Mid-arm muscle area is a better predictor of mortality than body mass index in COPD

Abstract

Background: A low body mass index (BMI) has been shown to be an independent indicator of poor prognosis in patients with COPD. However, some studies suggest that muscle mass depletion (MD) is the main factor responsible for the negative effects attributable to malnutrition.

Study objective: To evaluate the prognostic influence of MD estimated from anthropometric parameters.

Design and measurements: Mortality was studied in a prospective cohort of 96 male patients with COPD (average age, 69 +/- 9 years; FEV1 percentage of predicted, 44 +/- 18% [ +/- SD]) followed up for 3 years, with an evaluation of the prognostic influence of the following anthropometric parameters: BMI, mid-arm muscle area (MAMA), and fat-free mass index. Other risk factors were also analyzed, such as age, comorbidity (Charlson index), basal dyspnea index, the St. George's Respiratory Questionnaire score, the number of hospital admissions in the year prior to nutritional evaluation, the number of hospital admissions in the year immediately after nutritional evaluation (Hpost), spirometry, and blood gases.

Results: In the multivariate study, Pa(CO2) (p = 0.003; hazard ratio, 1.08), Hpost (p = 0.005, hazard ratio, 4.63), and a MAMA value less than or equal to percentile 25 of the reference value (p25) [p = 0.025; hazard ratio, 3.78] were found to be independent indicators of poor prognosis. Respiratory mortality after 12, 24, and 36 months in the patients with MAMA < or = p25 was 12.1%, 31.4%, and 39.2%, respectively, vs 5.9%, 7.9%, and 13% in the group of patients without MD (p = 0.006). In normal-weight or overweight patients, MAMA < or = p25 increased the risk of mortality 3.4-fold (p = 0.032).

Conclusions: MD is a better predictor of mortality than BMI in patients with COPD, fundamentally in normal-weight or overweight patients. The prognostic influence of MD can be estimated indirectly by determining the MAMA, an inexpensive, simple, and rapidly obtained anthropometric measure.