Nutritional status, vulnerability and disability in COPD patients

This study will take place in the Netherlands.

Frailty is a strong predictor for the adverse clinical outcome of disability. 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 a chronic obstructive pulmonary disease. The secondary objective is to explore adaptive strategies for dietary challenges in patients with chronic obstructive pulmonary disease, and thus identify predictors of dietary resilience, and dietary resiliency subsequently.

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 a chronic obstructive pulmonary disease. The secondary objective is to explore adaptive strategies for dietary challenges in patients with chronic obstructive pulmonary disease, and thus identify predictors of dietary resilience, and dietary resiliency subsequently.

Patients will be assessed 3 times during their 9 weeks of rehabilitation (begin, middle and end) and 4 times in follow-up setting (3 months, 6 months, one year and two years after finishing the rehabilitation program)

The following measures (tests and questionnaires) will be performed on every occasion: 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.

This study will be conducted in adult patients with chronic obstructive pulmonary disease following a rehabilitation program of 9 weeks. The sample will be stratified according to nutritional status classified by PG-SGA category A, B or C (classification A (well nourished), B (moderately malnourished or risk for malnutrition) or C (severely malnourished) to assure an adequate level of distribution in the domain of malnutrition in the study population.