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. 2015 Sep-Oct;41(5):415-21.
doi: 10.1590/S1806-37132015000000040.

Sarcopenia in COPD: relationship with COPD severity and prognosis

[Article in English, Portuguese]
Tatiana Munhoz da Rocha Lemos Costa  1 , Fabio Marcelo Costa  1 , Carolina Aguiar Moreira  1 , Leda Maria Rabelo  1 , César Luiz Boguszewski  1 , Victória Zeghbi Cochenski Borba  1
Affiliations

Sarcopenia in COPD: relationship with COPD severity and prognosis

[Article in English, Portuguese]
Tatiana Munhoz da Rocha Lemos Costa et al. J Bras Pneumol. 2015 Sep-Oct.

Abstract
in English, Portuguese

Objective: To evaluate the prevalence of sarcopenia in COPD patients, as well as to determine whether sarcopenia correlates with the severity and prognosis of COPD.

Methods: A cross-sectional study with COPD patients followed at the pulmonary outpatient clinic of our institution. The patients underwent dual-energy X-ray absorptiometry. The diagnosis of sarcopenia was made on the basis of the skeletal muscle index, defined as appendicular lean mass/height2 only for low-weight subjects and adjusted for fat mass in normal/overweight subjects. Disease severity (COPD stage) was evaluated with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. The degree of obstruction and prognosis were determined by the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) index.

Results: We recruited 91 patients (50 females), with a mean age of 67.4 ± 8.7 years and a mean BMI of 25.8 ± 6.1 kg/m2. Sarcopenia was observed in 36 (39.6%) of the patients, with no differences related to gender, age, or smoking status. Sarcopenia was not associated with the GOLD stage or with FEV1 (used as an indicator of the degree of obstruction). The BMI, percentage of body fat, and total lean mass were lower in the patients with sarcopenia than in those without (p < 0.001). Sarcopenia was more prevalent among the patients in BODE quartile 3 or 4 than among those in BODE quartile 1 or 2 (p = 0.009). The multivariate analysis showed that the BODE quartile was significantly associated with sarcopenia, regardless of age, gender, smoking status, and GOLD stage.

Conclusions: In COPD patients, sarcopenia appears to be associated with unfavorable changes in body composition and with a poor prognosis.

Objetivo:: Avaliar a prevalência de sarcopenia em pacientes com DPOC e determinar se sarcopenia está correlacionada com a gravidade e o prognóstico de DPOC.

Métodos:: Estudo retrospectivo em pacientes com DPOC atendidos no ambulatório de pneumologia de nossa instituição. Os pacientes realizaram absorciometria de dupla energia por raios X. O diagnóstico de sarcopenia foi baseado no índice de massa muscular esquelética, definido como massa magra apendicular/altura2 somente para indivíduos com baixo peso, sendo ajustado pela massa gorda para aqueles com peso normal/sobrepeso. A gravidade da doença (estádio da DPOC) foi avaliada com os critérios da Global Initiative for Chronic Obstructive Lung Disease (GOLD). O grau de obstrução e o prognóstico foram determinados pelo índice Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE).

Resultados:: Foram incluídos 91 pacientes (50 mulheres), com média de idade de 67,4 ± 8,7 anos e média de IMC de 25,8 ± 6,1 kg/m2. Sarcopenia foi diagnosticada em 36 (39,6%) dos pacientes, sem diferenças relacionadas a sexo, idade ou status tabágico. Não houve associação de sarcopenia com estádios GOLD ou VEF1 (utilizado como indicador do grau de obstrução). O IMC, a porcentagem de gordura corporal e a massa magra total foram menores nos pacientes com sarcopenia do que naqueles sem a doença (p < 0,001). A prevalência de sarcopenia foi maior nos pacientes com BODE nos quartis 3 ou 4 que naqueles com BODE nos quartis 1 ou 2 (p = 0,009). A análise multivariada mostrou que os quartis do BODE estavam significativamente associados à sarcopenia, independentemente de idade, gênero, status tabágico e estádio GOLD.

Conclusões:: Em pacientes com DPOC, sarcopenia parece estar associada a alterações desfavoráveis na composição corporal e pior prognóstico.

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Figures

Figure 1.
Figure 1.. Number of patients with sarcopenia, by BMI, depending on the set of criteria used for the diagnosis: (left) the criteria by Baumgartner et al.(16) in all patients; (center) the criteria by Newman et al.(17) in all patients; and (right) the criteria by Baumgartner et al.(16) for patients with a BMI < 22 kg/m2 and the criteria by Newman et al.(17) for patients with a BMI ≥ 22 kg/m2.
Figure 2.
Figure 2.. Prevalence of sarcopenia, diagnosed with dual-energy X-ray absorptiometry, among COPD patients (N = 91), by COPD severity (GOLD stage, in A) and degree of obstruction (FEV1, in B). Sarcopenia did not correlate significantly with GOLD stage (p = 0.305) or FEV1 (p = 0.599). Degree of obstruction (FEV1): Mild (≥ 80%); Moderate (50-79%); Severe (30-49%); and Very severe (< 30%).
Figure 3.
Figure 3.. Proportion of patients diagnosed with sarcopenia by densitometry according to the quartiles of the Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE) prognostic index, grouped by quartile (in A) and pooled (in B) into a less severe group (quartiles 1 and 2) and a more severe group (quartiles 3 and 4).
Figura 1.
Figura 1.. Número de pacientes com sarcopenia, segundo o IMC, dependendo do conjunto de critérios utilizado para o diagnóstico: (à esquerda) os critérios de Baumgartner et al.(16) em todos os pacientes; (no centro) os critérios de Newman et al.(17) em todos os pacientes; e (à direita) os critérios de Baumgartner et al.(16) para pacientes com IMC < 22 kg/m2 e os critérios de Newman et al.(17) para pacientes com IMC ≥ 22 kg/m2.
Figura 2.
Figura 2.. Prevalência de sarcopenia, diagnosticada por absorciometria de dupla energia por raios X, entre os pacientes com DPOC ((N = 91), segundo a gravidade da DPOC (estádios GOLD, em A) e o grau de obstrução (VEF1, em B). Não houve correlação significativa da sarcopenia com os estádios GOLD (p = 0,305) ou o VEF1 (p = 0,599). Grau de obstrução (VEF1): Leve (≥ 80%); Moderado (50-79%); Grave (30-49%); e Muito grave (< 30%).
Figura 3.
Figura 3.. Proporção de pacientes com diagnóstico densitométrico de sarcopenia de acordo com os quartis do índice prognóstico Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity (BODE), agrupados por quartil (em A) e reunidos (em B) em grupo menos grave (quartis 1 e 2) e grupo mais grave (quartis 3 e 4).
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