Casanova Macario Ciro, de Torres Tajes Juan Pablo, Palmero María Angeles Martín
Servicio de Neumología, Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, España.
Arch Bronconeumol. 2009;45 Suppl 4:31-5. doi: 10.1016/S0300-2896(09)72861-3.
Weight loss and malnutrition related mainly to lean mass loss can develop in advanced stages of chronic obstructive pulmonary disease (COPD) and are a clear indication of phenotypic heterogeneity. The presence of weight loss and malnutrition is associated with a worse prognosis, independently of forced expiratory volume in 1 second (FEV(1)). The most widely accepted thresholds for risk are 21 for the body mass index (BMI) and 17 and 14 for men and women, respectively, for the fat-free mass index (FFMI). The coexistence of both defines a situation of greater nutritional risk (cachexia). Nevertheless, a reduction in FFMI is an independent risk factor, although not superior to a low BMI. Therefore, although obtaining FFMI by bioelectric impedanciometry is reliable and relatively easy, we recommend the use of this procedure only in patients with COPD and low weight (BMI < 21), together with more specific nutritional evaluation. Currently, longitudinal studies providing data on the behavior of BMI within the natural course of the disease are lacking. Moreover, there is no solid scientific evidence that confirms the main mechanisms of malnutrition in COPD. This lack of evidence explains the difficulty of the therapeutic management of these patients, which has not advanced in the last few decades. Nevertheless, current evidence suggests that initiating individually-tailored nutritional treatment combined with pulmonary rehabilitation programs (exercise) is reasonable in patients with cachexia. Further studies are required to provide greater insight into the physiopathology and the role of other therapeutic options (hormones, antiinflammatory drugs) in malnutrition in patients with COPD.
体重减轻和主要与去脂体重减少相关的营养不良可在慢性阻塞性肺疾病（COPD）晚期出现，是表型异质性的明确指征。体重减轻和营养不良的存在与更差的预后相关，独立于一秒用力呼气容积（FEV₁）。最广泛接受的风险阈值为体重指数（BMI）21，男性和女性的去脂体重指数（FFMI）分别为17和14。两者并存定义了一种更高营养风险的情况（恶病质）。然而，FFMI降低是一个独立的风险因素，尽管并不优于低BMI。因此，尽管通过生物电阻抗法获得FFMI是可靠且相对容易的，但我们仅建议在体重低（BMI < 21）的COPD患者中使用该方法，并结合更具体的营养评估。目前，缺乏关于疾病自然病程中BMI行为的纵向研究数据。此外，没有确凿的科学证据证实COPD中营养不良的主要机制。这种证据的缺乏解释了这些患者治疗管理的困难，在过去几十年中没有进展。然而，目前的证据表明，对恶病质患者启动个体化营养治疗并结合肺康复计划（运动）是合理的。需要进一步研究以更深入了解生理病理学以及其他治疗选择（激素、抗炎药物）在COPD患者营养不良中的作用。
