Ogasawara Takashi, Marui Shiori, Miura Eriko, Sugiura Masayuki, Matsuyama Wataru, Aoshima Yoichiro, Kasamatsu Norio, Ogiku Masahito, Ikematsu Yoshito
Department of Respiratory Medicine, Hamamatsu Medical Center, Japan.
Department of Nutrition, Hamamatsu Medical Center, Japan.
Clin Nutr ESPEN. 2018 Dec;28:67-73. doi: 10.1016/j.clnesp.2018.09.076. Epub 2018 Oct 11.
BACKGROUND & AIMS: Systemic inflammation plays an important role in the pathogenesis of chronic obstructive pulmonary disease (COPD), resulting in depletion of lean body mass (LBM) and muscle mass. Both frequent exacerbation of COPD and low LBM are associated with poor prognosis. This study aimed to evaluate whether supplementation of eicosapentaenoic acid (EPA) prevents depletion of LBM and muscle mass in hospitalized patients with exacerbation of COPD.
This was a prospective randomized controlled trial, conducted between November 2014 and October 2017. Fifty patients were randomly assigned to receive 1 g/day of EPA-enriched oral nutrition supplementation (ONS) (EPA group) or EPA-free ONS of similar energy (control group) during hospitalization. The LBM index (LBMI) and the skeletal muscle mass index (SMI) were measured using a bioelectrical impedance analyzer at the time of admission and at the time of discharge. Patients underwent pulmonary rehabilitation and wore a pedometer to measure step counts and physical activity.
Forty-five patients that completed the experiment were analyzed. Baseline characteristics were similar between the EPA (n = 24) and control groups (n = 21). There were no significant differences in energy intake, step counts, physical activity, or length of hospitalization between the two groups. Although the plasma levels of EPA significantly increased only in the EPA group, we found an insignificant increase in LBMI and SMI in the EPA group compared with the control group (LBMI: +0.35 vs. +0.19 kg/m, P = 0.60, and SMI: +0.2 vs. -0.3 kg/m, P = 0.17, respectively). The change in the SMI was significantly correlated with the length of hospitalization in the EPA group, but not in the control group (r = 0.53, P = 0.008, and r = -0.09, P = 0.70, respectively).
EPA-enriched ONS in patients with exacerbation of COPD during short-time hospitalization had no significant advantage in preservation of LBM and muscle mass compared with EPA-free ONS. EPA supplementation for a longer duration might play an important role in the recovery of skeletal muscle mass after exacerbation of COPD.
全身炎症在慢性阻塞性肺疾病（COPD）的发病机制中起重要作用，导致瘦体重（LBM）和肌肉量减少。COPD频繁急性加重和低LBM均与预后不良相关。本研究旨在评估补充二十碳五烯酸（EPA）是否可预防COPD急性加重住院患者的LBM和肌肉量减少。
这是一项前瞻性随机对照试验，于2014年11月至2017年10月进行。50例患者在住院期间被随机分配接受1g/天富含EPA的口服营养补充剂（ONS）（EPA组）或能量相似的不含EPA的ONS（对照组）。在入院时和出院时使用生物电阻抗分析仪测量LBM指数（LBMI）和骨骼肌量指数（SMI）。患者接受肺康复治疗并佩戴计步器以测量步数和身体活动。
分析了45例完成实验的患者。EPA组（n = 24）和对照组（n = 21）的基线特征相似。两组之间的能量摄入、步数、身体活动或住院时间无显著差异。虽然仅EPA组的血浆EPA水平显著升高，但与对照组相比，我们发现EPA组的LBMI和SMI有不显著的增加（LBMI：+0.35 vs. +0.19kg/m，P = 0.60；SMI：+0.2 vs. -0.3kg/m，P = 0.17）。EPA组中SMI的变化与住院时间显著相关，而对照组中则不然（r = 0.53，P = 0.008；r = -0.09，P = 0.70）。
与不含EPA的ONS相比，COPD急性加重患者在短期住院期间接受富含EPA的ONS在保留LBM和肌肉量方面无显著优势。较长时间补充EPA可能在COPD急性加重后骨骼肌量的恢复中起重要作用。
