Correlation between Caloric Intake and Lung Function Parameters in Patients with Chronic Obstructive Pulmonary Disease

만성폐쇄성폐질환 환자에서 열량섭취와 폐기능지표와의 상관관계

  • Yoon, Ho Il (Medicine and Respiratory Center, Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Lung Institute of Seoul National University Medical Research Center) ;
  • Park, Young Mi (Department of Nutrition, Seoul National University Bundang Hospital) ;
  • Choue, Ryowon (Department of Medical Nutrition, Graduate School of East-West Medical Science, Research Institute of Clinical Nutrition, Kyung Hee University) ;
  • Kang, Yeong Ae (Medicine and Respiratory Center, Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Lung Institute of Seoul National University Medical Research Center) ;
  • Kwon, Sung Youn (Medicine and Respiratory Center, Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Lung Institute of Seoul National University Medical Research Center) ;
  • Lee, Jae Ho (Medicine and Respiratory Center, Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Lung Institute of Seoul National University Medical Research Center) ;
  • Lee, Choon-Taek (Medicine and Respiratory Center, Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, Lung Institute of Seoul National University Medical Research Center)
  • 윤호일 (분당서울대학교병원 폐센터, 서울대학교 의과대학 내과학교실 및 폐연구소) ;
  • 박영미 (분당서울대학교병원 영양과) ;
  • 조여원 (경희대학교 동서의학대학원 의학영양학과) ;
  • 강영애 (분당서울대학교병원 폐센터, 서울대학교 의과대학 내과학교실 및 폐연구소) ;
  • 권성연 (분당서울대학교병원 폐센터, 서울대학교 의과대학 내과학교실 및 폐연구소) ;
  • 이재호 (분당서울대학교병원 폐센터, 서울대학교 의과대학 내과학교실 및 폐연구소) ;
  • 이춘택 (분당서울대학교병원 폐센터, 서울대학교 의과대학 내과학교실 및 폐연구소)
  • Received : 2008.08.08
  • Accepted : 2008.10.06
  • Published : 2008.11.30

Abstract

Background: There are reports that food deprivation causes emphysematous changes in the lungs of rats and humans. However, the meaning of this phenomenon in patients with chronic obstructive pulmonary disease has not been evaluated. The aim of this study was to determine the correlations between the caloric intake and parameters of the lung function in patients with chronic obstructive pulmonary disease. Methods: Patients with chronic obstructive pulmonary disease who had visited the respiratory clinic from March, 2006 for one year were enrolled in this study. The patients underwent pulmonary function tests, and a dietitian evaluated their nutritional intake using a food record method. Results: There was no correlation between the total caloric intake and forced vital capacity (FVC, %predicted) or forced expiratory volume in one second ($FEV_1$, %predicted). The total caloric intake showed a positive correlation with the diffusing capacity of carbon monoxide (DLCO %predicted, DLCO/VA %predicted), and a negative correlation with the total lung capacity (TLC, %predicted). Of the calories taken, only calories from protein intake correlated with the diffusing capacity of carbon monoxide (DLCO %predicted, DLCO/VA %predicted). Conclusion: The total caloric intake of patients with chronic obstructive pulmonary disease showed a positive correlation with the diffusing capacity of the lung, and a negative correlation with the total lung capacity. Further study on the linkage between the caloric intake and severity of emphysema is needed.

연구배경: 이전의 연구에서 섭취의 제한은 폐기종과 유사한 변화를 유발할 수 있음이 알려져 왔다. 그러나 이러한 현상이 만성폐쇄성폐질환 환자에서 갖는 의미는 밝혀진 적이 없다. 저자들은 만성폐쇄성폐질환 환자에서 영양섭취량과 폐기능지표와의 상관관계를 알아보고자 본 연구를 수행하였다. 방 법: 분당서울대학교병원에서 2006년 3월부터 1년동안 진료받은 만성폐쇄성폐질환 환자들을 대상으로 하였으며 폐활량검사, 확산능검사, 폐용적검사와 함께 영양섭취상태평가를 시행한 후 분석하였다. 결 과: 총섭취열량과 1초간노력호기량이나 최대노력호기량(%예측치)과는 아무런 상관관계를 찾을 수 없었다. 반면 폐확산능의 지표인 DLCO (%예측치), DLCO/VA (%예측치)와는 양의 상관관계를, 총폐용량(%예측치)과는 음의 상관관계를 보임을 관찰할 수 있었다. 섭취한 열량 중 단백질섭취열량과 폐확산능 DLCO (%예측치), DLCO/VA (%예측치)은 통계적으로 의미 있는 상관관계를 보였다. 그러나 탄수화물 및 지방섭취에 의한 열량과 폐기능지표는 의미 있는 상관관계를 보이지 않았다. 결 론: 만성폐쇄성폐질환 환자의 하루 섭취 열량은 그 환자의 폐확산능과는 양의 상관관계, 총폐용량과는 음의상관관계에 있어 섭취열량과 폐기종의 관련성에 대한 추가 연구가 필요하다.

Keywords

References

  1. Walter RE, Wilk JB, Larson MG, Vasan RS, Keaney JF Jr, Lipinska I, et al. Systemic inflammation and COPD: the Framingham Heart Study. Chest 2008;133:19-25. https://doi.org/10.1378/chest.07-0058
  2. Agusti A. Systemic effects of COPD: just the tip of the Iceberg. COPD 2008;5:205-6. https://doi.org/10.1080/15412550802237317
  3. Hoeper MM, Welte T. Systemic inflammation, COPD, and pulmonary hypertension. Chest 2007;131:634-5. https://doi.org/10.1378/chest.06-2207
  4. Fabbri LM, Rabe KF. From COPD to chronic systemic inflammatory syndrome? Lancet 2007;370:797-9. https://doi.org/10.1016/S0140-6736(07)61383-X
  5. Ohara T, Hirai T, Muro S, Haruna A, Terada K, Kinose D, et al. Relationship between pulmonary emphysema and osteoporosis assessed by CT in patients with COPD. Chest 2008;0:chest.07-3054v1-0.
  6. Cote CG, Pinto-Plata VM, Marin JM, Nekach H, Dordelly LJ, Celli BR. The modified BODE index: validation with mortality in COPD. Eur Respir J 2008;32:1269-74. https://doi.org/10.1183/09031936.00138507
  7. Sin DD, Man SF. Skeletal muscle weakness, reduced exercise tolerance, and COPD: is systemic inflammation the missing link? Thorax 2006;61:1-3. https://doi.org/10.1136/thx.2006.065144
  8. Mascitelli L, Pezzetta F. Anemia and COPD. Chest 2005;128:3084.
  9. John M, Hoernig S, Doehner W, Okonko DD, Witt C, Anker SD. Anemia and inflammation in COPD. Chest 2005;127:825-9. https://doi.org/10.1378/chest.127.3.825
  10. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med 2004;350:1005-12. https://doi.org/10.1056/NEJMoa021322
  11. Stein J, Fenigstein H. Pathological anatomy of hunger disease. In: Winick M, editor. Hunger disease: studies by the Jewish physicians in the Warsaw Ghetto: current concepts in nutrition. New York: Wiley & Sons; 1979.
  12. Sahebjami H, MacGee J. Effects of starvation on lung mechanics and biochemistry in young and old rats. J Appl Physiol 1985;58:778-84. https://doi.org/10.1152/jappl.1985.58.3.778
  13. Kerr JS, Riley DJ, Lanza-Jacoby S, Berg RA, Spilker HC, Yu SY, et al. Nutritional emphysema in the rat: influence of protein depletion and impaired lung growth. Am Rev Respir Dis 1985;131:644-50.
  14. Dauber JH, Claypool WD. The role of nutrition in the pathogenesis of emphysema. Surv Synth Pathol Res 1984;3:83-92.
  15. D'Amours R, Clerch L, Massaro D. Food deprivation and surfactant in adult rats. J Appl Physiol 1983;55:1413-7. https://doi.org/10.1152/jappl.1983.55.5.1413
  16. Sahebjami H, Vassallo CL. Influence of starvation on enzyme- induced emphysema. J Appl Physiol 1980;48:284-8. https://doi.org/10.1152/jappl.1980.48.2.284
  17. Gail DB, Massaro GD, Massaro D. Influence of fasting on the lung. J Appl Physiol 1977;42:88-92.
  18. Stanescu D, Pieters T. Anorexia nervosa and emphysema. Am J Respir Crit Care Med 2005;172:398. https://doi.org/10.1164/ajrccm.172.3.951
  19. Coxson HO, Chan IH, Mayo JR, Hlynsky J, Nakano Y, Birmingham CL. Early emphysema in patients with anorexia nervosa. Am J Respir Crit Care Med 2004;170:748-52. https://doi.org/10.1164/rccm.200405-651OC
  20. Wilson NL, Wilson RH, Farber SM. Nutrition in pulmonary emphysema. J Am Diet Assoc 1964;45:530-6.
  21. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-55. https://doi.org/10.1164/rccm.200703-456SO
  22. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38. https://doi.org/10.1183/09031936.05.00034805
  23. Morris JF, Koski A, Johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 1971;103:57-67.
  24. Harik-Khan RI, Fleg JL, Wise RA. Body mass index and the risk of COPD. Chest 2002;121:370-6. https://doi.org/10.1378/chest.121.2.370
  25. Wouters EF. Nutrition and metabolism in COPD. Chest 2000;117:274S-80S. https://doi.org/10.1378/chest.117.5_suppl_1.274S
  26. Siedlinski M, Postma DS, van Diemen CC, Blokstra A, Smit HA, Boezen HM. Lung function loss, smoking, vitamin C intake, and polymorphisms of the glutamate- cysteine ligase genes. Am J Respir Crit Care Med 2008;178:13-9. https://doi.org/10.1164/rccm.200711-1749OC
  27. Jiang R, Paik DC, Hankinson JL, Barr RG. Cured meat consumption, lung function, and chronic obstructive pulmonary disease among United States adults. Am J Respir Crit Care Med 2007;175:798-804. https://doi.org/10.1164/rccm.200607-969OC
  28. Pearson P, Britton J, McKeever T, Lewis SA, Weiss S, Pavord I, et al. Lung function and blood levels of copper, selenium, vitamin C and vitamin E in the general population. Eur J Clin Nutr 2005;59:1043-8. https://doi.org/10.1038/sj.ejcn.1602209
  29. Mannino DM, Holguin F, Greves HM, Savage-Brown A, Stock AL, Jones RL. Urinary cadmium levels predict lower lung function in current and former smokers: data from the Third National Health and Nutrition Examination Survey. Thorax 2004;59:194-8. https://doi.org/10.1136/thorax.2003.012054
  30. Gilliland FD, Berhane KT, Li YF, Gauderman WJ, McConnell R, Peters J. Children's lung function and antioxidant vitamin, fruit, juice, and vegetable intake. Am J Epidemiol 2003;158:576-84. https://doi.org/10.1093/aje/kwg181
  31. Britton JR, Pavord ID, Richards KA, Knox AJ, Wisniewski AF, Lewis SA, et al. Dietary antioxidant vitamin intake and lung function in the general population. Am J Respir Crit Care Med 1995;151:1383-7. https://doi.org/10.1164/ajrccm.151.5.7735589