Cachexia and muscle wasting is a frequent but partly reversible complication in patients with chronic obstructive pulmonary disease (COPD), and affects the disease progression and prognosis. Weight loss in COPD is a consequence of increased energy requirements unbalanced by dietary intake. Nutritional supplement therapy has been shown to be effective for maintaining and improving the muscle strength and exercise tolerance in poorly nourished COPD patients, thereby decreasing morbidity and mortality. This mini review discusses the role of nutritional supplement therapy in the treatment of COPD.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Revised 2015. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Available at: www.goldcopd.org. Last accessed on November 2, 2015.
2. Halbert RJ, Natoli JL, Gano A, Badamgarav E, Buist AS, Mannino DM. Global burden of COPD: systematic review and meta-analysis. Eur Respir J 2006; 28:523–32.
3. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet 2007; 370: 765–73.
4. Decramer M, Janssens W, Miravitlles M. Chronic obstructive pulmonary disease. Lancet 2012; 379: 1341–51.
5. Vermeeren MA, Creutzberg EC, Schols AM, Postma DS, Pieters WR, Roldaan AC, et al. Prevalence of nutritional depletion in large out-patient population of patients with COPD. Respir Med 2006; 100: 1349–55.
6. Wagner PD. Possible mechanisms underlying the development of cachexia in COPD. Eur Respir J 2008; 31: 492-501.
7. Schols AM. Nutrition in chronic obstructive pulmonary disease. Curr Opin Pulm Med 2000; 6: 110–5.
8. Vestbo J, Prescott E, Almdal T, Dahl M, Nordestgaard BG, Andersen T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. Am J Respir Crit Care Med 2006;173:79–83.
9. Scheepers CA, Wouters EF. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005; 82:53–9.
10. Collins PF, Stratton RJ, Elia M. Nutritional support in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Am J Clin Nutr 2012; 95: 1385–95.
11. Hallin R, Koivisto-Hursti UK, Lindberg E, Janson C. Nutritional status, dietary energy intake and the risk of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Respir Med 2006; 100: 561–7.
12. Langen RC, Gosker HR, Remels AH, Schols AM. Triggers and mechanisms of skeletal muscle wasting in chronic obstructive pulmonary disease. Int J Biochem Cell Biol 2013; 45: 2245–56.
13. Remels AH, Gosker HR, Langen RC, Schols AM. The mechanisms of cachexia underlying muscle dysfunction in COPD. J Appl Physiol (1985) 2013; 114: 1253–62.
14. Schols AM, Fredrix EW, Soeters PB, Westerterp KR, Wouters EF. Resting energy expenditure in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 1991; 54: 983–7.
15. Grönberg AM, Slinde F, Engström CP, Hulthén L, Larsson S. Dietary problems in patients with severe chronic obstructive disease. J Hum Nutr Diet 2005; 18: 445–52.
16. Gan WQ, Man SF, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: A systematic review and a meta-analysis. Thorax 2004; 59: 574–80.
17. De Godoy I, Donahoe M, Calhoun WJ, Mancino J, Rogers RM. Elevated TNF-α production by peripheral blood monocytes of weight-losing COPD patients. Am J Respir Crit Care Med 1996; 153: 633–7.
18. Koehler F, Doehner W, Hoernig S, Witt C, Anker SD, John M. Anorexia in chronic obstructive pulmonary disease-association to cachexia and hormonal derangement. Int J Cardiol 2007; 119: 83–9.
19. Ouchi N, Parker JL, Lugus JJ, Walsh K. Adipokines in inflammation and metabolic disease. Nat Rev Immunol 2011; 11: 85–97.
20. Breyer MK, Rutten EP, Locantore NW, Watkins ML, Miller BE, Wouters EF. Dysregulated adipokine metabolism in chronic obstructive pulmonary disease. Nat Rev Immunol 2011; 11: 85–97.
21. Görek Dilektaşli A, Ulubay G, Bayraktar N, Eminsoy I, Oner Eyüboğlu F. The effects of cachexia and related components on pulmonary functions in patients with COPD. Tuberk Toraks 2009; 57: 298-305.
22. Barr RG, Bluemke DA, Ahmed FS, Carr JJ, Enright PL, Hoffman EA, et al. Percent emphysema, airflow obstruction, and impaired left ventricular filling. N Engl J Med 2010; 362: 217-27.
23. Donahoe M. Nutritional support in advanced lung disease. The pulmonary cachexia syndrome. Clin Chest Med 1997; 18: 547-61.
24. Balkom van RH, Heijden van der HF, Herwaarden van CL, Dekhuijzen PN. Corticosteroid induced myopathy of the respiratory muscles. Neth J Med 1994; 45: 114–22.
25. Gosker HR, Wouters EF, van der Vusse GJ, Schols AM. Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr 2000;71:1033–47.
26. Schols AM, Wouters EF. Nutritional abnormalities and supplementation in chronic obstructive pulmonary disease. Clin Chest Med 2000; 21: 753-62.
28. Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012; 12:CD000998.
29. Cai B, Zhu Y, Ma Yi, Xu Z, Zao Yi, Wang J, et al. Comer G.M. Effect of supplementing a high-fat, low-carbohydrate enteral formula in COPD patients. Nutrition 2003; 19: 229–32.
30. Shaheen SO, Jameson KA, Syddall HE, Aihie Sayer A, Dennison EM, Cooper C, et al. The relationship of dietary patterns with adult lung function and COPD. Eur Respir J 2010; 36: 277–84.
31. Rawal G, Yadav S, Shokeen P, Nagayach S. Medical nutrition therapy for the critically ill. Int J Health Sci Res 2015; 5: 384-93.
32. Thies F, Miles EA, Nebe-von-Caron G, Powell JR, Hurst TL, Newsholme EA, et al. Influence of dietary supplementation with long-chain n-3 or n-6 polyunsaturated fatty acids on blood inflammatory cell populations and functions and on plasma soluble adhesion molecules in healthy adults. Lipids 2001; 36:1183–93.
33. Persson LJ, Aanerud M, Hiemstra PS, Hardie JA, Bakke PS, Eagan TM. Chronic obstructive pulmonary disease is associated with low levels of vitamin D. PLoS One 2012; 7: e38934.
34. Sundar IK, Hwang JW, Wu S, Sun J, Rahman I. Deletion of vitamin D receptor leads to premature emphysema/COPD by increased matrix metalloproteinases and lymphoid aggregates formation. Biochem Biophys Res Commun 2011; 406: 127–33.
35. Rawal G, Yadav S, Shokeen P. Health and the vitamin D. Int J Health Sci Res 2015; 5: 416-23.
36. Schols AM, Ferreira IM, Franssen FM, Gosker HR, Janssens W, Muscaritoli M, et al. Nutritional assessment and therapy in COPD: a European Respiratory Society statement. Eur Respir J 2014; 44: 1504–20.