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ORIGINAL ARTICLE
Mini Nutritional Assessment Short-Form predicts exacerbation frequency in patients with chronic obstructive pulmonary disease MASANORI YOSHIKAWA, YUKIO FUJITA, YOSHIFUMI YAMAMOTO, MOTOO YAMAUCHI, KOICHI TOMODA, NORIKO KOYAMA AND HIROSHI KIMURA Second Department of Internal Medicine, Nara Medical University, Nara, Japan
ABSTRACT Background and objective: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity, mortality and reduced health status. Thus, to predict and prevent exacerbations is essential for the management of COPD. The aims of this study were to determine whether nutritional status as assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) predicts COPD exacerbation and to compare the ability of the MNA-SF to predict COPD exacerbation with that of the COPD Assessment Test (CAT). Methods: Pulmonary function, the modified Medical Research Council (mMRC) scale and body mass index (BMI) were evaluated in 60 stable patients with COPD (mean age, 72 years; mean forced expiratory volume in 1 s (FEV1), 51.1% predicted). The MNA-SF and CAT were also completed. Exacerbations were recorded prospectively for 1 year after the initial assessment. Results: The mean MNA-SF score was 11.4 ± 2.4 (well nourished, 51%; at risk, 37%; and malnourished, 12%). The mean CAT score was 14.4 ± 7.5 (low impact, 37%; medium impact, 38%; high impact, 20%; and very high impact, 5%). The CAT scores were significantly associated with the mMRC scale and %FEV1, but were not associated with BMI and the MNA-SF score. The exacerbation frequency was associated with the MNA-SF score but not with the CAT score. Conclusions: The MNA-SF predicts COPD exacerbation independently of the CAT. Key words: chronic obstructive pulmonary disease, COPD Assessment Test, exacerbation, Mini Nutritional Assessment Short-Form.
Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; DLCO, diffusing capacity for carbon monoxide; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting beta-agonists; mMRC, modified Correspondence: Masanori Yoshikawa, Second Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. Email: [email protected] Received 18 January 2014; invited to revise 24 March and 3 May 2014; revised 23 April and 22 June 2014; accepted 30 June 2014 (Associate Editor: Melissa Benton). Article first published online: 10 September 2014 © 2014 Asian Pacific Society of Respirology
SUMMARY AT A GLANCE Nutritional impairment is an important systemic manifestation associated with a poor prognosis in COPD. The Mini Nutritional Assessment ShortForm (MNA-SF) is a useful nutritional assessment tool of elderly patients. Although MNA-SF score did not correlate with COPD Assessment Test (CAT) score, it predicted exacerbation frequency in COPD independently of CAT.
Medical Research Council; MNA, Mini Nutritional Assessment; MNA-SF, Mini Nutritional Assessment Short-Form; RR, relative risk; RV, residual volume; VC, vital capacity.
INTRODUCTION The goal of the assessment of chronic obstructive pulmonary disease (COPD) is to determine the severity of the disease, its impact on the patient’s health status and the risk of future events such as exacerbations, hospital admission and death.1 To achieve this goal, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed a multidimensional approach to assess COPD patients, which includes the level of symptoms (as assessed by either the modified Medical Research Council (mMRC) score or the chronic COPD Assessment Test (CAT)),2 the forced expiratory volume in 1 s (FEV1) value (expressed as a percentage of predicted value) and the individual history of previous exacerbations.3 Exacerbations are important determinants of the natural history of COPD with considerable implications in health status, pulmonary function and mortality.4 Exacerbations became more frequent and more severe as the severity of COPD increases. However, there remain large differences in the yearly exacerbation incidence rates between patients of similar COPD severity.5 Therefore, the most important goals of the management of COPD should be to assess the risk of exacerbation and minimize the frequency of exacerbations. Although the CAT is a questionnaire designed to assess and quantify the impact of COPD Respirology (2014) 19, 1198–1203 doi: 10.1111/resp.12380
1199
MNA-SF predicts exacerbations in COPD
symptoms on health status,2 the CAT is reported to be associated with COPD exacerbations.6,7 Nutritional impairment, one of the major comorbidities of COPD, is significantly correlated with the pathophysiology as well as the mortality of COPD. Previous studies have mostly demonstrated a correlation between a low body mass index (BMI) and poor prognosis.8–10 Although the BMI is the most commonly used nutritional parameter in clinical practice, it was demonstrated that the BMI is inadequate for assessing malnutrition in COPD11,12 because a reduction in fat-free mass may not be detected by the BMI alone. The Mini Nutritional Assessment (MNA) questionnaire (the full MNA) is an established method for identifying malnourished subjects or individuals at risk of malnutrition or malnourished subjects.13 The full MNA has been evaluated in patients with COPD in several previous studies.14–17 However, the full MNA is used infrequently, and this is partly because it requires 10 to 15 min to complete. To reduce this time burden, the MNASF (http://www.mna-elderly.com/forms/mini/mna _mini_english.pdf), which comprises only six questions, was developed18 and was validated.19 The MNA-SF contains assessment questions not only related to nutritional and health conditions, but also other factors including independence, quality of life, cognition, mobility and subjective health. Therefore, we hypothesized that the suitability of the MNA-SF as a predictor of COPD exacerbations is similar to that of the CAT. The aim of the present study was to determine the relationship between the MNA-SF score and the CAT score and to compare the ability of the MNA-SF to predict exacerbation with that of CAT.
METHODS Study design and subjects Patients were recruited from the Nara Medical University Hospital in this prospective study. Consecutive patients with COPD who visited our hospital between August 2010 and December 2011 were eligible for enrollment. We enrolled 60 patients (58 men and 2 women) in stable condition in this study. COPD was diagnosed according to the definition of GOLD.1 We excluded patients who had known heart disease, malignancy, cor pulmonale or any other severe condition of inflammatory or metabolic disease. The local ethics committee approved the study and all subjects gave written informed consent. Monitoring and definition of exacerbation After the initial assessment, the patients were scheduled to visit our hospital every month or every other month for follow-up visits. Exacerbations were recorded prospectively for 1 year. An exacerbation was defined as an increase in respiratory symptoms (dyspnoea, cough and sputum production) that was beyond normal day-to-day variation and required additional treatment with bronchodilator inhalation, antibiotics and/or a systemic corticosteroid.1 Patients © 2014 Asian Pacific Society of Respirology
who experienced two or more exacerbations per year were classified as frequent exacerbators.
Pulmonary function tests All patients underwent pulmonary function testing. Vital capacity (VC), forced vital capacity (FVC), FEV1, residual volume (RV) and total lung capacity were measured by using a pulmonary function instrument with computer processing (FUDAC 70, Fukuda Denshi, Tokyo, Japan) and the FEV1/FVC ratio was calculated. Lung volumes were determined by using the helium gas dilution method, and the diffusing capacity for carbon monoxide (DLCO) was measured by the single-breath method. The values obtained were expressed as a percentage of the predicted values.20 Arterial blood samples obtained in room air were analysed by using a standard blood gas analyser (ABL800; Radiometer Corp., Copenhagen, Denmark). MNA-SF and CAT The MNA-SF comprises of only six questions and can be completed within 4 min.19 The total score can range from 0 to 14 points and the patients are classified as malnourished (≤7 points), at risk of malnutrition (8–11) or well nourished (≥12). CAT consists of eight items scored from 0 (best) to 5 (worst) relating to coughing, mucus production, chest tightness, capacity for exercise and activities, confidence, sleep quality and energy levels. The scaling range is from 0 to 40. CAT scores are categorized as follows: low impact (CAT score 1 to 10), medium impact (CAT score 11 to 20), high impact (CAT score 21 to 30) and very high impact (CAT score 31 to 40). All of the patients completed the Japanese version of the MNA-SF (http://www.mna-elderly.com/forms/ mini/mna_mini_japanese.pdf) and underwent a CAT at enrollment. Statistical analysis The values obtained are expressed as means ± standard deviation. Parameters were compared between three or four groups by using one-way analysis of variance followed by the Bonferroni multiple comparison test. Correlation between the MNA-SF and CAT score was determined by Spearman’s rank correlation coefficient. Logistic regression analysis was used to test whether individual factors were associated with exacerbations. P values < 0.05 were considered statistically significant. All statistical tests were carried out using the SPSS for Windows version 17.0 (SPSS Inc., Chicago, IL, USA).
RESULTS Patient characteristics The patient characteristics are summarized in Table 1. Of the total number of patients, 29 (48%) had mild-tomoderate airflow limitation and 31 (52%) had severe or very severe airflow limitation. Perception of dyspnoea as assessed by the mMRC scale, %FEV1 and BMI were Respirology (2014) 19, 1198–1203
1200
M Yoshikawa et al.
significantly associated with disease severity (P < 0.0001, P < 0.0001 and P < 0.02, respectively). At enrollment, 50 patients (83%) used long-acting muscarinic antagonists and 26 patients (43%) used long-acting beta-agonists (LABA). In addition, 27 patients (45%) were treated with inhaled corticosteroids (ICS) or ICS/LABA. No patients used oral corticosteroids.
MNA-SF score and CAT score The patients’ BMI, mMRC and pulmonary function variables according to the classification of the MNA-SF are shown in Table 2. The mean MNA-SF score was 11.4 ± 2.4 with 31 patients (51%) classified as ‘well nourished’, 22 patients (37%) as ‘at risk of malnutrition’ and 7 patients (12%) as ‘malnourished’. The BMI was associated with MNA-SF score (P < 0.0001) and the perception of dyspnoea was more severe in malnourished patients with COPD (P = 0.0002). The %VC, %FEV1 and %DLCO were significantly lower
Table 1
Patient characteristics
n Male/female Age, years mMRC BMI, kg/m2 GOLD stage , n I II III IV VC %pred. FEV1 %pred. RV %pred. DLCO %pred.
60 58/2 72.3 ± 9.2 2.0 ± 1.0 21.0 ± 3.5 6 23 26 5 91.1 ± 19.6 51.1 ± 19.8 138.3 ± 46.2 47.0 ± 21.4
Values are mean ± SD. BMI, body mass index; DLCO, diffusing capacity for carbon monoxide; FEV1, forced expiratory volume in 1 s; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, the modified Medical Research Council; RV, residual volume; VC, vital capacity.
Table 2
(P = 0.0023, P = 0.0111 and P = 0.0073, respectively), whereas the %RV was significantly higher (P = 0.0002) in malnourished patients with COPD. BMI, mMRC and pulmonary function variables according to the classification of CAT score are shown in Table 3. The mean CAT score was 14.4 ± 7.5 with 22 patients (37%) classified as ‘low impact’, 23 patients (38%) as ‘medium impact’, 12 patients (20%) as ‘high impact’ and 3 patients (5%) as ‘very high impact’. No significant relationship was observed between the BMI and CAT scores. In patients with a high CAT score, perceived dyspnoea was more severe (P = 0.0005), the %FEV1 was significantly lower (P = 0.0031) and the %RV was significantly higher (P = 0.0173). However, No significant relationship was found between the CAT score and %VC and %DLCO. The CAT score was not correlated with the MNA-SF score (r = -0.233, P = 0.074) (Fig. 1).
Relationship between exacerbation and MNA-SF and CAT scores The variables that were associated with exacerbation frequency are shown in Table 4. The mMRC scale showed a significant association with exacerbation frequency (P = 0.0295), whereas the %FEV1 and BMI did not. Exacerbation frequency was significantly associated with the MNA-SF score (P = 0.0197), but not with the CAT score. At enrollment, ICS or ICS/ LABA use was not different among the three groups. To determine the variables associated with exacerbation occurrence, logistic regression analysis was performed. MNA-SF score was significantly associated with exacerbation occurrence (relative risk (RR) 0.69, 95% confidence interval (CI): 0.48–0.99, P = 0.046), while CAT score was not (RR 0.94, 95% CI: 0.84–1.04, P = 0.231). In addition, other variables including age, mMRC scale, %FEV1 and BMI were not associated with exacerbation occurrence (P = 0.954, P = 0.193, P = 0.230 and P = 0.175, respectively).
DISCUSSION In the present study, we found that the MNA-SF was associated with perceived dyspnoea and pulmonary
Mini Nutritional Assessment Short-Form MNA-SF
n BMI, kg/m2 mMRC VC %pred. FEV1 %pred. RV %pred. DLCO %pred.
Well nourished
At risk of malnutrition
Malnutrition
P value
31 23.5 ± 2.5 1.5 ± 0.6 99.1 ± 15.9 58.5 ± 20.5 122.8 ± 41.2 54.1 ± 20.3
22 18.5 ± 2.4*** 2.4 ± 1.0*** 84.8 ± 17.8** 44.4 ± 13.3** 153.0 ± 34.4* 38.1 ± 17.9**
7 17.6 ± 1.6*** 2.5 ± 1.2** 75.3 ± 26.5** 40.2 ± 25.6* 240.3 ± 59.6**# 21.6 ± 27.4*
ORIGINAL ARTICLE
Mini Nutritional Assessment Short-Form predicts exacerbation frequency in patients with chronic obstructive pulmonary disease MASANORI YOSHIKAWA, YUKIO FUJITA, YOSHIFUMI YAMAMOTO, MOTOO YAMAUCHI, KOICHI TOMODA, NORIKO KOYAMA AND HIROSHI KIMURA Second Department of Internal Medicine, Nara Medical University, Nara, Japan
ABSTRACT Background and objective: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major cause of morbidity, mortality and reduced health status. Thus, to predict and prevent exacerbations is essential for the management of COPD. The aims of this study were to determine whether nutritional status as assessed by the Mini Nutritional Assessment Short-Form (MNA-SF) predicts COPD exacerbation and to compare the ability of the MNA-SF to predict COPD exacerbation with that of the COPD Assessment Test (CAT). Methods: Pulmonary function, the modified Medical Research Council (mMRC) scale and body mass index (BMI) were evaluated in 60 stable patients with COPD (mean age, 72 years; mean forced expiratory volume in 1 s (FEV1), 51.1% predicted). The MNA-SF and CAT were also completed. Exacerbations were recorded prospectively for 1 year after the initial assessment. Results: The mean MNA-SF score was 11.4 ± 2.4 (well nourished, 51%; at risk, 37%; and malnourished, 12%). The mean CAT score was 14.4 ± 7.5 (low impact, 37%; medium impact, 38%; high impact, 20%; and very high impact, 5%). The CAT scores were significantly associated with the mMRC scale and %FEV1, but were not associated with BMI and the MNA-SF score. The exacerbation frequency was associated with the MNA-SF score but not with the CAT score. Conclusions: The MNA-SF predicts COPD exacerbation independently of the CAT. Key words: chronic obstructive pulmonary disease, COPD Assessment Test, exacerbation, Mini Nutritional Assessment Short-Form.
Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; DLCO, diffusing capacity for carbon monoxide; FEV1, forced expiratory volume in 1 s; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting beta-agonists; mMRC, modified Correspondence: Masanori Yoshikawa, Second Department of Internal Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan. Email: [email protected] Received 18 January 2014; invited to revise 24 March and 3 May 2014; revised 23 April and 22 June 2014; accepted 30 June 2014 (Associate Editor: Melissa Benton). Article first published online: 10 September 2014 © 2014 Asian Pacific Society of Respirology
SUMMARY AT A GLANCE Nutritional impairment is an important systemic manifestation associated with a poor prognosis in COPD. The Mini Nutritional Assessment ShortForm (MNA-SF) is a useful nutritional assessment tool of elderly patients. Although MNA-SF score did not correlate with COPD Assessment Test (CAT) score, it predicted exacerbation frequency in COPD independently of CAT.
Medical Research Council; MNA, Mini Nutritional Assessment; MNA-SF, Mini Nutritional Assessment Short-Form; RR, relative risk; RV, residual volume; VC, vital capacity.
INTRODUCTION The goal of the assessment of chronic obstructive pulmonary disease (COPD) is to determine the severity of the disease, its impact on the patient’s health status and the risk of future events such as exacerbations, hospital admission and death.1 To achieve this goal, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed a multidimensional approach to assess COPD patients, which includes the level of symptoms (as assessed by either the modified Medical Research Council (mMRC) score or the chronic COPD Assessment Test (CAT)),2 the forced expiratory volume in 1 s (FEV1) value (expressed as a percentage of predicted value) and the individual history of previous exacerbations.3 Exacerbations are important determinants of the natural history of COPD with considerable implications in health status, pulmonary function and mortality.4 Exacerbations became more frequent and more severe as the severity of COPD increases. However, there remain large differences in the yearly exacerbation incidence rates between patients of similar COPD severity.5 Therefore, the most important goals of the management of COPD should be to assess the risk of exacerbation and minimize the frequency of exacerbations. Although the CAT is a questionnaire designed to assess and quantify the impact of COPD Respirology (2014) 19, 1198–1203 doi: 10.1111/resp.12380
1199
MNA-SF predicts exacerbations in COPD
symptoms on health status,2 the CAT is reported to be associated with COPD exacerbations.6,7 Nutritional impairment, one of the major comorbidities of COPD, is significantly correlated with the pathophysiology as well as the mortality of COPD. Previous studies have mostly demonstrated a correlation between a low body mass index (BMI) and poor prognosis.8–10 Although the BMI is the most commonly used nutritional parameter in clinical practice, it was demonstrated that the BMI is inadequate for assessing malnutrition in COPD11,12 because a reduction in fat-free mass may not be detected by the BMI alone. The Mini Nutritional Assessment (MNA) questionnaire (the full MNA) is an established method for identifying malnourished subjects or individuals at risk of malnutrition or malnourished subjects.13 The full MNA has been evaluated in patients with COPD in several previous studies.14–17 However, the full MNA is used infrequently, and this is partly because it requires 10 to 15 min to complete. To reduce this time burden, the MNASF (http://www.mna-elderly.com/forms/mini/mna _mini_english.pdf), which comprises only six questions, was developed18 and was validated.19 The MNA-SF contains assessment questions not only related to nutritional and health conditions, but also other factors including independence, quality of life, cognition, mobility and subjective health. Therefore, we hypothesized that the suitability of the MNA-SF as a predictor of COPD exacerbations is similar to that of the CAT. The aim of the present study was to determine the relationship between the MNA-SF score and the CAT score and to compare the ability of the MNA-SF to predict exacerbation with that of CAT.
METHODS Study design and subjects Patients were recruited from the Nara Medical University Hospital in this prospective study. Consecutive patients with COPD who visited our hospital between August 2010 and December 2011 were eligible for enrollment. We enrolled 60 patients (58 men and 2 women) in stable condition in this study. COPD was diagnosed according to the definition of GOLD.1 We excluded patients who had known heart disease, malignancy, cor pulmonale or any other severe condition of inflammatory or metabolic disease. The local ethics committee approved the study and all subjects gave written informed consent. Monitoring and definition of exacerbation After the initial assessment, the patients were scheduled to visit our hospital every month or every other month for follow-up visits. Exacerbations were recorded prospectively for 1 year. An exacerbation was defined as an increase in respiratory symptoms (dyspnoea, cough and sputum production) that was beyond normal day-to-day variation and required additional treatment with bronchodilator inhalation, antibiotics and/or a systemic corticosteroid.1 Patients © 2014 Asian Pacific Society of Respirology
who experienced two or more exacerbations per year were classified as frequent exacerbators.
Pulmonary function tests All patients underwent pulmonary function testing. Vital capacity (VC), forced vital capacity (FVC), FEV1, residual volume (RV) and total lung capacity were measured by using a pulmonary function instrument with computer processing (FUDAC 70, Fukuda Denshi, Tokyo, Japan) and the FEV1/FVC ratio was calculated. Lung volumes were determined by using the helium gas dilution method, and the diffusing capacity for carbon monoxide (DLCO) was measured by the single-breath method. The values obtained were expressed as a percentage of the predicted values.20 Arterial blood samples obtained in room air were analysed by using a standard blood gas analyser (ABL800; Radiometer Corp., Copenhagen, Denmark). MNA-SF and CAT The MNA-SF comprises of only six questions and can be completed within 4 min.19 The total score can range from 0 to 14 points and the patients are classified as malnourished (≤7 points), at risk of malnutrition (8–11) or well nourished (≥12). CAT consists of eight items scored from 0 (best) to 5 (worst) relating to coughing, mucus production, chest tightness, capacity for exercise and activities, confidence, sleep quality and energy levels. The scaling range is from 0 to 40. CAT scores are categorized as follows: low impact (CAT score 1 to 10), medium impact (CAT score 11 to 20), high impact (CAT score 21 to 30) and very high impact (CAT score 31 to 40). All of the patients completed the Japanese version of the MNA-SF (http://www.mna-elderly.com/forms/ mini/mna_mini_japanese.pdf) and underwent a CAT at enrollment. Statistical analysis The values obtained are expressed as means ± standard deviation. Parameters were compared between three or four groups by using one-way analysis of variance followed by the Bonferroni multiple comparison test. Correlation between the MNA-SF and CAT score was determined by Spearman’s rank correlation coefficient. Logistic regression analysis was used to test whether individual factors were associated with exacerbations. P values < 0.05 were considered statistically significant. All statistical tests were carried out using the SPSS for Windows version 17.0 (SPSS Inc., Chicago, IL, USA).
RESULTS Patient characteristics The patient characteristics are summarized in Table 1. Of the total number of patients, 29 (48%) had mild-tomoderate airflow limitation and 31 (52%) had severe or very severe airflow limitation. Perception of dyspnoea as assessed by the mMRC scale, %FEV1 and BMI were Respirology (2014) 19, 1198–1203
1200
M Yoshikawa et al.
significantly associated with disease severity (P < 0.0001, P < 0.0001 and P < 0.02, respectively). At enrollment, 50 patients (83%) used long-acting muscarinic antagonists and 26 patients (43%) used long-acting beta-agonists (LABA). In addition, 27 patients (45%) were treated with inhaled corticosteroids (ICS) or ICS/LABA. No patients used oral corticosteroids.
MNA-SF score and CAT score The patients’ BMI, mMRC and pulmonary function variables according to the classification of the MNA-SF are shown in Table 2. The mean MNA-SF score was 11.4 ± 2.4 with 31 patients (51%) classified as ‘well nourished’, 22 patients (37%) as ‘at risk of malnutrition’ and 7 patients (12%) as ‘malnourished’. The BMI was associated with MNA-SF score (P < 0.0001) and the perception of dyspnoea was more severe in malnourished patients with COPD (P = 0.0002). The %VC, %FEV1 and %DLCO were significantly lower
Table 1
Patient characteristics
n Male/female Age, years mMRC BMI, kg/m2 GOLD stage , n I II III IV VC %pred. FEV1 %pred. RV %pred. DLCO %pred.
60 58/2 72.3 ± 9.2 2.0 ± 1.0 21.0 ± 3.5 6 23 26 5 91.1 ± 19.6 51.1 ± 19.8 138.3 ± 46.2 47.0 ± 21.4
Values are mean ± SD. BMI, body mass index; DLCO, diffusing capacity for carbon monoxide; FEV1, forced expiratory volume in 1 s; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, the modified Medical Research Council; RV, residual volume; VC, vital capacity.
Table 2
(P = 0.0023, P = 0.0111 and P = 0.0073, respectively), whereas the %RV was significantly higher (P = 0.0002) in malnourished patients with COPD. BMI, mMRC and pulmonary function variables according to the classification of CAT score are shown in Table 3. The mean CAT score was 14.4 ± 7.5 with 22 patients (37%) classified as ‘low impact’, 23 patients (38%) as ‘medium impact’, 12 patients (20%) as ‘high impact’ and 3 patients (5%) as ‘very high impact’. No significant relationship was observed between the BMI and CAT scores. In patients with a high CAT score, perceived dyspnoea was more severe (P = 0.0005), the %FEV1 was significantly lower (P = 0.0031) and the %RV was significantly higher (P = 0.0173). However, No significant relationship was found between the CAT score and %VC and %DLCO. The CAT score was not correlated with the MNA-SF score (r = -0.233, P = 0.074) (Fig. 1).
Relationship between exacerbation and MNA-SF and CAT scores The variables that were associated with exacerbation frequency are shown in Table 4. The mMRC scale showed a significant association with exacerbation frequency (P = 0.0295), whereas the %FEV1 and BMI did not. Exacerbation frequency was significantly associated with the MNA-SF score (P = 0.0197), but not with the CAT score. At enrollment, ICS or ICS/ LABA use was not different among the three groups. To determine the variables associated with exacerbation occurrence, logistic regression analysis was performed. MNA-SF score was significantly associated with exacerbation occurrence (relative risk (RR) 0.69, 95% confidence interval (CI): 0.48–0.99, P = 0.046), while CAT score was not (RR 0.94, 95% CI: 0.84–1.04, P = 0.231). In addition, other variables including age, mMRC scale, %FEV1 and BMI were not associated with exacerbation occurrence (P = 0.954, P = 0.193, P = 0.230 and P = 0.175, respectively).
DISCUSSION In the present study, we found that the MNA-SF was associated with perceived dyspnoea and pulmonary
Mini Nutritional Assessment Short-Form MNA-SF
n BMI, kg/m2 mMRC VC %pred. FEV1 %pred. RV %pred. DLCO %pred.
Well nourished
At risk of malnutrition
Malnutrition
P value
31 23.5 ± 2.5 1.5 ± 0.6 99.1 ± 15.9 58.5 ± 20.5 122.8 ± 41.2 54.1 ± 20.3
22 18.5 ± 2.4*** 2.4 ± 1.0*** 84.8 ± 17.8** 44.4 ± 13.3** 153.0 ± 34.4* 38.1 ± 17.9**
7 17.6 ± 1.6*** 2.5 ± 1.2** 75.3 ± 26.5** 40.2 ± 25.6* 240.3 ± 59.6**# 21.6 ± 27.4*
