COPDのMNA、身体組成、入院

COPDのMNA、身体組成、入院に関する論文を紹介します。

Barbara Benedik, Jerneja Farkas, Mitja Kosnik, Sasa Kadivec, Mitja Lainscak: Mini nutritional assessment, body composition, and hospitalisations in patients with chronic obstructive pulmonary disease. Respiratory Medicine Volume 105, Supplement 1, October 2011, Pages S38-S43. doi:10.1016/S0954-6111(11)70009-9

108人のCOPD患者と22人の健常者で、MNA、身体組成、入院割合を比較しています。MNA点数はCOPD患者で有意に低く（27.0±1.7 vs 21.2±4.9)、GOLDステージと相関して点数が悪化し、14％が低栄養、55％が低栄養の恐れありでした。MNAと体脂肪量、除脂肪体重に正の相関を認めました。

6か月のフォローアップ期間にCOPD患者のうち45人（41％）が入院しています。低栄養患者は単変量解析でも多変量解析でも調査後6カ月以内の入院が多かったです。以上よりCOPDでは低栄養や低栄養の恐れありが多く、6か月後の入院を独立して予測する因子と結論付けています。

何度か同じことを書いていますが、日本で同じ研究をすればCOPDで低栄養や低栄養の恐れありと判定される割合はより高くなると推測します。また、この論文程度の観察研究であれば実現可能性が低くないので、ぜひ日本でもどなたかに似たような臨床研究を実践して発表してほしいなあと思います。

Summary
Background
Limited information is available about Mini Nutritional Assessment (MNA) questionnaire in patients with chronic obstructive pulmonary disease (COPD). We have conceived this analysis to study the associations between MNA questionnaire, body composition, and rehospitalisations in patients with COPD.
Methods
This prospective study recruited control subjects and COPD patients for pulmonary function testing, nutritional assessment using MNA questionnaire, body composition measurement, and dyspnoea evaluation. We recorded hospitalisations during 6 months after discharge.
Results
Our sample included 22 healthy controls (71 ±5 years, 59% men) and 108 COPD patients (71 ±10 years, 75% men, 85% severe or very severe COPD). MNA score was significantly higher in control subjects than in COPD patients (27.0±1.7 vs 21.2±4.9, p,0.001). MNA score decreased over GOLD stage (p = 0.02) and indicated malnutrition in 14% of patients, and further 55% were at risk of malnutrition. Body mass index but not body composition parameters was higher in control subjects when compared to COPD patients (29.1±3.8 vs 27.0±6.3, p = 0.041). A positive correlation between MNA score, body fat content (p = 0.001), and lean body mass (p<0.001) was observed. During follow-up, 45 (41%) patients were rehospitalised. Malnourished patients had higher risk of rehospitalisation in univariate analysis (HR 2.62, 95%Cl 1.13-6.07), which was maintained in an adjusted model (HR 2.93, 95%CI 1.05-7.32).
Conclusions
Malnutrition and risk of malnutrition was frequent, associated with lower body fat mass and lean body mass, and independently predicted hospitalisations at six months.