Comparison of Body Composition Indices of Chemical Warfare Veterans with Chronic Pulmonary Obstruction in Patients with Low and Moderate to High Disease Severity

Document Type : Original Research

Authors

1 Baqiyatallah University of Medical sciences

2 Ahvaz Jundishapur University of Medical Sciences

3 Exercise Physiology Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Background and Aim: More than 100,000 Iranian veterans suffer from chemical damage caused by mustard gas. The aim of this study was to determine the body composition status of chemical warfare veterans with chronic obstructive pulmonary disease (COPD).
Methods: This is a cross-sectional study. 97 chemical warfare veterans with COPD in Karaj, Iran were included in the study. The Patients were divided into two groups low and medium to high disease severity according to spirometry parameters. The body composition parameters were evaluated using the Bioelectrical Impedance Analysis method. 
Results: Mean age, height and weight of patients were 49.19±3.86, 171.85±6.11, 79.24±11.09, respectively. 65.6 % of them were overweight or obese. According to spirometry indexes, 55.7% (n=54) of veterans had low disease severity and 44.3% (n=43) had moderate to high disease severity. There was a significant difference between chemical veterans with low severity of COPD and moderate to high severity of COPD in body fat-free mass (p-value=0.031), body muscle mass (p-value=0.026) and body water (p-value=0.031) indices. All three indices in the group of veterans with moderate to high disease severity had a higher mean than the veterans with low disease severity. But no significant difference was observed in the fat mass index between these two groups (p-value=0.527).
Conclusion: According to the findings of this study, the severity of the disease in chemical veterans with COPD had an increasing effect on fat-free mass and muscle mass body composition.

Keywords


1. Balali-Mood M, Balali-Mood B. Sulphur mustard poisoning and its complications in Iranian veterans. Iranian Journal of Medical Sciences. 2009;34(3): 155-71. 2. Kehe K, Thiermann H, Balszuweit F, Eyer F, Steinritz D, Zilker T. Acute effects of sulfur mustard injury-Munich experiences. Toxicology. 2009;:263(1) 3-8. doi:10.1016/j.tox.2009.04.060 3. Rowell M, Kehe K, Balszuweit F, Thiermann H. The chroni c effects of sulfur mustard exposure. Toxicology. 2009;263(1):9-11. doi:10.1016/j.tox.2009.05.015 4. Attaran D, Lari SM, Towhidi M, Marallu HG, Ayatollahi H, Khajehdaluee M, et al. Interleukin-6 and airflow limitation in chemical warfare patients with chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2010; 5:335. doi:10.2147/COPD.S12545 5. Emad A, Rezaian GR: The diversity of the effects of sulfur mustard gas inhalation on respiratory system 10 years after a single, heavy exposure. Chest 1997, 112:734-738. doi:10.1378/chest.112.3.734 6. Khateri S, Ghanei M, Keshavarz S, Soroush M, Hains D. Incidence of lung, eye and skin lesions on late complications in 34,000 Iranian with wartime exposure to mustard agent. J Occu Environ Med 2003; 45:1136-43. doi:10.1097/01.jom.0000094993.20914.d1 7. Balali-Mood M, Hefazi M, Mahmoudi M, Jalali E, Attaran D, Maleki M, et al. Long term complications of sulfur mustard poisoning in severely intoxicated Iranian. Fundamental & clinical Pharmacology. 2005, 19, 713-721. doi:10.1111/j.1472-8206.2005.00364.x 8. Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's principles of internal medicine: McGraw-Hill Professional Publishing; 2018. 9. Adeloye D, Chua S, Lee C, Basquill C, Papana A, Theodoratou E, et al. Global and regional estimates of COPD prevalence: Systematic review and meta-analysis. Journal of global health. 2015;5(2). doi:10.7189/jogh.05.020415 10. Mannino DM, Braman S. The epidemiology and economics of chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society. 2007;4(7):502-6. doi:10.1513/pats.200701-001FM 11. Sin DD, Man SFP. Systemic inflammation and mortality in chronic obstructive pulmonary diseaseThis paper is one of a selection of papers published in this Special Issue, entitled Young Investigators' Forum. Canadian Journal of Physiology and Pharmacology. 2007;85(1):141-7. doi:10.1139/y06-093 12. Margretardottir OB, Thorleifsson SJ, Gudmundsson G, Olafsson I, Benediktsdottir B, Janson C, et al. Hypertension, systemic inflammation and body weight in relation to lung function impairment-an epidemiological study. COPD: Journal of Chronic Obstructive Pulmonary Disease. 2009;6(4):250-5. doi:10.1080/15412550903049157 13. Me'marian R, Mohammadi I, Mirbagheri N. The Effect of Planning Regular Walking as Rehabilitation in Chronic Obstructive Pulmonary Patients Clinical Status. Archives of Rehabilitation. 2009;10(2). 14. Ghanei M, Adibi I. Clinical review of mustard lung. Iranian Journal of Medical Sciences. 2007;32(2):58-65. 15. Shahbazpour N. Prevalence of overweight and obesity and their relation to hypertension in adult male university students in Kerman, Iran. International Journal of Endocrinology and Metabolism. 2003;1(2). 16. Poulain M, Doucet M, Major GC, Drapeau V, Series F, Boulet LP, et al. The effect of obesity on chronic respiratory diseases: pathophysiology and therapeutic strategies. CMAJ 2006; 174: 1293-9. doi:10.1503/cmaj.051299 17. Knight GS, Beddoe AH, Streat SJ, Hill GL. Body composition of two human cadavers by neutron activation and chemical analysis. American Journal of Physiology-Endocrinology and Metabolism. 1986;250(2):E179-85. doi:10.1152/ajpendo.1986.250.2.E179 18. Andreoli A, Garaci F, Cafarelli FP, Guglielmi G. Body composition in clinical practice. European journal of radiology. 2016;85(8):1461-8. doi:10.1016/j.ejrad.2016.02.005 19. Earthman CP. Body composition tools for assessment of adult malnutrition at the bedside: a tutorial on research considerations and clinical applications. Journal of Parenteral and Enteral Nutrition. 2015;39(7):787-822. doi:10.1177/0148607115595227 20. Siddiqui NI, Khan SA, Shoeb M, Bose S. Anthropometric predictors of bio-impedance analysis (BIA) phase angle in healthy adults. Journal of clinical and diagnostic research. 2016;10(6): CC01. doi:10.7860/JCDR/2016/17229.7976 21. Genton L, Herrmann FR, Spörri A, Graf CE. Association of mortality and phase angle measured by different bioelectrical impedance analysis (BIA) devices. Clinical nutrition. 2018;37(3):1066-9. doi:10.1016/j.clnu.2017.03.023 22. Rutten EP, Bakke PS, Pillai SG, Wagers S, Grydeland TB, Gulsvik A, et al. The association between body composition and self-reported co-morbidity in subjects with chronic obstructive pulmonary disease. Open Journal of Internal Medicine. 2012;2(02):100. doi:10.4236/ojim.2012.22019 23. Koblizek V, Pracharova S, Hronek M, Kovarik M, Palicka V, Pavlikova L, et al. Body composition of COPD patients indicated to ambulatory pulmonary rehabilitation program. Chest. 2012;142(4):790A. doi:10.1378/chest.1389401 24. Eisner MD, Blanc PD, Sidney S, Yelin EH, Lathon PV, Katz PP, et al. Body composition and functional limitation in COPD. Respiratory research. 2007;8(1):7. doi:10.1186/1465-9921-8-7 25. Sigari DN, Ghafori DB. Reliability of Persian Version of COPD Assessment Test and its correlation with disease severity. Scientific Journal of Kurdistan University of Medical Sciences. 2014;18(4):59-65. 26. Abbasi S, Mehdizadeh S, Moqaddam M. The relationship between fatigue and mental health in chemical warfare victims with bronchiolitis obliterans. EBNESINA. 2013;15(2):28-32. 27. Araghizadeh, Karimi Zarchi, Azizabadi Farahani M., Khoddami Vishte H. R. Risk Factors of Readmission Due to Exacerbation in Chemical Injured Patients with Chronic Pulmonary Diseases. Journal of Military Medicine. 2007;9(3):197-206. 28. Ghoddousi K, Ghanei M, Bahaeloo Horeh S, Khoddami Vishteh H. Body Mass Index in Veterans Exposed to Chemical Warfare Agents with Chronic Bronchiolitis. Iranian Journal of Endocrinology and Metabolism. 2007;9(3),285-290. 29. Hashemi javaheri AA, Saberi M, Mohamad rahimi N, Khodaei M. Body Mass Index, waist to hip ratio, and percentage of body fat of the Chemical war survivors in Razavi Khorasan. Iranian Journal of War and Public Health. 2012;4(2):34-40. 30. González Islas D, Orea Tejeda A, Verdeja Vendrell L, Jiménez Cepeda AG, Navarrete Peñaloza AG, Pérez Cortés GK, et al. Body composition assessment in COPD and pulmonary hypertension patients. European Respiratory Journal. 2017; 50 (suppl 61): PA2437. doi:10.1183/1393003.congress-2017.PA2437 31. Minas M, Papaioannou AI, Tsaroucha A, Daniil Z, Hatzoglou C, Sgantzos M, et al. Body composition in severe refractory asthma: comparison with COPD patients and healthy smokers. PloS one. 2010;5(10):e13233. doi:10.1371/journal.pone.0013233 32. Ischaki E, Papatheodorou G, Gaki E, Papa I, Koulouris N, et al. (2007) Body mass and fat-free mass indices in COPD: relation with variables expressing disease severity. Chest 132: 164-169. doi:10.1378/chest.06-2789 33. Vermeeren MA, Creutzberg EC, Schols AM, Postma DS, Pieters WR, Roldaan AC, et al. COSMIC Study Group. Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respiratory medicine. 2006 Aug 1;100(8):1349-55. doi:10.1016/j.rmed.2005.11.023 34. Gologanu D, Ionita D, Gartonea T, Stanescu C, Bogdan MA. Body composition in patients with chronic obstructive pulmonary disease. Maedica. 2014 Mar;9(1):25-32. 35. Nasiripoor Z, Abedi B, Hajirasouli M. Effect of a Training Program on Quality of Life of Severe Respiratory Chemical Veterans; A Case Study of Markazi Province. Iranian Journal of War and Public Health. 2016;8(2):89-94. 36. Casaburi R, Bhasin S, Cosentino L, Porszasz J, Somfay A, Lewis MI, et al. Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine. 2004;170(8):870-8. doi:10.1164/rccm.200305-617OC 37. Panton LB, Golden J, Broeder CE, Browder KD, Cestaro-Seifer DJ, Seifer FD. The effects of resistance training on functional outcomes in patients with chronic obstructive pulmonary disease. European journal of applied physiology. 2004;91(4):443-9. doi:10.1007/s00421-003-1008-y 38. Franssen FM, Broekhuizen R, Janssen PP, Wouters EF, Schols AM. Effects of whole-body exercise training on body composition and functional capacity in normal-weight patients with COPD. Chest. 2004;125(6):2021-8. doi:10.1378/chest.125.6.2021 39. Scoditti E, Massaro M, Garbarino S, Toraldo DM. Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment. Nutrients. 2019;11(6):1357. doi:10.3390/nu11061357 40. Aniwidyaningsih W, Varraso R, Cano N, Pison C. Impact of nutritional status on body functioning in chronic obstructive pulmonary disease and how to intervene. Current opinion in clinical nutrition and metabolic care. 2000,4(11)435-8. doi:10.1097/MCO.0b013e3283023d37