Predictive clinical value of nutritional assessment factors in COPD

Thirty-nine stable outpatients with moderate-to-severe chronic obstructive pulmonary disease (COPD) were studied prospectively to determine the predictive value of several nutritional factors on the clinical outcome. Physiologic evaluation including FEV1, diffusing capacity, PaO2, as well as nutritional evaluation including triceps skin fold (TSF), midarm muscle circumference, body weight percentage of standard, history of 5 percent weight loss in the year prior to clinic visit, and average daily caloric intake based on a three-day diet record were all done at the clinic visit. Hospitalization or death during the six months to one year following the initial evaluation were the clinical outcome factors evaluated. Five of the 16 patients (31 percent) needing hospitalization during that time had weight loss during the year prior to the initial evaluation, while eight out of the 23 (35 percent) not requiring hospitalization had weight loss. There was a significantly lower TSF percent standard (TSF%) in the subgroup who subsequently required hospitalization (p less than 0.05). Nonhospitalized patients with severe depletion of body fat (TSF% less than 60) at initial evaluation ingested significantly more calories per kilogram than the severely depleted patients requiring hospitalization in the next six to 12 months (p less than 0.05) suggesting a protective effect of increased caloric intake. Increased caloric intake did not improve mortality statistics.