Nutritional status, dietary intake, and health-related quality of life in outpatients with COPD

Figures & data

Table 1 Participant characteristics and malnutrition status

Variables	Total (n=168)	SGA-A (n=43)	SGA-B (n=70)	SGA-C (n=55)	P-value
Sociodemographic
Age (years), mean (SD)	63.9 (8.5)	61.9 (8.7)	64.2 (8.2)	65.0 (8.6)	0.188
Male, n (%)	151 (89.9)	35 (81.4)	64 (91.4)	52 (94.5)	0.086
Smoking status, n (%)
Active smoker	12 (7.1)	0 (0.0)	4 (5.7)	8 (14.5)	0.003
Ex-smoker	131 (78.0)	31 (72.1)	56 (80.0)	44 (80.0)
Nonsmoker	25 (14.9)	12 (27.9)	10 (14.3)	3 (5.5)
Smoking years, mean (SD)	30.8 (16.3)	23.3 (18.1)	31.0 (16.0)	36.5 (13.0)	<0.001
Disease condition
COPD stage, n (%)
GOLD 1 (mild)	14 (8.3)	5 (35.7)	6 (42.9)	3 (21.4)	0.039
GOLD 2 (moderate)	54 (32.1)	19 (35.2)	24 (44.4)	11 (20.4)
GOLD 3 (severe)	68 (40.5)	12 (17.6)	24 (35.3)	32 (47.1)
GOLD 4 (very severe)	32 (19.0)	7 (21.9)	16 (50.0)	9 (28.1)
Predicted FEV1%, mean (SD)	49.3 (23.1)	53.5 (19.4)	50.6 (26.8)	44.3 (19.9)	0.123
AECOPD,a mean (SD)	1.5 (2.2)	1.3 (1.7)	1.8 (2.9)	1.3 (1.2)	0.378
Anthropometry
BMI (kg/m^2), mean (SD)	20.0 (3.2)	23.5 (2.5)	20.4 (1.7)	16.7 (1.5)	<0.001
MAC (cm), mean (SD)	25.5 (2.8)	28.3 (1.9)	25.9 (1.8)	22.8 (2.0)	<0.001
TSF (mm), mean (SD)	10.1 (4.6)	14.9 (94.1)	10.2 (2.6)	6.2 (2.8)	<0.001
MAMC (cm), mean (SD)	22.3 (2.2)	23.6 (2.2)	22.7 (1.8)	20.9 (1.7)	<0.001
Weight (kg), mean (SD)	50.6 (8.9)	59.0 (7.9)	51.9 (5.9)	42.3 (4.9)	<0.001
Prevalence of weight loss, n (%)	137 (81.5)	30 (69.8)	55 (78.6)	52 (94.5)	0.005
Amount of weight loss in last 6 months (kg), mean (SD)	1.6 (2.4)	0.4 (1.7)	1.5 (2.3)	2.8 (2.4)	<0.001
Percentage of weight loss in last 6 months, mean (SD)	3.6 (5.1)	0.7 (3.0)	3.0 (4.6)	6.6 (5.5)	<0.001
Dietary intake
Number of daily meals, mean (SD)	2.8 (0.9)	3.3 (1.1)	2.6 (0.7)	2.7 (0.9)	<0.001
<3 meals per day, n (%)	45 (26.8)	4 (9.3)	24 (34.3)	17 (30.9)	<0.001
3 meals per day, n (%)	112 (66.7)	30 (69.8)	46 (65.7)	36 (65.5)
>3 meals per day, n (%)	11 (6.5)	9 (20.9)	0 (0.0)	2 (3.6)
Total EI, mean (SD)	1,305 (399)	1,371 (379)	1,322 (439)	1,233 (356)	0.215
Total protein intake, mean (SD)	51.6 (16.3)	54.8 (17.4)	52.3 (16.5)	48.1 (14.8)	0.121
EIb (kcal/kg/d), mean (SD)	26.4 (8.6)	23.5 (6.7)	25.8 (9.2)	29.3 (8.3)	0.003
PIc (g/kg/d), mean (SD)	1.04 (0.34)	0.94 (0.30)	1.02 (0.33)	1.15 (0.34)	0.008
%EER,d mean (SD)	74.8 (23.5)	78.4 (22.2)	73.7 (26.3)	73.3 (20.7)	0.508
%EPR,e mean (SD)	69.1 (22.7)	78.3 (25.3)	67.8 (22.3)	63.8 (19.0)	0.005
EER met, n (%)	24 (14.3)	8 (18.6)	10 (14.3)	6 (10.9)	0.558
EPR met, n (%)	25 (14.9)	9 (20.9)	7 (10.0)	9 (16.4)	0.282
QoL
SGRQ symptom score	54.9 (20.4)	50.3 (19.1)	54.3 (22.3)	59.3 (18.1)	0.086
SGRQ activity score	63.3 (28.5)	55.2 (26.7)	62.0 (32.8)	71.2 (21.8)	0.019
SGRQ impact score	38.2 (20.2)	31.7 (17.8)	36.8 (21.9)	44.9 (18.1)	0.004
SGRQ total score	48.6 (21.1)	41.9 (19.2)	47.4 (23.5)	55.4 (17.3)	0.006

a Notes: Number of acute exacerbations in the last 12 months; B/C, 1.5 g/kg body weight per day;

b EI per kg actual body weight;

c PI, protein intake per kg actual body weight;

d EER (30 kcal/kg body weight per day for SGA-A; 35–40 kcal/kg body weight per day for SGA-B/C);

e EPR (SGA-A: 1.2 g/kg body weight per day; SGA-B/C: 1.5 g/kg body weight per day). Boldface indicates statistical significance (P<0.05).

Abbreviations: AECOPD, acute exacerbations of COPD; BMI, body mass index; EER, estimated energy requirement; EI, energy intake; EPR, estimated protein requirement; GOLD, Global Initiative for Chronic Obstructive Lung Disease; MAC, mid-arm circumference; MAMC, mid-arm muscle circumference; QoL, quality of life; SGA, Subjective Global Assessment; SGRQ, St George Respiratory Questionnaire; TSF, triceps skinfold.

Table 2 Logistic regression model for predicting malnutrition

Variables	Block	P-value	Model	P-value	B	OR (95% CI)
Model fit	105.1	<0.001	119.8	<0.001
Variables
Age					0.026	1.03 (0.94–1.12)
Gender					−0.691	0.50 (0.04–6.07)
Smokea					0.043	1.04 (0.99–1.10)
AECOPDb					−0.136	0.87 (0.68–1.12)
FEV1%					0.010	1.01 (0.98–1.04)
%EERc					−0.28	0.97 (0.94–1.00)
N_meald					−1.69	0.18 (0.05–0.63)
BMI					−1.25	0.29 (0.18–0.47)

a Notes: Smoke: number of years smoking;

b number of exacerbations/year;

c percentage of EI compared to EERs;

d number of daily meals. Boldface indicates statistical significance (P<0.05).

Abbreviations: AECOPD, acute exacerbation of COPD; BMI, body mass index; EER, estimated energy requirement; EI, energy intake.

Table 3 Hierarchical regression model for prediction of QoL – total

Variables	R	R^2	Adjusted R^2	R^2 change	P-value	Unstandardized B	Standardized B
Block 1	0.205	0.042	0.025	0.042	0.069
Age						0.288	0.116
Gender						−8.76	−0.126
Smokea						0.057	0.045
Block 2	0.477	0.228	0.204	0.185	0.001
Age						0.410	0.165
Gender						−8.52	−0.122
Smoke						−0.003	−0.002
AECOPDb						2.65	0.270
FEV1%						−0.281	−0.307
Block 3	0.592	0.351	0.318	0.123	0.001
Age						0.420	0.169
Gender						−1.62	−0.023
Smoke						0.037	0.028
AECOPD						2.33	0.238
FEV1%						−0.295	−0.322
%EERc						−0.260	−0.290
N_mealsd						−3.61	−0.158
BMI						−0.322	−0.049

a Notes: Smoke: number of years smoking;

b number of exacerbations/year;

c percentage of EI compared to EERs;

d N_meals: number of daily meals. Boldface indicates statistical significance (P<0.05).

Abbreviations: AECOPD, acute exacerbation of COPD; BMI, body mass index; EER, estimated energy requirement; EI, energy intake; QoL, quality of life.

Figure S1 The relationship between nutritional status and QoL’s score (higher score indicates poorer QoL).

Abbreviations: QoL, quality of life; SGA, Subjective Global Assessment.

Table S1 Quality of life and related factors

Variables	Symptom	P-value	Activity	P-value	Impact	P-value	Total	P-value
Disease severity
GOLD 1	51.0 (27.0)	0.179	47.6 (34.4)	<0.001	34.1 (21.9)	0.017	40.9 (25.2)	0.001
GOLD 2	52.1 (23.0)		54.2 (30.1)		33.9 (21.7)		43.1 (23.3)
GOLD 3	54.9 (17.7)		65.2 (25.3)		37.9 (19.4)		49.1 (18.7)
GOLD 4	61.5 (16.8)		81.3 (19.1)		47.6 (16.0)		60.4 (14.9)
BMI categories
Underweight	57.6 (18.7)	0.124	71.6 (22.9)	0.066	44.7 (18.6)	0.031	55.2 (18.0)	0.038
Normal	55.2 (21.7)		59.5 (30.7)		35.3 (20.8)		46.0 (22.2)
Overweight	47.4 (18.4)		57.8 (30.4)		33.6 (19.9)		37.9 (21.8)
Obesity	67.6 (16.8)		64.1 (19.6)		37.8 (9.1)		50.8 (9.8)
Nutritional status
SGA-A	50.3 (19.1)	0.086	55.2 (26.7)	0.019	31.7 (17.8)	0.004	41.9 (19.2)	0.006
SGA-B	54.3 (22.3)		62.0 (32.8)		36.8 (21.9)		47.4 (23.5)
SGA-C	59.3 (18.1)		71.2 (21.8)		44.9 (18.1)		55.4 (17.3)
Total score	54.9 (20.4)	NA	63.3 (28.5)	NA	38.2 (20.2)	NA	48.6 (21.1)	NA

Abbreviations: BMI, body mass index; GOLD, Global Initiative for Chronic Obstructive Lung Disease; SGA, subjective global assessment; SGA-A, normal nutritional status; SGA-B, mild/moderate malnutrition; SGA-C, severe malnutrition.

Table S2 Hierarchical multiple regression for prediction of quality of life – symptoms

Variables	R	R^2	Adjusted R^2	R^2 change	P-value	Unstandardized B	Standardized B
Block 1	0.199	0.040	0.022	0.040	0.084
Age						0.402	0.167
Gender						−5.74	−0.085
Smokea						0.021	0.017
Block 2	0.448	0.201	0.176	0.161	0.001
Age						0.489	0.204
Gender						−5.16	−0.077
Smoke						−0.030	−0.024
Exacerbationb						3.09	0.327
FEV1%						−0.177	−0.201
Block 3	0.530	0.281	0.245	0.080	0.001
Age						0.531	0.221
Gender						0.991	−0.015
Smoke						0.017	0.013
Exacerbation						2.81	0.297
FEV1%						−0.205	−0.233
%EERc						−0.173	−0.199
N_mealsd						−3.98	−0.180
BMI						0.179	0.028

a Notes: Number of years smoking;

b number of attacks/year;

c percentage of EI compared to EERs;

d N_meals: number of daily meals. Boldface indicates statistical significance (P<0.05).

Abbreviations: BMI, body mass index; EER, estimated energy requirement; EI, energy intake.

Table S3 Hierarchical multiple regression for prediction of quality of life – activity

Variables	R	R^2	Adjusted R^2	R^2 change	P-value	Unstandardized B	Standardized B
Block 1	0.198	0.039	0.022	0.039	0.087
Age						0.452	0.135
Gender						−12.67	−0.134
Smokea						0.016	0.009
Block 2	0.486	0.236	0.213	0.197	0.001
Age						0.639	0.190
Gender						−12.76	−0.135
Smoke						−0.070	−0.040
Exacerbationb						2.80	0.211
FEV1%						−0.456	−0.369
Block 3	0.605	0.365	0.334	0.129	0.001
Age						0.660	0.196
Gender						−2.59	−0.027
Smoke						0.001	0.000
Exacerbation						2.34	0.177
FEV1%						−0.489	−0.395
%EERc						−0.361	−0.298
N_mealsd						−5.20	−0.168
BMI						0.123	−0.014

a Notes: Number of years smoking;

b number of attacks/year;

c percentage of EI compared to EERs;

d N_meals: number of daily meals. Boldface indicates statistical significance (P<0.05).

Abbreviations: BMI, body mass index; EER, estimated energy requirement; EI, energy intake.

Table S4 Hierarchical multiple regression for prediction of quality of life – impact

Variables	R	R^2	Adjusted R^2	R^2 change	P-value	Unstandardized B	Standardized B
Block 1	0.187	0.035	0.017	0.035	0.118
Age						0.152	0.064
Gender						−7.21	−0.108
Smokea						0.093	0.075
Block 2	0.408	0.167	0.141	0.132	0.001
Age						0.243	0.102
Gender						−6.90	−0.103
Smoke						0.045	0.036
Exacerbationb						2.39	0.255
FEV1%						−0.204	−0.232
Block 3	0.512	0.262	0.225	0.095	0.001
Age						0.238	0.100
Gender						−1.81	−0.027
Smoke						0.064	0.052
Exacerbation						2.15	0.229
FEV1%						−0.202	−0.230
%EERc						−0.223	−0.259
N_mealsd						−2.50	−0.114
BMI						0.590	−0.093

a Notes: Number of years smoking;

b number of attacks/year;

c percentage of EI compared to EERs;

d N_meals: number of daily meals. Boldface indicates statistical significance (P<0.05).

Abbreviations: BMI, body mass index; EER, estimated energy requirement; EI, energy intake.