Einfluss von Mangelernährung und Sarkopenie auf die Ergebnisse einer pneumologischen Rehabilitation bei Patient:innen mit COPD

Zusammenfassung

Mangelernährung und Sarkopenie treten bei älteren Menschen häufig auf und sind mit erhöhter Morbidität sowie Mortalität assoziiert. Die Ergebnisse der Malnut-Reha-Studie, welche die Prävalenz dieser Zustände in 5 Schweizer stationären Rehabilitationszentren untersuchte, wurden kürzlich publiziert. Die hier vorgestellte Subgruppenanalyse beleuchtet den Einfluss von Mangelernährung und Sarkopenie auf die Ergebnisse einer pneumologischen Rehabilitation (PR) bei Patient*innen mit chronisch obstruktiver Lungenerkrankung (COPD).
Insgesamt wurden 67 COPD-Patient*innen aus 2 Schweizer Rehabilitationszentren prospektiv in die Analyse einbezogen. Zur Beurteilung des Rehabilitationserfolgs wurden standardisierte Tests wie der 6-Minuten-Gehtest (6MWT), der Functional Independence Measure (FIM) und die Messung der Handgriffstärke (HGS) eingesetzt. Die Prävalenz von Mangelernährung und Sarkopenie betrug jeweils 46%, wobei 33% der Patient*innen beide Zustände aufwiesen. Trotz initial schlechterer körperlicher und funktioneller Ausgangswerte zeigten Patient*innen mit Mangelernährung und/oder Sarkopenie nach der PR signifikante Verbesserungen im 6MWT und FIM, unabhängig vom Ernährungsstatus oder der Muskelmasse.
Die Ergebnisse dieser Analyse bestätigen die Wirksamkeit der PR bei COPD-Patient*innen, unabhängig davon, ob eine Mangelernährung oder Sarkopenie vorlag. Zukünftige Studien sollten untersuchen, ob gezielte längerfristige ernährungs- und trainingsbasierte Interventionen zusätzliche Vorteile bieten können.

Abstract

Malnutrition and sarcopenia are common conditions in older people and are associated with increased morbidity and mortality. The results of the Malnut-Reha study, which was conducted in 5 Swiss rehabilitation centers and investigated the prevalence of these conditions in inpatient rehabilitation, have recently been published. The present subgroup analysis assesses the impact of malnutrition and sarcopenia on pulmonary rehabilitation (PR) outcomes in patients with Chronic Obstructive Pulmonary Disease (COPD).
A total of 67 patients with COPD from 2 Swiss rehabilitation centers were included in the analysis. Standardized assessments were used to evaluate rehabilitation outcomes, including the 6-Minute Walk Test (6MWT), the Functional Independence Measure (FIM), and the handgrip strength measurement (HGS). The prevalence of malnutrition and sarcopenia was 46% each, with 33% of patients presenting both conditions. Despite the worst initial physical and functional status, patients with malnutrition and/or sarcopenia showed significant improvements in 6MWT and FIM after PR, independently of their nutritional status or muscle mass.
The findings of this analysis confirm the effectiveness of PR in patients with COPD, regardless of the presence of malnutrition or sarcopenia. Future studies should investigate whether extended targeted nutritional and exercise interventions could provide additional benefits.

Schlüsselwörter

Mangelernährung - Sarkopenie - COPD - pneumologische Rehabilitation - 6-Minuten-Gehtest

Keywords

malnutrition - sarcopenia - COPD - pulmonary rehabilitation - 6-minute walk test

Publikationsverlauf

Eingereicht: 01. April 2025

Angenommen nach Revision: 01. August 2025

Artikel online veröffentlicht:
29. August 2025

• Literatur

• 1 Soderstrom L, Rosenblad A. Long-term association between malnutrition and all-cause mortality among older adults: A 10-years follow-up study. Clin Nutr 2023; 42: 2554-2561
• 2 Marshall S. Protein-energy malnutrition in the rehabilitation setting: Evidence to improve identification. Maturitas 2016; 86: 77-85
• 3 Kaiser MJ, Bauer JM, Ramsch C. et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010; 58: 1734-1738
• 4 GOLD report 2024. Zugriff am 27. Februar 2025 unter: https://goldcopd.org/2024-gold-report/
• 5 Leitl D, Glöckl R. Overview on pulmonary rehabilitation. Pneumologe (Berl) 2022; 19: 130-141
• 6 Kaluzniak-Szymanowska A, Krzyminska-Siemaszko R, Deskur-Smielecka E. et al. Malnutrition, sarcopenia, and malnutrition-sarcopenia syndrome in older adults with COPD. Nutrients 2021; 14: 44
• 7 Lehmann U, Uhlmann K, Meichtry A. et al. Malnutrition and sarcopenia in inpatient rehabilitation: prevalence and associations with changes in bodyweight, muscle strength, and functional independence. J Rehabil Med 2025; 57: jrm42215
• 8 Ter Beek L, van der Vaart H, Wempe JB. et al. Coexistence of malnutrition, frailty, physical frailty and disability in patients with COPD starting a pulmonary rehabilitation program. Clin Nutr 2020; 39: 2557-2563
• 9 Ng MGS, Kon SSC, Canavan JL. et al. Prevalence and effects of malnutrition in COPD patients referred for pulmonary rehabilitation. European Respiratory Journal 2013; 42: 5107
• 10 Mannino DM, Thorn D, Swensen A. et al. Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD. Eur Respir J 2008; 32: 962-969
• 11 Gosker HR, Wouters EF, van der Vusse GJ. et al. Skeletal muscle dysfunction in chronic obstructive pulmonary disease and chronic heart failure: underlying mechanisms and therapy perspectives. Am J Clin Nutr 2000; 71: 1033-1047
• 12 Sanders KJ, Kneppers AE, van de Bool C. et al. Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective. J Cachexia Sarcopenia Muscle 2016; 7: 5-22
• 13 Holland AE, Spruit MA, Troosters T. et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014; 44: 1428-1446
• 14 Linacre JM, Heinemann AW, Wright BD. et al. The structure and stability of the Functional Independence Measure. Arch Phys Med Rehabil 1994; 75: 127-132
• 15 Gagesch M, Wieczorek M, Abderhalden LA. et al. Grip strength cut-points from the Swiss DO-HEALTH population. Eur Rev Aging Phys Act 2023; 20: 13
• 16 Kondrup J, Allison SP, Elia M. et al. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22: 415-421
• 17 Cederholm T, Jensen GL, Correia M. et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle 2019; 10: 207-217
• 18 Cruz-Jentoft AJ, Bahat G, Bauer J. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16-31
• 19 Beaudart C, Biver E, Reginster JY. et al. Validation of the SarQoL(R), a specific health-related quality of life questionnaire for Sarcopenia. J Cachexia Sarcopenia Muscle 2017; 8: 238-244
• 20 American Academy of Orthotists & Prosthetists. Five Time Sit to Stand Test (FTSST). Zugriff am 04. März 2025 unter: https://www.youtube.com/watch?v=_jPl-IuRJ5A
• 21 Ishii S, Tanaka T, Shibasaki K. et al. Development of a simple screening test for sarcopenia in older adults. Geriatr Gerontol Int 2014; 14 (Suppl. 1) 93-101
• 22 Rossi AP, Fantin F, Micciolo R. et al. Identifying sarcopenia in acute care setting patients. J Am Med Dir Assoc 2014; 15: 303-e7
• 23 Cederholm T, Jensen GL, Correia MITD. et al. GLIM criteria for the diagnosis of malnutrition – A consensus report from the global clinical nutrition community. Clin Nutr 2019; 38: 1-9
• 24 Gagesch M, Wieczorek M, Abderhalden LA. et al. Grip strength cut-points from the Swiss DO-HEALTH population. Eur Rev Aging Phys Act 2023; 20: 13
• 25 Cruz-Jentoft AJ, Bahat G, Bauer J. et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48: 16-31
• 26 Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968; 16: 622-626
• 27 Zhu Y, Shen T, Guo R. et al. Global, regional, and national burden of young COPD, 1990–2021, with forecasts to 2050: a systematic analysis for the global burden of disease study 2021. BMC Public Health 2025; 25: 276
• 28 Guecamburu M, Coquelin A, Rapin A. et al. Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study. Respir Res 2023; 24: 102
• 29 Spielmanns M, Gloeckl R, Schmoor C. et al. Effects on pulmonary rehabilitation in patients with COPD or ILD: A retrospective analysis of clinical and functional predictors with particular emphasis on gender. Respir Med 2016; 113: 8-14
• 30 Fulk GD, Reynolds C, Mondal S. et al. Predicting home and community walking activity in people with stroke. Arch Phys Med Rehabil 2010; 91: 1582-1586
• 31 Sugawara K, Takahashi H, Kasai C. et al. Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD. Respir Med 2010; 104: 1883-1889
• 32 Collins PF, Yang IA, Chang YC. et al. Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update. J Thorac Dis 2019; 11 (Suppl. 17) S2230-S2237
• 33 Sugawara K, Takahashi H, Kashiwagura T. et al. Effect of anti-inflammatory suppleme ntation with whey peptide and exercise therapy in patients with COPD. Respir Med 2012; 106: 1526-1534
• 34 Gurgun A, Deniz S, Argin M. et al. Effects of nutritional supplementation combined with conventional pulmonary rehabilitation in muscle-wasted chronic obstructive pulmonary disease: a prospective, randomized and controlled study. Respirology 2013; 18: 495-500
• 35 van Wetering CR, Hoogendoorn M, Mol SJ. et al. Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial. Thorax 2010; 65: 7-13