Resting energy expenditure in patients with chronic obstructive pulmonary disease1’2 Annemie MWJ Schols, Elisabeth Klaas R Westerterp, and Emiel Resting

ABSTRACT

energy

WHM Fredrix, FM Wouters expenditure

(REE)

Peter

was

B Soeters,

mea-

sured in 68 patients with stable chronic obstructive pulmonary disease (COPD) and in 34 weight-stable, age-matched (65 ± 8 y; I ± SD) healthy control subjects. Fat-free mass (FFM) determined by bioelectrical resistance explained 84% ofthe variation in REE in the control group but only 34% in the COPD patients.

REE

could

not reliably

be predicted

from

regression

equations

either developed in healthy subjects or in COPD patients. REE adjusted for FFM was significantly higher (P < 0.05) in weightlosing (n = 34) than in weight-stable (n = 34) patients (6851 ± 78 1 and 6495 ± 650 kJ/d, respectively). Pulmonary function was more compromised in weight-losing patients. Adjusted REE in weight-stable patients was significantly higher (P < 0.01) than in the healthy COPD, factors

control group (613 1 ± 405 kJ/d). in addition to FFM are important

of REE. A disease-related contribute to weight loss of an adaptive response patients. AmfClinNutr

KEY

WORDS

In patients with determinants

increase in REE develops, which may in COPD in combination with a lack to undernutrition in weight-losing l99l;54:983-7.

COPD,

energy

expenditure,

body

compo-

training

(Table

piratory ofa -2

volume agonist

condition, severe

I). Patients

exhibiting

an increase

in lS (FEV1) > 10% ofbaseline or patients suffering from cancer,

active

gastrointestinal

endocrine

disorders,

in forced

unstable

cardiac

recent

surgery,

abnormalities, or obesity

[body

cx-

after inhalation

mass

index

(BMI;

in kg/m2) 30] were excluded from the study. To exclude a possible confounding effect ofacute exacerbation oftheir disease,

only patients in a stable pulmonary and cardiac condition were studied. None of the patients was suffering from a respiratorytract infection or had clinical signs of edema. Control

subjects

Control 82 y living stable

subjects in the

weights,

they

disease;

were 34 healthy same area as the

a BMI underwent


1 10%

hypermetabolic.

was

on

individuals

This

Boothby

exhibit

(20)

(REE/Moore) of that predicted

considered based

a measured

within

Frequency

test. Statistical analyses were age (23). Results are expressed at the

the

of predicted equations of

COPD-specific with a meaformula were

of hypermetabolism

REE

propriate.

were

definition

finding

analysis was performed followed by Tukey’s (18). The Mann-Whitney data

and

(21). Subjects by the HB

(22)

et al’s

Statistical variance procedure

determined

as a percentage by using the

that

95% of normal

10% ofthat

predicted.

by using one-way analysis pairwise multiple-comparison U test was used where compared

done with as means

by using

of ap-

the chi-square

the SAS statistical ± SD. Significance

pack-

was

5% level.

Results

function I

spirometer;

FFM whether

to the control in 1 7 control

information regarding previous study (13).

Pulmonari’

to underweight

weight.

diture obtained by using the individual FFM regression equation of REE on FFM generated

on their right sides as described by Lukaski et al (12). In an earlier study we established a good correlation between height2/ resistance and total body water (TBW), as assessed by deuterium

dilution

as the difference

actual

admission.

The

basis. Fredrix et al (10) showed that physical activities, including a short do not

minus when

before

but on an outpatient

Gas-exchange data were collected over a 20of steady state. Reproducibility of measurements

loss was calculated

weight

6 mo amounted to 10% ofusual stable patients and the control group had been

2 h after the patients Measurements in

similarly

stable significant

0.05.