Anorexia in chronic obstructive pulmonary disease — Association to cachexia and hormonal derangement

Background In patients with chronic obstructive pulmonary disease (COPD) weight loss frequently occurs that may ultimately lead to cachexia as a serious co-morbidity, indicating severely impaired functional capacity, health status and increased mortality. Increased energy expenditure due to mechanic and metabolic inefficiency and systemic inflammation are determinants of a hypermetabolic state that is not balanced by dietary intake. Anorexia may importantly contribute to weight loss in COPD, however, the association between immune and hormonal derangement and altered appetite has not been studied in detail. Aim The aim of the present study was to investigate whether anorexia in COPD is related to inflammation and hormonal derangement in association to weight loss. Methods We prospectively enrolled 103 consecutive patients with COPD (age 59.8 ± 1.3 years, 35% female, mean FEV1 38.3 ± 1.7%) in comparison to healthy controls of similar age (n = 15). Results In 34 patients (33%) cachexia was diagnosed (weight loss > 7.5%, BMI ≤ 24 kg/m2). Cachectic COPD patients had lower BMI (19.0 ± 0.5 vs 25.6 ± 0.7 kg/m2) and impaired lung function (FEV1 31 ± 2% vs 42 ± 2%, FVC 51 ± 3 vs 59 ± 3%, both p < 0.001). Inflammatory immune activation (IL-6 and IL-6/IL-10 ratio) was significantly higher in cachectic COPD patients. Analysis of the extent of anorexia (visual analogue scale) revealed that cachectic COPD patients had significantly decreased subjective desire to eat compared to non-cachectic patients (3.5 ± 0.3 vs 6.3 ± 0.2, p < 0.001). Patients with COPD and cachexia showed evidence of acquired GH resistance (decreased IGF-1/GH ratio) and insulin resistance (HOMA). Anorexia showed a direct correlation with the IGF-1/GH ratio (r = 0.34, p < 0.05) and was further related to BMI and % weight loss (both p < 0.001). Conclusion In COPD anorexia relates to hormonal derangement and inflammatory immune activation. Anorexia contributes to development of cachexia. The concept of appetite stimulating therapy emerges as a novel therapeutic option in cachectic COPD patients.