Body Composition and Resting Energy Expenditure in Clinically Stable, Non–Weight-Losing Patients With Severe Emphysema

doi:10.1378/chest.124.4.1365

Chest

Volume 124, Issue 4, October 2003, Pages 1365-1372

https://doi.org/10.1378/chest.124.4.1365 Get rights and content

Study objectives

To characterize the metabolic status of weight-stable and clinically stable individuals with advanced emphysema.

Patients

Seventy-nine patients with severe emphysema (FEV₁, 29 ± 13% of predicted [mean ± SD]) evaluated for enrollment in the National Emphysema Treatment Trial and 20 age-matched healthy subjects were studied.

Setting

Pulmonary function laboratory of university-affiliated teaching hospital.

Interventions

Data collection.

Measurements and results

We measured lung function, body composition, serum leptin levels, serum tumor necrosis factor receptors (sTNF-Rs), resting oxygen consumption (R $\dot{V}$ o₂) normalized to weight in kilograms (R $\dot{V}$ o₂/kg), and R $\dot{V}$ o₂ normalized to fat-free mass (FFM) [R $\dot{V}$ o₂/FFM]. The patient group and healthy group had similar age, body mass index (BMI), and body composition. R $\dot{V}$ o₂/kg, R $\dot{V}$ o₂/FFM, and sTNF-R levels were higher in patients compared to healthy subjects. There were no differences in serum leptin levels between emphysematous and healthy subjects, and there was no correlation between leptin and sTNF-R and R $\dot{V}$ o₂/kg. Furthermore, both groups had similar gender-related differences in FFM, percentage of body fat, and serum leptin levels. Patients with lower BMI showed the greatest differences from control subjects in R $\dot{V}$ o₂/kg.

Conclusion

In weight-stable subjects with advanced emphysema, R $\dot{V}$ o₂/kg and R $\dot{V}$ o₂/FFM were higher compared to healthy subjects, especially in those with BMI in the lower end of the normal range. R $\dot{V}$ o₂/kg and R $\dot{V}$ o₂/FFM did not correlate with leptin or sTNF-R levels. These data show that a higher metabolic rate is found in patients with emphysema who are clinically and weight stable. Thus, hypermetabolism is a feature of the disease and not sufficient to lead to weight loss.

Section snippets

Materials and Methods

The National Emphysema Treatment Trial (NETT) provided an ideal opportunity to examine individuals with severe emphysema who were weight stable. The NETT is a large nationwide trial of lung volume reduction surgery in patients with severe emphysema, the details of which were published elsewhere.¹³All patients screened for this study have activity-limiting dyspnea and emphysema. Seventy-nine patients (43 men and 36 women) evaluated for enrollment into the NETT were recruited into this study.

Results

Both patient and healthy groups were comparable in terms of age, BMI, body composition, and leptin levels (Table 1). The main differences between the two groups were in R $\dot{V}$ o₂, R $\dot{V}$ o₂/kg, and R $\dot{V}$ o₂/FFM, which were significantly greater in patients than in healthy subjects.

Discussion

In this study, we were interested in weight-stable subjects, since these make up the majority of patients with emphysema, and this group has not been studied as carefully as weight-losing patients. Furthermore, we compared these weight-stable patients with severe emphysema to a group of healthy subjects with similar ages. The R $\dot{V}$ o₂/kg, R $\dot{V}$ o₂/FFM, and sTNF-R levels were higher in patients compared to healthy subjects. However, there were no differences in serum leptin between the two

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This study was presented in abstract forms at the American Thoracic Society International Conference Toronto 2000 (May 5–10, 2000) and San Francisco 2001 (May 18–23, 2001).

Supported by the Weisman Pulmonary Research Fund.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

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Chest

Clinical InvestigationsBody Composition and Resting Energy Expenditure in Clinically Stable, Non–Weight-Losing Patients With Severe Emphysema

Study objectives

Patients

Setting

Interventions

Measurements and results

Conclusion

Section snippets

Materials and Methods

Results

Discussion

Am J Clin Nutr

Clin Chest Med

Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

Energy balance in chronic obstructive pulmonary disease

Am Rev Respir Dis

Influence of body weight on the severity of dyspnea in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Prognostic value of nutritional status in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Weight loss in chronic obstructive pulmonary disease

Eur Respir J

Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation

Am Rev Respir Dis

Metabolic rate and weight loss in chronic obstructive lung disease

J Parenteral Enteral Nutr

Evidence for a relationship between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease

Thorax

Tumor necrosis factor α levels and weight loss in chronic obstructive pulmonary disease

Am J Respir Crit Care Med

Clinical Investigations
Body Composition and Resting Energy Expenditure in Clinically Stable, Non–Weight-Losing Patients With Severe Emphysema