Body composition and micronutrient deficiencies in patients with an acute exacerbation of chronic obstructive...

Chronic obstructive pulmonary disease (COPD) is a multisystem disorder. Abnormal body composition (BC) and micronutrient deficiencies (MD) contribute significantly to morbidity associated with acute exacerbations of COPD (AECOPD). COPD is a major health problem in Western Sydney.

To study the pattern of BC and MD in patients admitted with an AECOPD to Western Sydney.

The BC and serum levels of selected micronutrients were recorded in prospective, consecutive patients admitted to hospital with AECOPD in Western Sydney.

A total of 94 patients was enrolled, 43% female, and the average age was 69.8 ± 8.2 years (SD). Admission spirometry revealed a mean spirometric ratio of 0.42 ± 0.14 (SD) and a severely reduced mean percentage FEV₁ of predicted at 29.1% ± 11.6 (SD). A total of 51% of the population was overweight or obese, with an average body mass index of 25.9 ± 7.7 kg/m² (SD). When fat-free mass (FFM) was also considered 23% were cachectic, 9% had muscle atrophy and 6% were semi-starved. Vitamin D deficiency (<50 nmol/L) was present in 53% and vitamin B12 deficiency (<222 pmol/L) was present in 31%. Anaemia was present in 30%, with 38% of these being iron deficient. Living status (alone or with family) was not associated with BC or micronutrient deficiencies (MD). Patients with ≥2 hospital admissions for AECOPD had a significantly lower mean B12 level (280.5 ± 143.0 pmol/L (SD) vs 360.5 ± 198.1 pmol/L (SD) P = 0.042). The malnutrition screening tool, a questionnaire-based assessment of malnutrition used by the local health area did not accurately predict patients with abnormal BC or those with >2 MD.

In patients admitted with AECOPD, the majority of subjects were overweight or obese, with a low FFM. MD, in particular B12 and vitamin D, were common. Interventional studies addressing BC and MD are required to assess potential improvements in AECOPD-related morbidity and mortality.