Tumour necrosis factor-alpha and weight loss in chronic obstructive pulmonary diseases (PDF)

Master's Thesis from the year 2001 in the subject Medicine - Neoplasms, Oncology, , language: English, abstract: Weight loss is a common feature in patients with chronic obstructive pulmonary disease (COPD). The clinical importance of weight loss; particularely loss of fat-free mass (FFM) has been demonstrated in its adverse effects on physical performance and quality of life. Moreover; weight loss and a low body weight are unfavorable prognostic factors in survival, independent of lung function.

Mechanisms of malnutrition in those patients are not fully understood. Several factors have been implicated. Increased resting energy expenditure (REE) contributes the main hypothesis for weight loss in COPD patients. However, not all patients with COPD who lose weight are hypermetabolic.

Recent data have shown that a systemic inflammatory response is present in patients with COPD. A clear evidence for a relationship between weight loss and plasma tumour necrosis factor-alpha (TNF-*) has been shown in COPD patients. TNF-* produces a cachexia-like syndrome in animal models and has been implicated as a mediator of cachexia in several clinical conditions including cancer, chronic heart failure, cystic fibrosis and anorexia nervosa.

Nutritional assessment for COPD patients is essential; to identify those individuals who will benifit from nutritional support therapies and to determine baseline values to measure the effectiveness of nutritional intervention. It includes several methods, no simple recommendation can be given regarding the best method for nutritional assessment.

Because of the negative impact of malnutrition on the respiratory system in COPD patients, contributing to morbidity and mortality; it's valuable to include management strategies that increase energy balance in order to increase weight and fat-free mass in those malnourished COPD patients.

The aim of this study is to determine the most valuable measurements to assess the nutritional status of COPD patients; as regards the anthropometric measurements, the somatic and visceral proteins and markers of inflammation; and to evaluate the correlation between serum TNF-* levels and weight loss among those patients; as a trial to improve their clinical prognosis and quality of life.