Risk Factors for Nutritional Status in Patients with Chronic Obstructive Pulmonary Disease

Jun Hee Jang; Hye Sook Min; Jin-Han Park

doi:10.7475/kjan.2019.31.6.585

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Jang, Min, and Park: Risk Factors for Nutritional Status in Patients with Chronic Obstructive Pulmonary Disease

Original Article

Korean J Adult Nurs 2019;31(6):585-594.

Published online: 21 December 2019

DOI: https://doi.org/10.7475/kjan.2019.31.6.585

Risk Factors for Nutritional Status in Patients with Chronic Obstructive Pulmonary Disease

Jun Hee Jang¹, Hye Sook Min^2,, Jin-Han Park³

¹Part-Time Lecturer, Department of Nursing, Dong-A University, Busan, Korea

²Professor, Department of Nursing, Dong-A University, Busan, Korea

³Assistant Professor, Department of Pulmonology, Inje University Haeundae Paik Hospital, Busan, Korea

Corresponding author: Min, Hye Sook https://orcid.org/0000-0002-9292-1944 Department of Nursing, Dong-A University, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea. Tel: +82-51-240-2872, Fax: +82-51-240-2947, E-mail: hsmin@dau.ac.kr

Received 24 September 20194 November 2019 Accepted 14 November 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the characteristics of nutritional status and its risk factors in patients with Chronic Obstructive Pulmonary Disease(COPD).

Methods

Participants included 136 patients with COPD in Donga University hospital and Haeundae paik hospital in Busan city. The data, collected by a trained research assistant from January 10 to July 18, 2017, were analyzed using Fisher's exact test, the Mann-Whitney U test, and logistic regression analysis with SPSS/WIN 21.0.

Results

Among the 136 patients with COPD, 31 (22.8%) had abnormal nutritional status. According to the results of the logistic regression analysis, gender(Odds Ratio [OR]=5.27, 95% Confidence Interval [CI]=1.18~23.49, p=.029), percent predicted forced expiratory volume in one second [FEV1%] (OR=1.04, 95% CI=0.92~0.99, p=.012), symptom experience(OR=16.19, 95% CI=3.08~85.00, p=.001), carbohydrate intake(OR=1.01, 95% CI=1.00~1.02, p=.037), protein intake(OR=1.06, 95% CI=0.90~0.99, p=.012), and fat intake(OR=1.04, 95% CI=1.01-1.08, p=.015) were associated with nutritional status in patients with COPD.

Conclusion

In order to improve the nutrutional status of COPD patients, nursing education is needed with intensive screen on female patients and patients with low lung function, managing symptoms and increasing protein intake.

Keywords: Pulmonary disease, chronic obstructive, Nutritional status, Symptom assessment

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Table 1.

Difference in Characteristics of Participants according to Nutritional Status (N=136)

Characteristics	Categories		Total (n=136)	Normal nutritional status (n=105)	Abormal nutritional status (n=31)	x² or Z	p
Characteristics	Categories		n (%) or Mean± SD	n (%) or Mean± SD	n (%) or Mean± SD	x² or Z	p
Gender	Men		116 (85.3)	93 (88.6)	23 (74.2)	3.94	.079
Gender	Women		20 (14.7)	12 (11.4)	8 (25.8)
Age (year)			67.82±7.73	67.42±7.37	69.19±8.84	-1.44	.150
Marital status	Yes		133 (97.8)	102 (97.1)	31 (100.0)	0.91	＞.999
Marital status	No		3 (2.2)	3 (2.9)	0 (0.0)
Education	None		2 (1.5)	1 (1.0)	1 (3.2)	2.99	.539
	Elementary school		26 (19.1)	19 (18.1)	7 (22.6)
	Middle school		34 (25.0)	29 (27.6)	5 (16.1)
	High school		41 (30.1)	31 (29.5)	10 (32.3)
	≥ College		33 (24.3)	25 (23.8)	8 (25.8)
Smoking history	Never smoker		17 (12.5)	11 (10.5)	6 (19.4)	2.63	.282
	Current smoker		28 (20.6)	24 (22.9)	4 (12.9)
	Ex-smoker		91 (66.9)	70 (66.7)	21 (67.7)
Period from diagnosis (year)			8.42±8.16	7.84±7.88	10.40±8.91	-1.45	.147
FEV1%			54.93±16.43	57.51±15.83	46.16±15.63	-3.27	.001
Symptom experience	Physical	Frequency	2.20±2.27	1.86±1.91	3.35±2.96	-2.83	.005
	symptom	Distress	0.33±0.43	0.23±0.28	0.65±0.65	-4.51	.001
	Psychologic	Frequency	1.76±1.48	1.44±1.28	2.84±1.63	-4.26	.001
	symptom	Distress	0.42±0.50	0.30±0.33	0.85±0.69	-4.73	.001
	Total	Frequency	3.96±3.35	3.30±2.80	6.19±4.06	-3.97	.001
		Distress	0.38±0.43	0.26±0.28	0.75±0.63	-5.33	.001
Functional status			2.19±0.65	2.34±0.53	1.70±0.78	-4.05	.001
Daily diet intake	Carbohydrate (g)^†		224.11±79.71	226.97±76.15	214.42±91.47	-0.77	.443
	Protein (g)		54.04±21.82	56.53±21.44	45.60±21.28	-2.47	.014
	Fat (g)		32.02±20.91	21.52±2.10	31.81±18.99	-0.11	.913

FEV1%=percent predicted forced expiratory volume in one second; SD=standard deviation;

^† t- test.

Table 2.

Symptom Experience and Symptom Distress in Patients with Chronic Obstructive Pulmonary Disease (N=136)

Variables^†	Symptom experience	Distress score
Variables^†	n (%)	Mean± SD
Warrying	72 (52.9)	0.61±0.77
Cough	69 (50.7)	0.87±1.13
Shortness of breath	59 (43.4)	0.97±1.34
Feeling irritable	48 (35.3)	0.61±1.00
Difficulty sleeping	40 (29.4)	0.55±1.00
Feeling sad	32 (23.5)	0.32±0.68
Lack of energy	28 (20.6)	0.46±0.98
Dry mouth	28 (20.6)	0.37±0.93
Difficulty concentrating	20 (14.7)	0.26±0.78
Pain	19 (14.0)	0.32±0.82

SD=standard deviation;

^† Multiple choice.

Table 3.

Prevalence of Nutritional Status in Patients with Chronic Obstructive Pulmonary Disease (N=136)

Variables	Mean± SD	n (%)
Total	12.22±2.11	136 (100.0)
Normal (MNA-SF ≥12)	13.17±0.77	105 (77.2)
Abnormal (MNA-SF ＜12)	9.00±2.03	31 (22.8)
Risk of malnutrition (MNA-SF 8~11)	10.00±1.09	23 (16.9)
Malnutrition (MNA-SF ≤7)	6.13±1.13	8 (5.9)

MNA-SF=mini nutritional assessment short form; SD=standard deviation;.

Table 4.

Risk Factors for Abnormal Nutritional Status in Patients with Chronic Obstructive Pulmonary Disease (N=136)

Variables	B	SE	p	OR	95% CI
Gender (reference=men)	1.66	0.76	.029	5.27	1.18~23.49
FEV1%	-0.05	0.02	.012	1.04	1.01~1.09
Symptom distress	2.78	0.85	.001	16.19	3.08~85.00
Functional status	-0.80	0.46	.079	0.45	0.18~1.10
Carbohydrate intakes	0.01	0.00	.037	1.01	1.00~1.02
Protein intakes	-0.06	0.02	.012	1.06	1.01~1.11
Fat intakes	0.04	0.02	.015	1.04	1.01~1.08
		R²=.51, Hosmer & Lemeshow test x²=6.14, p=.632

CI=confidence interval; FEV1%=percent predicted forced expiratory volume in one second; OR=odds ratio; SE=standard error.

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