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

Body composition and micronutrient deficiencies in patients with an acute exacerbation of chronic obstructive pulmonary disease.
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Horadagoda C, Dinihan T, Roberts M, Kairaitis K,


Horadagoda C, Dinihan T, Roberts M, Kairaitis K, (click to view)

Horadagoda C, Dinihan T, Roberts M, Kairaitis K,

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Internal medicine journal 2017 04 12() doi 10.1111/imj.13453
Abstract

Chronic obstructive pulmonary disease (COPD) is a multisystem disorder. Abnormal body composition (BC) and low serum micronutrient levels contribute significantly to morbidity associated with acute exacerbations of COPD (AECOPD). The BC and serum levels of selected micronutrients were recorded in prospective, consecutive patients admitted to hospital with an AECOPD in Western Sydney. 94 patients were enrolled, 43% female, the average age was 69.8 ± 8.2years(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). 51% of the population were overweight or obese, with an average BMI of 25.9 ± 7.7kgm(-2) (SD). When fat-free mass (FFM) was also considered 23% were cachectic, 9% had muscle-atrophy and 6% were semi-starved. Vitamin D deficiency (<50nmol/L) was present in 53% and vitamin B12 deficiency (<222pmol/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 (MDs). Patients with ≥2 hospital admissions for AECOPD had a significantly lower mean B12 level [280.5 ± 143.0pmol/L(SD) vs 360.5 ± 198.1pmol/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 MDs. In patients admitted with an AECOPD the majority of subjects were overweight or obese, with a low FFM. MDs, in particular B12 and vitamin D were common. Interventional studies addressing BC and MDs are required to assess potential improvements in AECOPD related morbidity and mortality.

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