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      Anthropometric status of individuals with COPD in the city of São Paulo, Brazil, over time - analysis of a population-based study Translated title: Análise evolutiva antropométrica em indivíduos com DPOC na cidade de São Paulo - estudo de base populacional

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          ABSTRACT

          Objective:

          To evaluate the anthropometric data obtained for residents of the city of São Paulo, Brazil, in a study of Latin America conducted in two phases (baseline, in 2003, and follow-up, in 2012).

          Methods:

          This was an analysis of data obtained for São Paulo residents in a two-phase population-based study evaluating the prevalence of COPD and its relationship with certain risk factors among individuals ≥ 40 years of age. The anthropometric data included values for weight, height, body mass index (BMI), and waist circumference. In the follow-up phase of that study, the same variables were evaluated in the same population sample as that of the baseline phase.

          Results:

          Of the 1,000 São Paulo residents enrolled in the baseline phase of that study, 587 participated in the follow-up phase, and 80 (13.6%) of those 587 subjects had COPD. Comparing the baseline and follow-up phases, we found increases in all anthropometric measures in both groups (COPD and non-COPD), although the differences were significant only in the non-COPD group. The subjects with mild COPD showed increases in weight and BMI (Δweight = 1.6 ± 5.7 and ΔBMI = 0.7 ± 2.2), whereas those with moderate or severe COPD showed reductions (Δweight = −1.7 ± 8.1 and ΔBMI = −0.4 ± 3.0), as did those with severe or very severe COPD (Δweight = −0.5 ± 5.4 and ΔBMI = −0.8 ± 3.3).

          Conclusions:

          Between the two phases of the study, the subjects with mild COPD showed increases in weight and BMI, whereas those with a more severe form of the disease showed reductions.

          RESUMO

          Objetivo:

          Avaliar a evolução dos dados antropométricos obtidos em uma pesquisa latino-americana realizada em duas fases (basal, em 2003, e seguimento, em 2012) na cidade de São Paulo.

          Métodos:

          Estudo de base populacional que avaliou indivíduos com idade ≥ 40 anos com o objetivo de definir a prevalência da DPOC e sua relação com alguns fatores de risco. A avaliação antropométrica incluiu medições de peso, altura, índice de massa corpórea (IMC) e circunferência abdominal. Foram avaliadas as mesmas variáveis na mesma população na fase de seguimento.

          Resultados:

          Dos 1.000 indivíduos incluídos inicialmente, 587 participaram da fase de seguimento; desses, 80 (13,6%) tinham DPOC. Entre a avaliação inicial e a de seguimento ambos os grupos (DPOC e não DPOC) apresentaram aumentos nas medidas antropométricas, mas esses somente foram significativos no grupo não DPOC. Os indivíduos com DPOC leve tiveram aumentos de peso e IMC (Δpeso = 1,6 ± 5,7 kg e ΔIMC = 0,7 ± 2,2 kg/m 2) enquanto aqueles com doença moderada ou grave tiveram reduções dessas medidas (DPOC moderada: Δpeso = −1,7 ± 8,1 kg e ΔIMC = −0,4 ± 3,0 kg/m 2; e DPOC grave ou muito grave (Δpeso = −0,5 ± 5,4 kg e ΔIMC = −0,8 ± 3,3 kg/m 2).

          Conclusões:

          Entre as duas fases da pesquisa, os pacientes com DPOC leve tiveram aumento de peso e IMC, enquanto aqueles com doença mais grave apresentaram perda ponderal e redução do IMC.

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          Most cited references35

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          Characteristics of physical activities in daily life in chronic obstructive pulmonary disease.

          Quantification of physical activities in daily life in patients with chronic obstructive pulmonary disease has increasing clinical interest. However, detailed comparison with healthy subjects is not available. Furthermore, it is unknown whether time spent actively during daily life is related to lung function, muscle force, or maximal and functional exercise capacity. We assessed physical activities and movement intensity with the DynaPort activity monitor in 50 patients (age 64 +/- 7 years; FEV1 43 +/- 18% predicted) and 25 healthy elderly individuals (age 66 +/- 5 years). Patients showed lower walking time (44 +/- 26 vs. 81 +/- 26 minutes/day), standing time (191 +/- 99 vs. 295 +/- 109 minutes/day), and movement intensity during walking (1.8 +/- 0.3 vs. 2.4 +/- 0.5 m/second2; p < 0.0001 for all), as well as higher sitting time (374 +/- 139 vs. 306 +/- 108 minutes/day; p = 0.04) and lying time (87 +/- 97 vs. 29 +/- 33 minutes/day; p = 0.004). Walking time was highly correlated with the 6-minute walking test (r = 0.76, p < 0.0001) and more modestly to maximal exercise capacity, lung function, and muscle force (0.28 < r < 0.64, p < 0.05). Patients with chronic obstructive pulmonary disease are markedly inactive in daily life. Functional exercise capacity is the strongest correlate of physical activities in daily life.
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            Body composition and mortality in chronic obstructive pulmonary disease.

            Survival studies have consistently shown significantly greater mortality rates in underweight and normal-weight patients with chronic obstructive pulmonary disease (COPD) than in overweight and obese COPD patients. To compare the contributions of low fat-free mass and low fat mass to mortality, we assessed the association between body composition and mortality in COPD. We studied 412 patients with moderate-to-severe COPD [Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) stages II-IV, forced expiratory volume in 1 s of 36 +/- 14% of predicted (range: 19-70%). Body composition was assessed by using single-frequency bioelectrical impedance. Body mass index, fat-free mass index, fat mass index, and skeletal muscle index were calculated and related to recently developed reference values. COPD patients were stratified into defined categories of tissue-depletion pattern. Overall mortality was assessed at the end of follow-up. Semistarvation and muscle atrophy were equally distributed among disease stages, but the highest prevalence of cachexia was seen in GOLD stage IV. Forty-six percent of the patients (n = 189) died during a maximum follow-up of 5 y. Cox regression models, with and without adjustment for disease severity, showed that fat-free mass index (relative risk: 0.90; 95% CI: 0.84, 0.96; P = 0.003) was an independent predictor of survival, but fat mass index was not. Kaplan-Meier and Cox regression plots for cachexia and muscle atrophy did not differ significantly. Fat-free mass is an independent predictor of mortality irrespective of fat mass. This study supports the inclusion of body-composition assessment as a systemic marker of disease severity in COPD staging.
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              Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study.

              Low body mass index (BMI) is a marker of poor prognosis in chronic obstructive pulmonary disease (COPD). In the general population, the harmful effect of low BMI is due to the deleterious effects of a low fat-free mass index (FFMI; fat-free mass/weight(2)). We explored distribution of low FFMI and its association with prognosis in a population-based cohort of patients with COPD. We used data on 1,898 patients with COPD identified in a population-based epidemiologic study in Copenhagen. FFM was measured using bioelectrical impedance analysis. Patients were followed up for a mean of 7 yr and the association between BMI and FFMI and mortality was examined taking age, sex, smoking, and lung function into account. The mean FFMI was 16.0 kg/m(2) for women and 18.7 kg/m(2) for men. Among subjects with normal BMI, 26.1% had an FFMI lower than the lowest 10th percentile of the general population. BMI and FFMI were significant predictors of mortality, independent of relevant covariates. Being in the lowest 10th percentile of the general population for FFMI was associated with a hazard ratio of 1.5 (95% confidence interval, 1.2-1.8) for overall mortality and 2.4 (1.4-4.0) for COPD-related mortality. FFMI was also a predictor of overall mortality when analyses were restricted to subjects with normal BMI. FFMI provides information in addition to BMI and assessment of FFM should be considered in the routine assessment of COPD.
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                Author and article information

                Journal
                J Bras Pneumol
                J Bras Pneumol
                jbpneu
                Jornal Brasileiro de Pneumologia
                Sociedade Brasileira de Pneumologia e Tisiologia
                1806-3713
                1806-3756
                Nov-Dec 2019
                Nov-Dec 2019
                : 45
                : 6
                : e20170157
                Affiliations
                [1 ]. Disciplina de Pneumologia, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM/UNIFESP - São Paulo (SP) Brasil.
                [2 ]. Universidade Federal de Pelotas -UFPEL -, Pelotas (RS) Brasil.
                [3 ]. Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México.
                [4 ]. Faculdade de Medicina São Leopoldo Mandic, Campinas (SP) Brasil.
                Author notes
                [Correspondence to: ] Oliver Augusto Nascimento. Rua Botucatu, 740, 3º Andar, Disciplina de Pneumologia, Universidade Federal de São Paulo (UNIFESP), CEP 04023-062, São Paulo, SP, Brasil. Tel.: 55 11 5572-4301. E-mail: oliver.nascimento@ 123456unifesp.br
                Author information
                http://orcid.org/0000-0001-9548-7066
                http://orcid.org/0000-0002-6061-785X
                http://orcid.org/0000-0002-0176-5051
                http://orcid.org/0000-0002-6258-799X
                http://orcid.org/0000-0002-4129-0898
                http://orcid.org/0000-0002-1132-5308
                http://orcid.org/0000-0002-7178-8187
                http://orcid.org/0000-0003-3138-2219
                Article
                00200
                10.1590/1806-3713/e20170157
                6715159
                31365731
                cf226caf-5571-49e5-80a3-bccbc1e38973
                © 2019 Sociedade Brasileira de Pneumologia e Tisiologia

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 24 August 2017
                : 18 January 2019
                Page count
                Figures: 6, Tables: 6, Equations: 0, References: 39
                Categories
                Original Article

                pulmonary disease, chronic obstructive,body mass index,obesity,waist circumference,doença pulmonar obstrutiva crônica,índice de massa corporal,obesidade,circunferência da cintura.

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