 2003; 124(4): 1365 - 1372.
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E F M Wouters
Eat well to get well
Thorax, September 1, 2003; 58(9): 739 - 740.
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K. H. Groenewegen, A. M.W.J. Schols, and E. F.M. Wouters
Mortality and Mortality-Related Factors After Hospitalization for Acute Exacerbation of COPD
Chest, August 1, 2003; 124(2): 459 - 467.
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E. Chailleux, J.-P. Laaban, and D. Veale
Prognostic Value of Nutritional Depletion in Patients With COPD Treated by Long-term Oxygen Therapy: Data From the ANTADIR Observatory
Chest, May 1, 2003; 123(5): 1460 - 1466.
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 Am. J. Respir. Crit. Care Med.Home page
T. L. Croxton, G. G. Weinmann, R. M. Senior, R. A. Wise, J. D. Crapo, and A. S. Buist
Clinical Research in Chronic Obstructive Pulmonary Disease: Needs and Opportunities
Am. J. Respir. Crit. Care Med., April 15, 2003; 167(8): 1142 - 1149.
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T. Matsumura, M. Nakayama, H. Satoh, A. Naito, K. Kamahara, and K. Sekizawa
Plasma Orexin-A Levels and Body Composition in COPD
Chest, April 1, 2003; 123(4): 1060 - 1065.
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G. L. Snider
Nosology for Our Day: Its Application to Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., March 1, 2003; 167(5): 678 - 683.
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T. Oga, K. Nishimura, M. Tsukino, S. Sato, and T. Hajiro
Analysis of the Factors Related to Mortality in Chronic Obstructive Pulmonary Disease: Role of Exercise Capacity and Health Status
Am. J. Respir. Crit. Care Med., February 15, 2003; 167(4): 544 - 549.
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A.G.N. Agusti, A. Noguera, J. Sauleda, E. Sala, J. Pons, and X. Busquets
Systemic effects of chronic obstructive pulmonary disease
Eur. Respir. J., February 1, 2003; 21(2): 347 - 360.
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M D L Morgan
Preventing hospital admissions for COPD: role of physical activity
Thorax, February 1, 2003; 58(2): 95 - 96.
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A. G. N. Agusti, J. Sauleda, C. Miralles, C. Gomez, B. Togores, E. Sala, S. Batle, and X. Busquets
Skeletal Muscle Apoptosis and Weight Loss in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., August 15, 2002; 166(4): 485 - 489.
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N.J.M. Cano, H. Roth, I. Court-Fortune, L. Cynober, M. Gerard-Boncompain, A. Cuvelier, J-P. Laaban, J-C. Melchior, C. Pichard, J-C. Raphael, et al.
Nutritional depletion in patients on long-term oxygen therapy and/or home mechanical ventilation
Eur. Respir. J., July 1, 2002; 20(1): 30 - 37.
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E. F. M. Wouters, E. C. Creutzberg, and A. M. W. J. Schols
Systemic Effects in COPD*
Chest, May 1, 2002; 121(5_suppl): 127S - 130S.
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R. I. Harik-Khan, J. L. Fleg, and R. A. Wise
Body Mass Index and the Risk of COPD
Chest, February 1, 2002; 121(2): 370 - 376.
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British Thoracic Society Standards of Care Subcomm
Pulmonary rehabilitation
Thorax, November 1, 2001; 56(11): 827 - 834.
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A. A. EID, A. A. IONESCU, L. S. NIXON, V. LEWIS-JENKINS, S. B. MATTHEWS, T. L. GRIFFITHS, and D. J. SHALE
Inflammatory Response and Body Composition in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., October 15, 2001; 164(8): 1414 - 1418.
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J. GARCIA-AYMERICH, E. MONSO, R. M. MARRADES, J. ESCARRABILL, M. A. FELEZ, J. SUNYER, J. M. ANTO, and the EFRAM Investigators
Risk Factors for Hospitalization for a Chronic Obstructive Pulmonary Disease Exacerbation . EFRAM STUDY
Am. J. Respir. Crit. Care Med., September 15, 2001; 164(6): 1002 - 1007.
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E. F. HANSEN, J. VESTBO, K. PHANARETH, A. KOK-JENSEN, and A. DIRKSEN
Peak Flow as Predictor of Overall Mortality in Asthma and Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., March 1, 2001; 163(3): 690 - 693.
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