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RELATIONSHIP OF NUTRITIONAL STATE WITH EXERCISE CAPACITY, QUALITY OF LIFE AND DYSPNEA IN COPD PATIENTS

RELATIONSHIP OF NUTRITIONAL STATE WITH EXERCISE CAPACITY, QUALITY OF LIFE AND DYSPNEA IN COPD PATIENTS. Ataturk Chest Disease and Chest Surgery Center PULMONARY REHABILITATION and HOME CARE UNIT Şengül F , Dyt ; Kaymaz D, MD ; Ergun P, MD ; Egesel N, Psy; Topcuoglu F, RN.

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RELATIONSHIP OF NUTRITIONAL STATE WITH EXERCISE CAPACITY, QUALITY OF LIFE AND DYSPNEA IN COPD PATIENTS

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  1. RELATIONSHIP OF NUTRITIONAL STATE WITH EXERCISE CAPACITY, QUALITY OF LIFE AND DYSPNEA IN COPD PATIENTS Ataturk Chest Disease and Chest Surgery Center PULMONARY REHABILITATION and HOME CARE UNIT Şengül F, Dyt; Kaymaz D, MD;Ergun P, MD; Egesel N, Psy;Topcuoglu F, RN

  2. Weight loss and muscle weakness in patients with COPD • Respiratory and peripheral muscle functions • Exercise capacity • Health related quality of life • Effects mortality negatively Systemic effects which can be reversed. 1-Eur Respir J 1994;7:1793-97 2-Eur Respir J 1997;10:2807-13 3-Eur Respir J 1997;10:1575-80 4-Am J Clin Nutr 2005;82:53-9

  3. COPD • Increases in catecolamins(β agonistler) • ↑Systemic inflammation(TNF,IL-6,Leptin ) • ↑Energy consumption of respiratory muscles • Stress response and steroids • Hypoxia • GIS perfusion ↓ • Dont want eating • Difficulty in chewing and swallowing • Peptic Ulcer, Drug adverse- dyspepsia • Losses in appetide Increased energy consumption Insufficient calori intake ENERGY EXPANDITURE > ENERGY INTAKE WEIGHT LOSS– FAT FREE MASS LOSS MALNUTRITION

  4. MALNUTRITION; Malnutrition is a state of nutrition in which a deficiency or excess (or imbalance) of energy, protein, and other nutrients causes measurable adverse effects on tissue/body form (body shape, size and composition) and function, and clinical outcome. ESPEN GUIDELINES

  5. Methods for Detection of Nutritionel Status-I Biochemical parameters; Nitrogen balance Plasma proteins (prealbumin, CRP, albumin, transferrin, (retinol binding protein) 24 h urine creatinine ve creatinine-height index (body muscle mass) Immunologic parameters; (Total lymphocytes, delayed skin hypersensitivity) Screening tools; (MUST, NRS2002, MNA)

  6. Methods for Detection of Nutritionel Status-II • Body composition; • Antropometric Measurements (weight,height, ideal body weight ratio, body mass index, triceps skinfold, upper arm circumference) • Advanced Measurements (Densitometry, isotop dillussion, DEXA, MRI, bioelectrical impedans analysis. • Clinical Assesment ;Subjective Global Assessment (SGA)

  7. Subjective Global Assessment (SGA) • Body weight • Nutritional impairment • GIS symptoms • Functionel capasity • Physical examination

  8. SGA; Changes in Weight • Weight loss in last 6 months • kilograms • Percentage (>%5 !) • Changes in last month

  9. SGA; Oral Intake • No changes • Changes (+) • Time • Types • Suboptimal • Fluid diet • Hypocaloric fluid diet • Starvation

  10. SGA; GIS Symtoms • Nausea • Vomiting • Diarrhea • Poor appetide

  11. SGA; Functional Capacity • Optimal • Suboptimal • Ambulatuary • Bed-bounding • Time

  12. SGA; Physical Examination • Subcutanous fat tissue • Loss of muscle (Deltoid, Quadriceps, Handgrip) • Pretibial eudema • Sacral eudema • Ascid (0) Normal (1) Mild (2) Moderate (3) Severe

  13. Subjective Global Assessment (SGA) Physical examination 1-Loss of muscle mass 2-Loss of sc. fat tissue 3-Pretibial eudema 4-Sacral eudema 5-Ascid History 1-Changes in weight 2-Nutritional impairment 3-GIS symptoms 4-Functional capacity A: Well nourished B: Well to moderate nourished C: Severe malnutrition SGA is more sensitive than other objective tests

  14. Aim To evaluate relationship between nutritional status and • Exercise capacity • Quality of life • Dyspnea

  15. Material and Methods • 100 patients with COPD (GOLD evre III + IV ) • Comprehensive PR programme in our center • Nutritionel Status:SGA • Exercise capacity: • Incremental Shuttle Walking Test (ISWT) • Endurance Shuttle Walking Test (ESWT) • Health releated quality of life :St. George Respiratory Questionary(SGRQ) • Measurement of dyspnea :Medical Research Council ( MRC)

  16. Demographics

  17. sga 33% of our patients were moderate to severe nourished

  18. Demographics

  19. MRC scores in Group II is higher than in Group I (r =0.363, P<0.05). SGA and Dyspnea Sensation n MRC

  20. SGA and Exercise Capacity *p>0.05

  21. SGA and Quality of Life *p>0.05

  22. DISCUSSION

  23. SGA is a common method for evaluating nutritional status in cronic diseases. Çiçek ve ark.Türk Anest Rean Der Dergisi 2007;35(1):51-56 İnanç BESLENME, 18(10): 52-56, 2006 Valentini ve ark.Nutrition 24(2008) 694-702 25-40% of severe COPD patients are malnourished ESPEN

  24. BMI,BIA,antropometric measurements, biochemical parameters are used for evalution of nutritional status. Relationship of PFT parameters, severity of COPD, severity of dyspnea Ulubay ve ark. Toraks Dergisi 2007;8(1):26-30 Coşkun ve ark. Solunum Hastalıkları 2005;16:153-160 Salepçi ve ark.Tüberkiloz ve Toraks Dergisi 2007;55(4):342-349 Deveci ve ark.Tüberkiloz ve Toraks Dergisi 2005;53(4):330-339 MWJ Schols Am. J. of Clin. Nutr., Vol. 82, No. 1, 53-59, July 2005

  25. COPD is a systemic disease with high malnutrition rates Negative effects of malnutrition could be reversed with treatment. SGA, is a method for screening nutritional status in COPD which is an important component of comprehensive PR programme CONCLUSİON

  26. “If we could give every individual the right amount of nourishment and exercise , not too little and not too much, we would have found the safest way to health’’ Hippocrates

  27. THANKS

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