2012年8月6日月曜日

COPDへのホエイペプチド栄養剤+運動療法

COPD患者に対するホエイペプチドを含んだ栄養剤+運動療法の併用の効果をみた研究を紹介します。

Sugawara K, Takahashi H, Kashiwagura T, Yamada K, Yanagida S, Homma M, Dairiki K, Sasaki H, Kawagoshi A, Satake M, Shioya T. Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD. Respir Med. 2012 Aug 2. [Epub ahead of print]

リサーチクエスチョンは以下の通りです。

P:COPD患者(%IBWが110%以下、%FEV(1)が80%以下)に
I:運動療法+栄養指導+メイン1日2本飲んでもらうと(3ヶ月間)
C:運動療法+栄養指導と比較して
O:栄養状態、炎症が改善する(一次アウトカム不明)
D:ランダム化比較試験

低負荷運動療法の内容は、呼吸指導、呼吸筋のストレッチ・筋トレ、四肢運動、15分以上の平地歩行です。メインは抗炎症作用があると言われているホエイペプチドを含んだ栄養剤です。詳細は下記HPを参照してください。
http://www.meiji-eiyoucare.jp/select/product/mein_business/index.html

結果ですが、対照群と比較して、介入群で有意に体重、エネルギー摂取量、アルブミン、炎症マーカー、QOLが改善しました。メインは実際には1日平均1.5本飲んでいました。これよりホエイペプチドを含んだ栄養剤+運動療法の併用は、栄養状態や炎症の改善に有用という結論です。

リハ栄養的には実に素晴らしい結果で、運動と栄養を併用すべきということは確かです。ただ、3ヶ月間の実際の変化量は、体重は50.8kgから52.1kgへと1.3kg増、CRPは0.268mg/dlから0.174mg/dlへと0.096減、アルブミンは4.0g/dlから4.2g/dlへと0.2増と、決して大きいとは言えません。

メインでなければいけないかどうかは、今回の研究では不明です。他の1日400kcal、蛋白20gの栄養剤でも有効かもしれません。また、栄養剤を飲むタイミングに関しては明らかな記載がありません。リハ栄養的には運動療法直後に栄養剤を飲むほうが、より効果を期待できると思われます。

Abstract

BACKGROUND:

One of the major pathophysiologies in advanced chronic obstructive pulmonary disease (COPD) has been attributed to systemic inflammation. Meta-analysis of the 2005 Cochrane Database concluded the effect of nutritional supplementation alone on stable COPD was insufficient to promote body weight gain or exercise capacity. The aim of this study was to investigate the effectiveness of nutritional supplementation therapy using a nutritional supplement containing whey peptide with low-intensity exercise therapy in stable elderly patients with COPD.

METHOD:

In stable elderly COPD patients with %IBW and %FEV(1) of less than 110 and 80%, respectively, anti-inflammatory nutritional supplementation therapy was added to low-intensity exercise therapy. Thirty-six COPD patients were divided into those with and those without the ingestion of an anti-inflammatory nutritional supplement containing whey peptide, which exhibited an anti-inflammatory effect. These two groups were designated as the nutritional support and the control groups, respectively. The body composition, skeletal muscle strength, exercise tolerance, health-related QOL (HRQOL), and inflammatory cytokines were evaluated before and three months after nutritional support combined with exercise therapy in both the nutritional support group and the control group.

RESULTS:

In the nutritional support group, the body weight, %IBW, FM, energy intake, %AC, Alb, PImax, PEmax, 6MWD, WBI, emotional function, and CRQ total were significantly increased, and the levels of hsCRP, IL-6, IL-8, and TNF-α were reduced significantly, while no significant change was noted in any item of physiological evaluation or any biomarker in the control group.

CONCLUSION:

Concomitant use of a anti-inflammatory nutritional supplement containing whey peptide, which exhibits an anti-inflammatory effect, with exercise therapy in stable elderly COPD patients with %IBW<110 also="also" and="and" body="body" but="but" exercise="exercise" hrqol.="hrqol." improve="improve" increase="increase" inflammation="inflammation" inhibit="inhibit" may="may" not="not" only="only" p="p" systemic="systemic" thus="thus" tolerance="tolerance" weight="weight">

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