Chronic obstructive pulmonary disease, Fat-free mass index, 6-minute walk test, Smoking
Citation Information :
Agrawal A, Singh K, Kharb S, Kaur J. Study the Association of Fat-free Mass Index with Disease Severity in COPD Patients by Conducting 6-minute Walk Test. Indian J Chest Dis Allied Sci 2023; 65 (2):103-108.
Background: Chronic obstructive pulmonary disease (COPD) is a disabling and often a progressive disease with multiple systemic effects, which is associated with limited functional capacity, impaired health status, depression, poor prognosis, and high risk of mortality. It has been cited that fat-free mass present in the skeleton muscle responsible for limitation in daily activities as well as exercise capacities.
Aim and objectives: Study to assess the correlation of fat-free mass index (FFMI) with disease severity in COPD patients by conducting 6-min walk test (6MWT).
Methods: A case–control, multi-group study designed with 150 subjects. Comprises in three groups—G1: 50 COPD patients; G2a: 50 apparently healthy smokers; and G2b: healthy nonsmokers. Pulmonary function test (PFT), 6MWT, and FFMI were conducted in all study subjects. Fat-free mass index measured by the bioelectrical impedance method. Chi-square/Fischer exact test, the Student t-test, and the Pearson correlation test were used to analyze data. p-value of < 0.05 was considered as statistically significant.
Results: Fat-free mass index was significantly low among COPD subjects (14.41 ± 3.07) compared to healthy nonsmokers [15.89 ± 1.53 kg/m2; p = 0.003, odd ratio 7.58 (CI 3.112,19.56)]. Fat-free mass index has robust and significant positive correlation (r = 0.440; p = 0.001) with 6MWT in COPD patients. The Modified Medical Research Council Dyspnea score was found to have significant inverse relation with the fat-free mass in COPD patients.
Conclusion: The study indicates that decrement in FFMI is significantly associated with risk of dyspnea and fatigability among COPD patients on physical activity compared with healthy control.
Clinical significance: The study highlights that decrement in physical activity among COPD patients is due to loss of fat-free mass at significant level compared to healthy people, hence nutritional support as well as physical exercise is equally important as bronchodilator therapy in treatment plan.
Singh D, Agusti A, Anzueto A, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD Science Committee Report 2019. Eur Respir J 2019;53(5):1900164. DOI: 10.1183/13993003.00164-2019.
Luo Y, Zhou L, Li Y, et al. Fat-free mass index for evaluating the nutritional status and disease severity in COPD. Am J Respir Care 2016;61(5):680–688. DOI: 10.4187/respcare.04358.
Maltais F, Decamer M, Casaburi R, et al. An official American Thoracic society/European Respiratory Society Statement: Update on limb muscle dysfunction in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2014;189(9):e15–62. DOI: 10.1164/rccm.201402-0373ST.
Vestbo J, Prescott E, Almdal T, et al. Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: Findings from the Copenhagen City Heart Study. Am J Respire Crit Care Med 2006;173(1):79–83. DOI: 10.1164/rccm.200506-969OC.
Caram LM, Ferrari R, Bertani AL, et al. Smoking and early COPD as independent predictors of body composition, exercise capacity, and health status. PLoS One 2016;13;11(10):e0164290. DOI: 10.1371/journal.pone.0164290.
Degens H, Gayan–van Hees HW. Smoking induced skeletal muscle dysfunction: from, evidence to mechanism. Am J Respir Crit Care Med 2015;191(6):620–625. DOI: 10.1164/rccm.201410-1830PP.
Ischaki E, Papatheodorou G, Gaki E, et al. Body mass and fat-free mass indices in COPD: Relation with variable expressing disease severity. Chest 2007;132(1):164–169. DOI: 10.1378/chest.06-2789.
Teopompi E, Tzani P, Aiello M, et al. Fat free mass depletion is associated with poor exercise capacity irrespective of dynamic hyperinflation in COPD patient. Respir Care 2014;59(5):718–725.
Matkovic Z, Cvetko D, Rahelic D, et al. Nutritional status of patients with chronic obstructive pulmonary disease in relation to their physical performance. COPD 2017;14(6):626–634. DOI: 10.1080/15412555.2017.1386643.
Frisk B, Espehaug B, Hardie JA, et al. Physical activity and longitudinal change in 6min walk distance in COPD patients. Respir Med 2014;108(1):86–94. DOI: 10.1016/j.rmed.2013.09.004.
Sabino PG, Silva BM, Brunetto AF. Nutritional status is related to fat free, mass, exercise capacity and inspiratory strength in severe COPD patient. Clinics 2010;65(6):599–605. DOI: 10.1590/S1807-59322010000600007.
Schols AM, Broekhuizen R, Weling-Scheepere CA, et al. Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 2005;82:53–59. DOI: 10.1093/ajcn.82.1.53.
Creutberg EC, Wouters EF, Mostert R, et al. Efficiency of nutritional supplementation therapy in depleted patient with chronic obstructive pulmonarydisease. Nutrition 2003;19(2)120–127. DOI: 10.1016/s0899-9007(02)00841-9.
ATS Committee on Proficiency Standards of Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for six minute walk test. Am J Respir Crit Care Med 2002;166(1)111–117. DOI: 10.1164/ajrccm.166.1.at1102.
Waschki B, Kirsten AM, Holz O, et al. Disease progression and changes in physical activity in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015;192(3):295–306. DOI: 10.1164/rccm.201501-0081OC.
Gologanu D, Ionita D, Gartonea T, et al. Body composition in patients with chronic obstructive pulmonary disease. Maedica (Buchar) 2014;9(1):25–32.
Hopkinson NS, Tennant RC, Dayer MJ, et al. A prospective study of decline in fat free mass and skeletal muscle strength in chronic obstructive pulmonary disease. Respir Res 2007;8(1):25. DOI: 10.1186/1465-9921-8-25.
Agrawal SR, Joshi R, Jain A. Correlation of severity of chronic obstructive pulmonary disease with health-related quality of life and six-minute walk test in a rural hospital of central India. Lung India 2015;32(3):233–240. DOI: 10.4103/0970-2113.156231.
Emtner M, Hallin R, Arnardottir RH, et al. Effect of physical training on fat-free mass in patients with chronic obstructive pulmonary disease (COPD). Ups J Med Sci 2015;120(1):52–58. DOI: 10.3109/03009734.2014.990124.
Yang L, Zhu Y, Huang JA, et al. A low lean-to-fat ratio reduces the risk of acute exacerbation of chronic obstructive pulmonary disease in patients with a normal or low body mass index. Med Sci Monit 2019;25:5229–5236. DOI: 10.12659/MSM.914783.