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Body Composition and Resting Energy Expenditure in Clinically Stable, Non–Weight-Losing Patients With Severe Emphysema^*

Rubin I. Cohen, MD, FCCP; Kamel Marzouk, MD; Patricia Berkoski, RRT; Chris P. O’Donnell, PhD; Vsevolady Y. Polotsky, PhD and Steven M. Scharf, MD, PhD

^* From the Division of Pulmonary and Critical Care Medicine (Drs. Cohen, Marzouk, and Scharf), The Long Island Jewish Medical Center, The Long Island Campus for The Albert Einstein College of Medicine, New Hyde Park, NY; and Division of Pulmonary and Critical Care Medicine (Drs. O’Donnell and Polotsky), Johns Hopkins University School of Medicine, Baltimore, MD. Currently at the Pulmonary and Critical Care Division, University of Maryland, Baltimore, MD.

Correspondence to: Rubin Cohen, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Long Island Jewish Medical Center, RM C-20, 270-05 76th Ave, New Hyde Park, NY, 11040; e-mail: rcohen{at}lij.edu

Study objectives: To characterize the metabolic status of weight-stable and clinically stable individuals with advanced emphysema.

Patients: Seventy-nine patients with severe emphysema (FEV₁, 29 ± 13% of predicted [mean ± SD]) evaluated for enrollment in the National Emphysema Treatment Trial and 20 age-matched healthy subjects were studied.

Setting: Pulmonary function laboratory of university-affiliated teaching hospital.

Interventions: Data collection.

Measurements and results: We measured lung function, body composition, serum leptin levels, serum tumor necrosis factor receptors (sTNF-Rs), resting oxygen consumption (RO₂) normalized to weight in kilograms (RO₂/kg), and RO₂ normalized to fat-free mass (FFM) [RO₂/FFM]. The patient group and healthy group had similar age, body mass index (BMI), and body composition. RO₂/kg, RO₂/FFM, and sTNF-R levels were higher in patients compared to healthy subjects. There were no differences in serum leptin levels between emphysematous and healthy subjects, and there was no correlation between leptin and sTNF-R and RO₂/kg. Furthermore, both groups had similar gender-related differences in FFM, percentage of body fat, and serum leptin levels. Patients with lower BMI showed the greatest differences from control subjects in RO₂/kg.

Conclusion: In weight-stable subjects with advanced emphysema, RO₂/kg and RO₂/FFM were higher compared to healthy subjects, especially in those with BMI in the lower end of the normal range. RO₂/kg and RO₂/FFM did not correlate with leptin or sTNF-R levels. These data show that a higher metabolic rate is found in patients with emphysema who are clinically and weight stable. Thus, hypermetabolism is a feature of the disease and not sufficient to lead to weight loss.

Key Words: body mass index • emphysema • leptin • nutrition • oxygen consumption • tumor necrosis factor receptors