COPDの運動効果を高める栄養療法

COPDの運動効果を高める栄養療法に関するレビュー論文を紹介します。

van de Bool C, Steiner MC, Schols AM. Nutritional targets to enhance exercise performance in chronic obstructive pulmonary disease. Curr Opin Clin Nutr Metab Care. 2012 Nov;15(6):553-60. doi: 10.1097/MCO.0b013e328358bdeb.

COPDでの筋肉量減少には、ビタミンD欠乏やBCAA濃度低下が関連している可能性があります。COPDに対する運動療法の有用性は確立していますが、栄養介入による身体機能の改善に関する明らかなエビデンスは不十分です。

1つのRCTでは、運動に不飽和脂肪酸を併用することで運動能力が改善しました。呼吸リハとクレアチンのサプリメントの併用は賛否両論です。グルタミン酸やグルタミンの長期使用に関する有用性は不明です。最近、筋肉量だけでなく内臓脂肪も栄養＋運動療法のターゲットとすべきだと言われています。

抄録しか読んでいないので詳細不明ですが、COPDの運動療法の効果を高める栄養療法のエビデンス構築が重要であることは確かです。ここはまさにリハ栄養の領域であり、日本からのさらなるエビデンス発信を期待したいところです。

Abstract

PURPOSE OF REVIEW:

This review presents current knowledge regarding the rationale and efficacy of nutrition as an ergogenic aid to enhance the effects of exercise and training in chronic obstructive pulmonary disease (COPD).

RECENT FINDINGS:

Altered body composition and skeletal muscle dysfunction in COPD suggest that exercise capacity can be targeted via several metabolic routes. Muscle metabolic alterations in COPD include a reduced oxidative metabolism and enhanced susceptibility for oxidative stress. Muscle wasting may be associated with deficiencies of vitamin D and low branched-chain amino acid levels. Exercise training is of established benefit in COPD but clear-cut clinical trial evidence to support the performance enhancing effect of nutritional intervention is lacking. One randomized controlled trial suggested that augmentation of training with polyunsaturated fatty acids may improve exercise capacity. Conflicting results are reported on dietary creatine supplementation in patients with COPD receiving pulmonary rehabilitation and results from acute intervention studies do not directly imply long-term effects of glutamate or glutamine supplementation as an ergogenic aid in COPD. Recent data indicate that not only muscle but also visceral fat may be an important additional target for combined nutrition and exercise intervention in COPD to improve physical performance and decrease cardiometabolic risk.

SUMMARY:

There is a clear need for adequately powered and controlled intervention and maintenance trials to establish the role of nutritional supplementation in the enhancement of exercise performance and training and the wider management of the systemic features of the disease.