Weight loss is an important issue in patients with COPD. About 20-30% of COPD patients are underweight . In addition, although some patients have normal weight, they may have a low fat-free mass (FFM) . FFM and body weight are very important, as it has been shown that these are related to survival and exercise capacity [64,65]. Nutritional support was found to be beneficial in patients with COPD in improving respiratory and peripheral muscle strength, as well as improving exercise tolerance. In a large trial, Schols et al. investigated the physiological effects of daily nutritional supplements, alone or in combination with anabolic steroids, as an integrated part of a rehabilitation programme . Treatment with exercise and nutrition resulted in increased weight, fat-free mass and PImax. Another finding in this study was that not all patients responded to therapy—i.e. some did not gain weight or improve their respiratory muscle strength. It appeared that weight gain and increase in PImax were related to improved survival. Cox regression analysis showed that weight gain and body mass index were significant predictors of survival (Fig. 12.6) . In the recent ATS statement, it was therefore concluded that nutritional supplementation should be considered for patients with COPD suffering from involuntary weight loss and for all depleted patients. It is recommended to give oral or enteral protein and caloric support to achieve a positive energy balance, in combination with exercise as an anabolic stimulus to enhance FFM. The reason for the failure to respond to nutrition is not clear, but some hypermetabolic patients showed elevated levels of acute-phase proteins, suggesting that systemic inflammation is responsible for tissue depletion . If this hypothesis is correct, it means that caloric support alone is not sufficient to increase weight and FFM.
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A time for giving and receiving, getting closer with the ones we love and marking the end of another year and all the eating also. We eat because the food is yummy and plentiful but we don't usually count calories at this time of year. This book will help you do just this.