Department of Physiotherapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina, Londrina, Brazil.
Department of Physiotherapy, Centro Universitário Filadélfia, Londrina, Brazil.
Eur J Clin Nutr. 2019 Nov;73(11):1512-1519. doi: 10.1038/s41430-019-0390-4. Epub 2019 Jan 14.
BACKGROUND/OBJECTIVES: Abnormal body composition is an independent determinant of COPD outcomes. To date, it is already known that patient stratification into body composition phenotypes are associated with important outcomes, such as exercise capacity and inflammation, but there are no data comparing physical activity and muscle strength among these phenotypes. Thus, the aim of this study was to compare clinical characteristics and physical function in patients with COPD stratified into body composition phenotypes.
SUBJECTS/METHODS: Two-hundred and seventy stable COPD patients were classified according to the 10th and 90th percentiles of sex-age-BMI-specific reference values for fat-free and fat mass indexes into four groups: Normal body composition (NBC), Obese, Sarcopenic, and Sarcopenic-obese (SO). Patients underwent assessment of exercise capacity, peripheral and respiratory muscle strength, physical activity, dyspnea severity, functional status, and symptoms of anxiety and depression.
The prevalence of patients classified as NBC, Obese, Sarcopenic, and SO was 39%, 13%, 21%, or 27%, respectively. SO presented lower 6MWT compared with NBC (P < 0.05). Sarcopenic and SO groups presented worse muscle strength compared with NBC (P < 0.05). Sarcopenic group presented more time in moderate-to-vigorous physical activity compared to all other groups (P < 0.05) and less sedentary time when compared with NBC and obese groups (P < 0.05). There were no differences regarding dyspnea severity, functional status, and symptoms of anxiety and depression (P > 0.16). Sarcopenic and SO groups had, respectively, 7.8 [95% CI: 1.6-37.7] and 9.5 [2.2-41.7] times higher odds to have a 6MWT equal or lower to 350 meters.
Body composition phenotypes are associated with physical function in patients with COPD. Sarcopenic-obese patients were the most impaired.
背景/目的：异常的身体成分是 COPD 结局的独立决定因素。迄今为止，已经知道将患者分为身体成分表型与重要结局相关，例如运动能力和炎症，但尚无数据比较这些表型之间的身体活动和肌肉力量。因此，本研究的目的是比较根据性别-年龄-BMI 特异性参考值的体脂和去脂体重指数的第 10 和 90 百分位数将 COPD 患者分为身体成分表型后的临床特征和身体功能。
受试者/方法：根据性别-年龄-BMI 特异性参考值的体脂和去脂体重指数的第 10 和 90 百分位数，将 270 名稳定的 COPD 患者分为四组：正常体成分（NBC）、肥胖、肌少症和肌少症合并肥胖（SO）。患者接受运动能力、外周和呼吸肌肉力量、身体活动、呼吸困难严重程度、功能状态以及焦虑和抑郁症状的评估。
NBC、肥胖、肌少症和 SO 患者的患病率分别为 39%、13%、21%和 27%。与 NBC 相比，SO 组的 6MWT 更短（P<0.05）。与 NBC 相比，肌少症和 SO 组的肌肉力量更差（P<0.05）。与其他所有组相比，肌少症组的中等到剧烈体力活动时间更多（P<0.05），与 NBC 和肥胖组相比，久坐时间更少（P<0.05）。呼吸困难严重程度、功能状态以及焦虑和抑郁症状无差异（P>0.16）。与 NBC 相比，肌少症和 SO 组的 6MWT 等于或低于 350 米的可能性分别高出 7.8 倍[95%置信区间：1.6-37.7]和 9.5 倍[2.2-41.7]。
身体成分表型与 COPD 患者的身体功能相关。肌少症合并肥胖患者的受损最严重。
