The pulmonary cachexia syndrome: aspects of energy balance

• Published in: Proceedings of the Nutrition Society Vol. 58; no. 2; pp. 321 - 328
• Main Author: Congleton, Jo
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-05-1999
• Subjects: Body-weight loss; Cachexia - complications; Chronic obstructive pulmonary disease; Clinical Nutrition and Metabolism Group Symposium on ‘Nutrition and lung health’; Energy balance; Energy Metabolism; Humans; Lung Diseases - complications; Lung Diseases, Obstructive - complications; Lung Diseases, Obstructive - mortality; Malnutrition; Nutrition Disorders - etiology; Pulmonary cachexia syndrome; Syndrome; Weight Loss; Energy balance; Chronic obstructive pulmonary disease; Pulmonary cachexia syndrome; Body-weight loss; Malnutrition
• ISSN: 0029-6651; 1475-2719
• DOI: 10.1017/S0029665199000439

The present paper reviews current knowledge of the pulmonary cachexia syndrome with reference to chronic obstructive pulmonary disease (COPD). Aspects of incidence, aetiology and management are discussed. Malnutrition occurs in approximately one-quarter to one-third of patients with moderate to severe COPD. Both fat mass and fat-free mass become depleted. Loss of fat-free mass is the more important and appears to be due to a depression of protein synthesis. Weight loss is an independent prognostic indicator of mortality, and is associated with increased morbidity and decreased health-related quality of life. The aetiology of malnutrition in COPD is not well understood. Reduced food intake does not seem to be the primary cause. Resting energy expenditure (REE) is elevated in a proportion of patients and probably contributes to negative energy balance. Measurement of actual REE is helpful when considering the adequacy of nutritional supplementation. The underlying reason for a hypermetabolic state is not known. Although weight-losing COPD patients are not catabolic, nutritional supplementation alone does not appear to reverse the loss of fat-free mass. Strategies involving nutritional supplementation in combination with a second intervention are being explored, and there are some encouraging results using anabolic hormones.