Nutritional status of subjects with chronic obstructive pulmonary disease.

Chung Mei-lan.Thesis (M.Phil.)--Chinese University of Hong Kong, 2000.Includes bibliographical references (leaves 118-124).Abstracts in English and Chinese.Abstract --- p.iDeclaration --- p.vAcknowledgment --- p.viAbbreviations --- p.viiiList of Figures --- p.xList of Tables & Graphs --- p.xiChapter 1. --- Background --- p.1Chapter Chapter 1: --- Age-Associated Changes in Nutritional Status in the Elderly --- p.1Chapter 1.1. --- Body Composition --- p.1Chapter 1.2. --- Nutritional Requirements --- p.2Chapter 1.2.1. --- Energy requirement in the elderly --- p.3Chapter 1.2.2. --- Protein requirement in the elderly --- p.3Chapter 1.2.3. --- Vitamin and minerals requirement in the elderly --- p.4Chapter 1.3. --- Food Intake --- p.4Chapter 1.3.1. --- Biobehavioral factors --- p.5Chapter 1.3.2. --- Social factors --- p.9Chapter 1.3.3. --- Psychological factors --- p.9Chapter 1.3.4. --- Physical factors --- p.10Chapter 1.3.5. --- Medical factors --- p.10Chapter 1.4. --- Age-Related Changes in Gastrointestinal Tract --- p.10Chapter Chapter 2: --- Energy Expenditure in the Elderly --- p.12Chapter 2.1. --- Total Daily Energy Expenditure (TEE) --- p.13Chapter 2.2. --- Basal Metabolic Rate (BMR) --- p.14Chapter 2.2.1. --- Mechanisms Leading to a Decrease in FFM Adjusted BMR --- p.15Chapter (i) --- Sex --- p.15Chapter (ii) --- Sympathetic Nervous System (SNS) Activity --- p.16Chapter (iii) --- Physical Activity --- p.17Chapter (iv) --- Body Weight --- p.17Chapter (v) --- Hormones --- p.18Chapter 2.3. --- Diet-Induced Thermogenesis (DIT) --- p.18Chapter 2.4. --- Energy Costs of Physical Activity --- p.20Chapter Chapter 3: --- Methods for the Measurements of Energy Expenditure --- p.22Chapter 3.1. --- Direct Calorimetry --- p.22Chapter 3.1.1. --- Principle of Direct Calorimetry --- p.22Chapter 3.1.2. --- Isothermal calorimetry --- p.23Chapter 3.1.3. --- Gradient-layer direct calorimetry --- p.23Chapter 3.1.4. --- Advantages and Disadvantages of Direct Calorimetry --- p.24Chapter 3.2. --- Indirect Calorimetry --- p.25Chapter 3.2.1. --- Principle of Indirect Calorimetry --- p.25Chapter 3.2.2. --- Whole body indirect calorimetry --- p.25Chapter 3.2.3. --- "Indirect calorimetry: ventilated hood system, a face mask, or mouthpiece" --- p.26Chapter 3.2.4. --- Advantages and Disadvantages of Indirect Calorimetry --- p.27Chapter 3.3. --- The Doubly-Labeled Water Method --- p.27Chapter 3.3.1. --- Principle --- p.27Chapter 3.3.2. --- Advantages and Disadvantages --- p.28Chapter 3.4. --- The Labeled Bicarbonate Method --- p.29Chapter 3.4.1. --- Principle of Isotope Dilution Method --- p.29Chapter 3.4.2. --- Principle of Traditional Labeled HC03 Method --- p.32Chapter 3.4.3. --- Labeled Bicarbonate-Urea Method --- p.34Chapter I. --- Calculations --- p.35Chapter A. --- Determination of energy equivalent of CO2 --- p.35Chapter B. --- Relationship between specific activity of urea and specific activity of CO2 --- p.35Chapter C. --- Fixation of infused label in the body --- p.36Chapter D. --- Calculation of CO2 production from the specific 3 activity of urinary urea --- p.6Chapter E. --- Two assumptions in labeled bicarbonate-urea method --- p.36Chapter 3.4.4. --- Advantages and Disadvantages of Labeled Bicarbonate-Urea Method --- p.37Chapter 3.5. --- Heart Rate Monitoring --- p.37Chapter 3.5.1. --- Principle --- p.37Chapter 3.5.2. --- Advantages and Disadvantages --- p.38Chapter 3.6. --- Activity Monitoring --- p.39Chapter 3.6.1. --- Principle --- p.39Chapter 3.6.2. --- Advantages and Disadvantages --- p.39Chapter 3.7. --- Activity Diaries --- p.40Chapter 3.7.1. --- Retrospective activity questionnaires --- p.40Chapter I. --- Principle --- p.40Chapter II. --- Advantages and Disadvantages --- p.40Chapter 3.7.2. --- Current diary method --- p.41Chapter I. --- Principle --- p.41Chapter II. --- Advantages and Disadvantages --- p.42Chapter 3.7.3. --- Time-and-motion study --- p.42Chapter I. --- Principle --- p.42Chapter II. --- Advantages and Disadvantages --- p.43Chapter Chapter 4: --- Nutritional Status and Energy Expenditure in Chronic Obstructive Pulmonary Disease (COPD) Patients --- p.44Chapter 4.1. --- Nutritional Status --- p.44Chapter 4.1.1. --- Body weight --- p.44Chapter 4.1.2. --- Fat-free mass (FFM) --- p.44Chapter 4.2. --- REE --- p.46Chapter 4.3. --- DIT --- p.47Chapter 4.4. --- TEE --- p.47Chapter 4.5. --- Nutrition Repletion by Caloric Supplement --- p.48Chapter 2. --- Objectives --- p.50Chapter 3. --- Subject and Method --- p.51Chapter 3.1. --- Part A: Subject and Methods I --- p.51Chapter 3.1.1. --- Subjects --- p.51Chapter 3.1.2. --- Methods --- p.51Chapter I. --- Anthropometric Assessment --- p.51Chapter II. --- Nutrient Intake --- p.52Chapter III. --- Clinical Assessment --- p.52Chapter IV. --- Energy Expenditure --- p.53Chapter V. --- Mini Nutritional Assessment Questionnaire --- p.53Chapter VI. --- Statistical Analysis --- p.54Chapter 3.2. --- Part B: Subject and Methods II --- p.55Chapter 3.2. --- Subjects --- p.55Chapter I. --- Patients --- p.55Chapter II. --- Control subjects --- p.55Chapter 3.2.2. --- Methods --- p.56Measurement of TEE by Labeled Bicarbonate-Urea Method --- p.56Chapter I. --- Study Protocol --- p.56Chapter Figure 6: --- Study protocol in Hospital --- p.57Chapter II. --- Clinical Protocol --- p.58Chapter A. --- Preparing the infusion --- p.58Chapter B. --- "Inserting the subcutaneous cannula, and starting the infusion" --- p.58Chapter C. --- Urine collection --- p.59Chapter D. --- Blood sample --- p.59Chapter III. --- Laboratory Procedures --- p.60Chapter A. --- Measuring the radioactivity of the infused bicarbonate solution --- p.60Chapter B. --- Measuring of specific activity of urea --- p.60Chapter (i) --- Titration of hyamine hydroxide solution --- p.60Chapter (ii) --- Urine radioactivity quantification --- p.61Chapter (1) --- Removal of dissolved CO2 from urine --- p.61Chapter (2) --- Determination of specific activity of C02 --- p.62Chapter (a) --- Principle --- p.62Chapter (b) --- Laboratory procedures for the determination of specific activity of urea --- p.62Chapter IV. --- Measurement in Hospital --- p.63Chapter A. --- Anthropometry --- p.63Chapter B. --- Indirect calorimetry --- p.63Chapter (i) --- Principle --- p.63Chapter (ii) --- Measurement of REE --- p.64Chapter (iii) --- Measurement of DIT --- p.65Chapter C. --- Food supply and dietary record during the study --- p.65Chapter D. --- Record of physical activity in rehabilitation program --- p.66Chapter E. --- Mini Nutritional Assessment Questionnaire --- p.67Chapter V. --- Statistical Analysis --- p.67Chapter 4. --- Results --- p.68Chapter 4.1. --- Results of Part A Study --- p.68Chapter 4.1.1. --- Anthropometry --- p.68Chapter 4.1.2. --- Nutrient Intake --- p.69Chapter 4.1.3. --- Caloric Balance --- p.71Chapter 4.1.4. --- Mini Nutritional Assessment Questionnaire --- p.72Chapter 4.2. --- Results of Part B Study --- p.73Chapter 4.2.1. --- Anthropometric Data --- p.73Chapter 4.2.2. --- REE --- p.74Chapter 4.2.3. --- DIT --- p.75Chapter 4.2.4. --- Nutrient Intake --- p.75Chapter 4.2.5. --- TEE --- p.76Chapter 4.2.6. --- Caloric Balance --- p.77Chapter 4.2.7. --- Mini Nutritional Assessment Questionnaire --- p.77Chapter 4.3. --- Table 1-1 --- p.78Chapter 4.4. --- Table 2-1 --- p.89Chapter 4.5. --- Graph1 --- p.100Chapter 5. --- Discussion --- p.103Chapter 5.1. --- Anthropometry in COPD patients --- p.103Chapter 5.2. --- Caloric and Nutrient intake in COPD patients --- p.105Chapter 5.3. --- Resting Energy Expenditure (REE) --- p.107Chapter 5.4. --- Diet-Induced Thermogenesis (DIT) --- p.108Chapter 5.5. --- Total Daily Energy Expenditure (TEE) --- p.108Chapter 5.6. --- Caloric Balance --- p.109Chapter 5.7. --- Limitation of this Study --- p.112Chapter 5.7.1. --- 24-hrs dietary recall --- p.112Chapter 5.7.2. --- Bicarbonate-urea method --- p.113Chapter 5.7.3. --- Anthropometry of community healthy elderly --- p.113Chapter 5.8. --- Recommendations --- p.114Chapter 5.8.1. --- Anthropometry monitoring in COPD patients --- p.114Chapter 5.8.2. --- Caloric supplements --- p.114Chapter 5.8.3. --- Physical activity in COPD patients --- p.115Chapter 6. --- Conclusions --- p.117Chapter 7. --- References --- p.118Chapter 8. --- Appendix I --- p.125Chapter A. --- Calculation of Total Energy Expenditure (TEE) --- p.125Chapter B. --- Sample of Calculation of Total Energy Expenditure (TEE) in Part B of the Study --- p.129Chapter 9. --- Appendix II - Equations --- p.133Chapter 10. --- Appendix III - Flow Calibration --- p.13