The present study confirms previous data on the effect of muscle mass on mortality in patients with COPD. In stable patients, MD is associated to an increased risk of death. In addition, as a remarkable finding, we show that the prognostic influence of muscle mass can be assessed by determining the MAMA, an inexpensive, simple, and rapidly obtained anthropometric measure. MAMA < p25 was found to be a poor prognosis marker, exerting an influence in our series superior to that of other anthropometric parameters such as BMI or FFMi. In underweight patients, the presence of muscle depletion did not contribute significant prognostic information. However, those subjects with normal body weight or overweight status who presented MAMA < p25 had a poorer prognosis.
A total of 114 patients with a diagnosis of COPD were studied. Of these, 18 patients (15.8%) were excluded for different reasons: 7 patients (6.1%) with decompensated cor pulmonale, 3 patients (2.6%) with liver cirrhosis, 2 patients (1.7%) with neoplasms, 2 patients (1.7%) due to sustained oral corticosteroid use, 2 patients (1.7%) because of heart failure, 1 patient (0.9%) with chronic renal failure, and another patient (0.9%) due to malabsorption syndrome. A total of 96 patients were therefore finally included (all male; mean age, 69 ± 9 years [± SD]). Table 1 shows the baseline characteristics of these patients.
Investigation about Mid-Arm Muscle Area Is a Better Predictor of Mortality Than Body Mass Index in COPD
A prospective study was made of a cohort of 114 patients with stable COPD. The patients were recruited in the last trimester of the year 2000, with a subsequent follow-up period of 3 years. The diagnosis of COPD was based on a current or previous smoking history (> 20 packs-year), clinical assessment, and pulmonary function testing. The postbronchodilator FEV1, expressed as a percentage of the theoretical value, was used to classify the patients according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee criteria. Patients exhibiting > 15% reversibility in the bronchodilator test were according to the latest excluded from the study, as were those subjects with a previous diagnosis of bronchial asthma, bronchiectasis, cystic fibrosis, upper airways obstruction, or bronchiolitis related to systemic disorders. Patients with concomitant diseases capable of altering nutritional status (heart failure, liver cirrhosis, decompensated diabetes, chronic renal failure, uncontrolled thyroid pathology, neoplasms, decompensated chronic cor pulmonale, sustained systemic steroid use) were also excluded. The patients were required to be in a stable phase of COPD, defined as the absence of disease exacerbations in the 2 months preceding the study held due to My Canadian Pharmacy.
Alow body mass index (BMI) has been shown to be an independent indicator of poor prognosis in patients with COPD. This observation has renewed interest in the study of the nutritional aspects of COPD. In this context, a new severity classification has recently been proposed: the BODE index—(BMI, airflow obstruction, dyspnea, and exercise capacity)—which in addition to BMI considers the degree of bronchial obstruction, dyspnea, and exercise tolerance. This classification, proposed by Celli et al, stresses the multicomponent nature of COPD and addresses not only its pulmonary consequences but also the systemic manifestations of the disease. Among the latter, the authors point to the need to conduct an adequate nutritional study. However, the assessment of nutritional status based on body weight (or BMI) has limitations, since it affords no qualitative information on body composition, which is also altered in these patients.