低栄養のCOPD患者に対する栄養療法＋低強度運動療法

今日は、低栄養のCOPD患者に対する栄養療法＋低強度運動療法の論文を紹介します。日本からこのような論文が世界に発信されるのは嬉しいことです。

Sugawara K et al: Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD. RespiratoryMedicine(2010),doi:10.1016/j.rmed.2010.05.008

結論としては、低栄養のCOPD患者に対する、12週間の栄養療法＋低強度運動療法は、体重増、エネルギー摂取量増、呼吸機能改善、大腿四頭筋筋力改善、6分間歩行距離改善、QOL改善、CRP改善、IL-6、IL-8、TNF-α低下につながるというランダム化比較試験です。ややよくなりすぎな感じもしますが…。

栄養療法は1日400ml、400kcalの栄養剤を経口摂取です。特徴はn-3系多価不飽和脂肪酸を0.6g、ビタミンAを248μg含んでいることです。

COPDに対するリハの有用性は十分エビデンスがありますが、それにEPAを含めた栄養療法を併用することで、全身炎症が軽減し、より改善を期待できるといえます。

COPDの低栄養患者のかなりが悪液質ですので、単なる飢餓でなく悪液質の場合には、エネルギー摂取量を増やすだけでなく、EPAを含む栄養剤もしくはEPA製剤（エパデールなど）を投与したほうがよいと考えます。

Abstract
STUDY OBJECTIVES: The first aim of this study was to investigate the effects of nutritional supplementation combined with low-intensity exercise on body components, exercise tolerance, and health-related quality of life (HRQOL) in malnourished patients with COPD. The second aim of this study was to examine the degree of systemic inflammation and the actual changes in levels of systemic CRP, TNFalpha, IL-6 and IL-8 actual changes after a combination of nutritional supplementation and low-intensity exercise in these patients. DESIGN: A prospective randomized trial. PATIENTS: Thirty-two moderate to severe, clinically stable malnourished COPD patients.

METHODS: Patients were randomly divided into a nutritional supplementation with low-intensity exercise group and a control group. Lung function, maximum inspiratory and expiratory muscle force, the Chronic Respiratory Disease Questionnaire (CRQ), the 6-min walking distance (6MWD), and the Borg scale were measured at baseline and were re-assessed at 3 months after intervention. The degree of systemic inflammation and the changes in levels of systemic CRP, TNFalpha, IL-6 and IL-8 were assessed before and after a combination nutritional supplementation with low-intensity exercise.

RESULTS: Body weight and FFM increased significantly after 12 weeks of nutritional supplementation therapy in patients with COPD. The dietary intake energy increased and the REE:REEpred ratio decreased significantly in the nutrition with low-intensity exercise group. PI(max), Quadriceps muscle force and the 6-min walking distance (6MWD) increased significantly from baseline through week 12. Health status, as assessed by CRQ, improved in the domains of dyspnea and total sores significantly in the nutrition with low-intensity exercise group after intervention. In this group, hsCRP, IL-6, IL-8, and TNFalpha, decreased significantly after intervention compared with the control group.

CONCLUSIONS: The combination of nutritional supplementation with low-intensity exercise training was successful in increasing weight and energy intake as well as exercise capacity and health-related QOL in our patients. Moreover, REE and major inflammatory cytokines decreased significantly after nutritional supplementation with low-intensity exercise training. The present study results suggest a potential role for the combination of nutritional supplementation and low-intensity exercise in the management of malnourished patients with COPD.