Aniwidyaningsih Wahju, Varraso Raphaëlle, Cano Noel, Pison Christophe
Department of Emergency and Community Medicine, Clinic of Pulmonology, University Hospital of Grenoble, Inserm U884, University of Joseph Fourier, Grenoble, France.
Curr Opin Clin Nutr Metab Care. 2008 Jul;11(4):435-42. doi: 10.1097/MCO.0b013e3283023d37.
Chronic obstructive pulmonary disease is the fifth leading cause of mortality in the world. This study reviews diet as a risk or protective factor for chronic obstructive pulmonary disease, mechanisms of malnutrition, undernutrition consequences on body functioning and how to modulate nutritional status of patients with chronic obstructive pulmonary disease.
Different dietary factors (dietary pattern, foods, nutrients) have been associated with chronic obstructive pulmonary disease and the course of the disease. Mechanical disadvantage, energy imbalance, disuse muscle atrophy, hypoxemia, systemic inflammation and oxidative stress have been reported to cause systemic consequences such as cachexia and compromise whole body functioning. Nutritional intervention makes it possible to modify the natural course of the disease provided that it is included in respiratory rehabilitation combining bronchodilators optimization, infection control, exercise and, in some patients, correction of hypogonadism.
Diet, as a modifiable risk factor, appears more as an option to prevent and modify the course of chronic obstructive pulmonary disease. Reduction of mechanical disadvantage, physical training and anabolic agents should be used conjointly with oral nutrition supplements to overcome undernutrition and might change the prognosis of the disease in some cases. Major research challenges address the role of systemic inflammation and the best interventions for controlling it besides smoking cessation.
慢性阻塞性肺疾病是全球第五大致死原因。本研究回顾了饮食作为慢性阻塞性肺疾病的风险或保护因素、营养不良的机制、营养不足对身体功能的影响以及如何调节慢性阻塞性肺疾病患者的营养状况。
不同的饮食因素（饮食模式、食物、营养素）与慢性阻塞性肺疾病及其病程相关。据报道，机械劣势、能量失衡、废用性肌肉萎缩、低氧血症、全身炎症和氧化应激会导致恶病质等全身后果，并损害全身功能。营养干预能够改变疾病的自然病程，前提是将其纳入呼吸康复方案，该方案包括优化支气管扩张剂、控制感染、运动，以及在某些患者中纠正性腺功能减退。
饮食作为一个可改变的风险因素，似乎更像是预防和改变慢性阻塞性肺疾病病程的一种选择。减少机械劣势、体育锻炼和合成代谢药物应与口服营养补充剂联合使用，以克服营养不足，在某些情况下可能会改变疾病的预后。主要的研究挑战在于全身炎症的作用以及除戒烟外控制炎症的最佳干预措施。
