Routine malnutrition screening for COPD patients ‘vital’: Vietnam study

By Nathan GRAY

- Last updated on GMT

Malnutrition is very common among COPD patients in Vietnam. ©iStock
Malnutrition is very common among COPD patients in Vietnam. ©iStock

Related tags: Nutrition

Researchers in Vietnam have argued that routine screening of chronic obstructive pulmonary disease (COPD) patients could avoid the development of malnutrition and its associated risks, costs and complications.

The research, published in the Journal of Human Nutrition and Dietetics,​ investigated the incidence of malnutrition in outpatients with COPD in Vietnam, while also assessing the usefulness of common methods for identifying malnutrition in that group.

Led by senior author Peter Collins from Queensland University of Technology in Australia, the team performed a cross-sectional pilot study in addition to a larger retrospective study, which together showed that malnutrition is very common among COPD patients in Vietnam and that new ways of identifying and easily screening patients are needed.

“Within the larger retrospective cohort, malnutrition was found to be a common clinical problem, with half of all patients assessed found to be at nutritional risk,”​ Collins and colleagues reported – adding that a similar prevalence (45%) was found within the smaller prospective cohort when full nutritional assessment was completed.

Furthermore, they reported strong relationships between muscle wasting, malnutrition and BMI. Indeed, all patients with a BMI of less than 21 were considered to have muscle depletion, the team said.

“As a result of the wasting nature of the disease, simple nutritional screening tools that do not include an assessment of body weight or BMI may not be able to identify all of those who are at risk,”​ they warned.

BMI: A simple solution?

“In light of the findings of the present study, as well as the current American Thoracic Society and European Respiratory Society's recommendation of a BMI cut-off of less than 21 kg m–2​, this would appear to be a simple and pragmatic means of highlighting those who are at nutritional risk and require further nutritional assessment by a trained individual,” ​commented Collins and his team.

However, the Australian researchers also conceded that since Vietnam is a country that is going through socio-economic transition – and experiencing concurrent states of under-nutrition and growing levels of over-nutrition – “it is likely that the sensitivity of BMI as a screening method for malnutrition is reduced with increasing body fat.”

As a result, they warn that while it is more likely that a comprehensive assessment of fat-free mass may be needed in the future, but added that the use of a threshold BMI of 21 for the screening of COPD patients remains vital to reducing malnutrition.

“The present study is the first to assess the utility of commonly used nutritional screening and assessment methods with the aim of identifying malnutrition in Vietnamese COPD outpatients,”​ Collins et al​ said.

“Given the clinical significance of malnutrition in COPD, and the fact that, if it is identified, it is amenable to treatment, consideration of nutrition screening methods is imperative,”​ they argued.

 

Source: Journal of Human Nutrition and Dietetics

Published online ahead of print, doi: 10.1111/jhn.12402

“Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease”

Authors: D. Hogan, et al

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