The triad of physiological challenges: investigating the intersection of sarcopenia, malnutrition, and malnutrition-sarcopenia syndrome in patients with COPD - a cross-sectional study

BMC Pulmonary Medicine · 4 authors, 2 centres

AI SUMMARY

FIDELITY 92%

POPULATIONHospitalized adult patients with COPD (mean age 48±5 years, 56.2% male) at a tertiary care hospital in India

INTERVENTIONAssessment of malnutrition (by MNA-SF and GLIM criteria), sarcopenia (by EWGSOP2 criteria using BIA and handgrip strength), and malnutrition-sarcopenia syndrome

COMPARISONPatients without malnutrition, without sarcopenia, or without MSS

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

“

TL;DR

This cross-sectional study of 160 hospitalized COPD patients found a high prevalence of sarcopenia (61.9%), malnutrition (45.6%), and malnutrition-sarcopenia syndrome (32.5%). These conditions were significantly associated with prolonged hospital stay, readmission within 6 months, and higher COPD Assessment Test scores, with sarcopenia showing the strongest associations. The findings highlight the need for routine screening and multidisciplinary management of these conditions in COPD patients.

Full summary

4,613 CHARS

**Background:** Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory disorder and the fourth leading cause of mortality worldwide. Patients with COPD frequently experience abnormal nutritional status and body composition changes, including malnutrition and sarcopenia. Malnutrition-sarcopenia syndrome (MSS), the coexistence of both conditions, increases mortality risk more than either alone. While previous studies have examined these conditions separately, limited research has used recent diagnostic standards (GLIM and EWGSOP2) to assess both simultaneously. This study aimed to determine the prevalence of malnutrition, sarcopenia, and MSS in hospitalized COPD patients and their association with disease severity.

**Methods:** This hospital-based analytical cross-sectional study was conducted at a tertiary care hospital in Jamnagar, Gujarat, India, from January to March 2023. A total of 160 hospitalized COPD patients without acute exacerbation were enrolled (mean age 48±5 years; 56.2% male). Data were collected using a self-structured questionnaire covering sociodemographics, clinical profiles, anthropometrics, and bioimpedance indices. Sarcopenia was diagnosed per EWGSOP2 recommendations using low muscle strength (handgrip <27 kg for men, <20 kg for women) and low muscle mass (skeletal muscle mass index <7.0 kg/m² for men, <5.5 kg/m² for women) measured by bioelectrical impedance analysis (BIA). Malnutrition risk was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF) and confirmed by GLIM criteria (phenotypic: weight loss >5% in 6 months, low BMI <20 kg/m² if <70 years or <22 kg/m² if ≥70 years, low muscle mass; etiologic: reduced food intake or disease burden/inflammation). COPD severity was measured using the COPD Assessment Test (CAT), with scores ≥10 indicating symptomatic COPD. Statistical analysis included bivariate comparisons (Student's t-test, Mann-Whitney) and multivariate logistic regression adjusting for age, sex, and BMI, with outcomes of prolonged length of stay (LOS >10 days), readmission within 6 months, and CAT score ≥10.

**Key Results:** The prevalence of sarcopenia was 61.9% (n=99), malnutrition was 45.6% (n=73), and MSS was 32.5% (n=52). Exclusive malnutrition occurred in 13.1% (n=21), exclusive sarcopenia in 29.4% (n=47), and 25% (n=40) had neither condition. Patients with sarcopenia had significantly lower body weight (48.64±11 vs. 59.41±10.5 kg, p<0.001), BMI (18.86±5.11 vs. 23.37±4.71 kg/m², p<0.001), fat-free mass (18.2±4.5 vs. 23.5±4.6 kg, p<0.05), SMMI (5±0.8 vs. 19.98±4.1 kg/m², p<0.001), handgrip strength (7.67±6.7 vs. 13.13±13.07 kg, p<0.001), and MNA-SF scores (8±2.4 vs. 11±2.5, p<0.05) compared to non-sarcopenic patients. Similarly, patients with malnutrition had significantly lower body weight (43.28±5.87 vs. 61.02±10.40 kg, p<0.001), BMI (16.5±2.38 vs. 24±4.32 kg/m², p<0.001), FFM (15.5±4.7 vs. 22.9±5.2 kg, p<0.05), SMMI (6.79±4.35 vs. 14.62±8.34 kg/m², p<0.001), handgrip (7.12±7.90 vs. 11.95±11.08 kg, p=0.008), and MNA-SF (9.2±3.2 vs. 12.5±2.5, p<0.05). MSS patients showed similar significant differences. Multivariate logistic regression revealed that malnutrition was associated with 2.35 times higher odds of prolonged LOS (OR=2.35, p=0.024), 2.45 times higher odds of readmission (OR=2.45, p=0.009), and 2.17 times higher odds of CAT ≥10 (OR=2.17, p=0.021). Sarcopenia showed stronger associations: OR=3.68 (p=0.004) for prolonged LOS, OR=3.92 (p=0.001) for readmission, and OR=2.80 (p=0.005) for CAT ≥10. MSS was associated with OR=2.72 (p=0.004) for prolonged LOS, OR=1.98 (p=0.04) for readmission, and OR=2.08 (p=0.029) for CAT ≥10.

**Clinical Implications:** This study demonstrates a high prevalence of sarcopenia, malnutrition, and MSS in hospitalized COPD patients, with sarcopenia showing the strongest independent associations with adverse outcomes. These findings underscore the importance of routine screening for these conditions using standardized criteria (EWGSOP2 and GLIM) in COPD management. The results suggest that sarcopenia may be a particularly critical target for intervention, potentially through exercise and pharmacological strategies, while malnutrition requires nutritional support. A multidisciplinary approach involving pulmonologists, dietitians, and physiotherapists is recommended. Limitations include the cross-sectional design (precluding causal inference), single-center setting, and relatively small sample size. Future longitudinal studies and intervention trials are needed to establish temporal relationships and optimize treatment strategies.

PICO

PPOPULATION

Hospitalized adult patients with COPD (mean age 48±5 years, 56.2% male) at a tertiary care hospital in India

IINTERVENTION

Assessment of malnutrition (by MNA-SF and GLIM criteria), sarcopenia (by EWGSOP2 criteria using BIA and handgrip strength), and malnutrition-sarcopenia syndrome

OOUTCOME

Prolonged length of stay (>10 days), readmission within 6 months, and COPD Assessment Test (CAT) score ≥10

STUDY TYPE

cross-sectional

SPECIALTY

pulmonology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

92% · A

ORIGINAL PAPER

PMC10840248

The triad of physiological challenges: investigating the intersection of sarcopenia, malnutrition, and malnutrition-sarcopenia syndrome in patients with COPD - a cross-sectional study

BMC Pulmonary Medicine

READ THE FULL PAPER

ABSTRACT

Background One of the most prevalent respiratory disorders in modern society is chronic obstructive pulmonary disease (COPD). Frequent comorbidities in patients with COPD are abnormal nutritional status and body composition variations. Malnutrition-sarcopenia syndrome, which occurs when the 2 conditions – malnutrition and sarcopenia – coexist, raises the risk of death more than either condition alone. The current study sought to determine the prevalence of malnutrition, sarcopenia, and malnutrition-sarcopenia syndrome in patients with COPD as well as the association between these diseases and the severity of COPD. Methods The study was an analytical cross-sectional study conducted on hospitalized patients with COPD. The sample size of the study was calculated to be 160. A self-structured questionnaire was used to collect the data, containing sociodemographic characteristics, clinical profiles, anthropometric assessment, and bioimpedance indices. Sarcopenia was diagnosed with low muscle strength and muscle mass by the EWGSOP2 recommendations. Muscle mass is measured by BIA and muscle strength (Handgrip) was measured by a Hand Dynamometer. Assessment of the risk of malnutrition was performed using the Mini Nutritional Assessment-Short Form questionnaire and was confirmed by GLIM criteria. The COPD assessment test (CAT) tool determined the severity of the condition. For the data analysis, comparisons were made using Student’s t test and Mann–Whitney test in bivariate analysis. Multivariate logistic regression analyses were performed considering the outcomes of patients with COPD by CAT scores, prolonged length of stay, and hospital readmission 6 months after discharge. Results The mean age of the participants was 48 ± 5 years. Approximately 61.9% were found to be sarcopenic. Approximately 45.6% of participants had malnutrition. Malnutrition sarcopenia syndrome was diagnosed in 32.5% of patients. The study analysis revealed that patients with COPD with malnutrition-sarcopenia syndrome had more than twice the odds of prolonged hospital stay, re-admission within 6 months, and higher CAT scores. Conclusion The study revealed a high prevalence of sarcopenia, malnutrition, and malnutrition sarcopenia syndrome in patients with COPD. These conditions were found to be statistically significant with prolonged length of stay, re-admission within 6 months, and CAT scores. The findings highlight the importance of addressing these conditions as part of the management of the patients.

CITATION EXPORT

M. Yogesh, Jenish Patel, Naresh Makwana et al.. The triad of physiological challenges: investigating the intersection of sarcopenia, malnutrition, and malnutrition-sarcopenia syndrome in patients with COPD - a cross-sectional study. BMC Pulmonary Medicine. (2024). https://doi.org/10.1186/s12890-024-02884-3

AUTHORS

4 · 2 CENTRES

M. Yogesh, Jenish Patel, Naresh Makwana, Mansi Mody

1Department of Community Medicine, Shri M P Shah Government Medical College, Jamnagar, Gujarat India
2Shri M P Shah Government Medical College, Jamnagar, Gujarat 361008 India