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Vol. 45. Núm. S4.
EPOC y comorbilidad: una visión global
Páginas 31-35 (Marzo 2009)
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Vol. 45. Núm. S4.
EPOC y comorbilidad: una visión global
Páginas 31-35 (Marzo 2009)
DOI: 10.1016/S0300-2896(09)72861-3
Acceso a texto completo
EPOC y malnutrición
COPD disease and malnutrition
Visitas
...
Ciro Casanova Macarioa,??
Autor para correspondencia
casanovaciro@gmail.com

Autor para correspondencia.
, Juan Pablo de Torres Tajesb, María Ángeles Martín Palmeroc
a Servicio de Neumología, Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, España
b Servicio de Neumología, Clínica Universitaria de Navarra, Pamplona, Navarra, España
c Unidad de Nutrición Clínica, Servicio de Endocrinología y Nutrición, Hospital de San Pedro, Logroño, La Rioja, España
Información del artículo
Resumen

La pérdida de peso y la desnutrición relacionadas, fundamentalmente, con la pérdida de la masa magra pueden aparecer en estadios avanzados de la enfermedad pulmonar obstructiva crónica (EPOC) y constituyen un exponente claro de su heterogeneidad fenotípica. Su presencia está asociada a un peor pronóstico, independientemente del volumen espiratorio forzado durante el primer segundo. Los umbrales de riesgo más aceptados son 21 para el índice de masa corporal (IMC), y para el IM libre de grasa (IMLG) 17 y 14 para varones y mujeres, respectivamente. La coexistencia de ambos define la situación de mayor gravedad nutricional (caquexia). No obstante, una disminución del IMLG es un factor de riesgo independiente, aunque no superior a un BMI bajo. Por ello, aunque la obtención del IMLG por impedancia bioeléctrica es fiable y relativamente fácil de obtener, nosotros recomendamos la realización de esta prueba sólo en los casos de EPOC con peso bajo (IMC < 21), junto con una evaluación nutricional más específica.

En la actualidad, carecemos de estudios longitudinales que nos aporten datos sobre el comportamiento del IMC dentro de la evolución natural de la enfermedad. Además, no hay evidencias científicas sólidas que nos confirmen cuáles son los principales mecanismos de la desnutrición en la EPOC. Esto explica la dificultad del manejo terapéutico de estos pacientes, el cual no ha mostrado avances en las últimas décadas. No obstante, con la evidencia actual, en los pacientes con caquexia, parece razonable iniciar un tratamiento nutricional individualizado en combinación con programas de rehabilitación pulmonar (ejercicio). Son necesarios nuevos estudios que permitan avanzar en el conocimiento de la fisiopatología, y sobre el papel que pueden desempeñar otras opciones terapéuticas (hormonas, antiinflamatorios) en la desnutrición de los pacientes con EPOC.

Palabras clave:
EPOC
Desnutrición
Abstract

Weight loss and malnutrition related mainly to lean mass loss can develop in advanced stages of chronic obstructive pulmonary disease (COPD) and are a clear indication of phenotypic heterogeneity. The presence of weight loss and malnutrition is associated with a worse prognosis, independently of forced expiratory volume in 1 second (FEV1).

The most widely accepted thresholds for risk are 21 for the body mass index (BMI) and 17 and 14 for men and women, respectively, for the fat-free mass index (FFMI). The coexistence of both defines a situation of greater nutritional risk (cachexia). Nevertheless, a reduction in FFMI is an independent risk factor, although not superior to a low BMI. Therefore, although obtaining FFMI by bioelectric impedanciometry is reliable and relatively easy, we recommend the use of this procedure only in patients with COPD and low weight (BMI < 21), together with more specific nutritional evaluation.

Currently, longitudinal studies providing data on the behavior of BMI within the natural course of the disease are lacking. Moreover, there is no solid scientific evidence that confirms the main mechanisms of malnutrition in COPD. This lack of evidence explains the difficulty of the therapeutic management of these patients, which has not advanced in the last few decades. Nevertheless, current evidence suggests that initiating individually-tailored nutritional treatment combined with pulmonary rehabilitation programs (exercise) is reasonable in patients with cachexia. Further studies are required to provide greater insight into the physiopathology and the role of other therapeutic options (hormones, antiinflammatory drugs) in malnutrition in patients with COPD.

Keywords:
COPD
Malnutrition
El Texto completo está disponible en PDF
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