Body composition and micronutrient deficiencies in patients with an acute exacerbation of chronic obstructive pulmonary disease

Background: Chronic obstructive pulmonary disease (COPD) is a multisystem disorder. Abnormal body composition (BC) and micronutrient deficiencies (MD) contribute significantly to morbidity associated with acute exacerbations of COPD (AECOPD). COPD is a major health problem in Western Sydney.

Aims: To study the pattern of BC and MD in patients admitted with an AECOPD to Western Sydney.

Methods: The BC and serum levels of selected micronutrients were recorded in prospective, consecutive patients admitted to hospital with AECOPD in Western Sydney.

Results: A total of 94 patients was enrolled, 43% female, and the average age was 69.8 ± 8.2 years (SD). Admission spirometry revealed a mean spirometric ratio of 0.42 ± 0.14 (SD) and a severely reduced mean percentage FEV₁ of predicted at 29.1% ± 11.6 (SD). A total of 51% of the population was overweight or obese, with an average body mass index of 25.9 ± 7.7 kg/m² (SD). When fat-free mass (FFM) was also considered 23% were cachectic, 9% had muscle atrophy and 6% were semi-starved. Vitamin D deficiency (<50 nmol/L) was present in 53% and vitamin B12 deficiency (<222 pmol/L) was present in 31%. Anaemia was present in 30%, with 38% of these being iron deficient. Living status (alone or with family) was not associated with BC or micronutrient deficiencies (MD). Patients with ≥2 hospital admissions for AECOPD had a significantly lower mean B12 level (280.5 ± 143.0 pmol/L (SD) vs 360.5 ± 198.1 pmol/L (SD) P = 0.042). The malnutrition screening tool, a questionnaire-based assessment of malnutrition used by the local health area did not accurately predict patients with abnormal BC or those with >2 MD.

Conclusions: In patients admitted with AECOPD, the majority of subjects were overweight or obese, with a low FFM. MD, in particular B12 and vitamin D, were common. Interventional studies addressing BC and MD are required to assess potential improvements in AECOPD-related morbidity and mortality.