Disease-related Malnutrition, Frailty and Disability:
Relations and Clinical Outcome in COPD patients

Frailty is considered to be a clinical state in which there is an increase in
an individual*s vulnerability for developing increased dependency and/or
mortality when exposed to a stressor (Morley, Vellas et al. 2013). Frailty is a
strong predictor for the adverse clinical outcome of disability. This is an
individual problem, but also very relevant to society; people are getting older
but not necessarily in an independent and healthy way. The complex interactions
between factors of the multidimensional and dynamic concept of frailty remain
to be clarified (de Vries, Staal et al. 2011).
Since malnutrition has such an impact on physical performance, frailty and
malnutrition are suspected to correlate firmly. Knowing in what way these
conditions influence each other is extremely important in achieving to revolve
the process of becoming frail and disable.

The main objective of this study is to investigate whether changes in
nutritional status correlate to changes in frailty status, and whether these
changes impact on disability as a clinical outcome in patients with chronic
obstructive pulmonary disease. The secondary objective is to explore adaptive
strategies for dietary challenges in chronically ill patients, and thus
predictors of dietary resilience, and dietary resiliency subsequently.

For this study (quantitative and qualitative research), an exploratory
longitudinal study design is used.

Patients will be assessed during rehabilitation at the UMCG-rehabilitation
center. In this longitudinal design, patients will be assessed 3 times during
their rehabilitation and 4 times in follow-up setting.
The following tests and questionnaires will be used: body weight, length,
accelerometer, mid upper arm circumference and triceps skinfold, bio-electrical
impedance analysis (including vector analysis), muscle ultrasound scan,
handgrip strength, gait speed, Short Physical Performance Battery, muscle tone,
PG-SGA, MNA, EFIP, GFI, Fried*s criteria, WHODAS 2.0, food diary. The burden of
these study measurements is minimal (about 70 minutes per study measurement at
the UMCG-rehabilitation center and 45 minutes in preparation). The risks of
these measurements are negligible. In the qualitative study, duration of the in
depth interviews is 60 min. at maximum.