Dietary intake of elderly outpatients with chronic obstructive pulmonary disease Alice Laudisio a, *, Luisa Costanzo a , Claudia Di Gioia a , Anna Sofia Delussu b , Marco Traballesi b , Antonella Gemma c , Raffaele Antonelli Incalzi a a Department of Geriatrics, Campus Bio-Medico University, Via Álvaro del Portillo, 200-00128 Rome, Italy b Fondazione Santa Lucia, IRCCS, Rome, Italy c UOS Accesso e Presa in Carico Assistenziale, Azienda Sanitaria Locale Roma E, Borgo S. Spirito, 3 Rome, Italy A R T I C L E I N F O Article history: Received 7 October 2015 Received in revised form 30 December 2015 Accepted 7 January 2016 Available online 14 January 2016 Keywords: Chronic obstructive pulmonary disease Nutrition Diet Elderly Epidemiology A B S T R A C T Purpose: Chronic obstructive pulmonary disease (COPD) is often associated with malnutrition, which is in turn associated with poor outcomes. Accordingly, in COPD patients adequate nutrition might improve several clinical and functional outcomes. Nevertheless, information about nutrient intake of older populations with COPD is still scanty. Materials and methods: We analysed data of 523 elderly attending a geriatric ambulatory. Of these, 165 had a diagnosis of COPD, while 358 were control participants, matched for demographic characteristics and free from respiratory diseases. COPD was diagnosed according to the global initiative for chronic obstructive lung disease (GOLD) criteria. The intake of micro and macronutrients was recorded using the European prospective investigation into cancer and nutrition (EPIC) questionnaire. Nutrient intake of COPD patients was compared with that of the control group and with recommended dietary allowances RDA. Results: COPD patients had a lower energy intake, as compared with control participants (29.4 vs 34.4 kcal/kg of ideal weight; P <.0001), due to reduced intake of carbohydrates and proteins. Accordingly, in the energy intake was lower than recommended in 52% of COPD patients, vs 30% of controls (P <.0001). The intake of calcium, potassium, folate, cholecalciferol, retinol, and thiamine was lower than RDA in over 75% of COPD patients. Conclusions: The diet of elderly COPD outpatients does not provide the recommended energy intake, nor does it meet the RDA for many micronutrients. Such deficits are more severe than in age matched non- respiratory subjects. ã 2016 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Chronic obstructive pulmonary disease (COPD) is characterized by a variable, yet clinically significant impact on nutritional status and body composition. Indeed, decreased free fat mass has been repeatedly reported and variously ascribed to muscle autophagy, increased energy expenditure and inadequate nutrient intake (Guo et al., 2013; Sergi et al., 2006; Itoh, Tsuji, Nemoto, Nakamura, & Aoshiba, 2013). Malnutrition becomes more severe in COPD patients on long-term oxygen therapy, although to a lesser extent than in people requiring long-term oxygen therapy because of restrictive and neuromuscular diseases or bronchiectases (Cano et al., 2002). However, age per se seems to modulate the effects of COPD on nutritional status: in COPD patients aged 65 and over, loss of appetite and reduced intake of liquids are primarily associated with malnutrition (Battaglia et al., 2011). Coexisting obesity might also contribute to malnutrition by promoting systemic inflammation and loss of free fat mass (Tkacova, 2010). Finally, female patients are at greater risk of nutritional depletion; neither the Forced Expiratory Volume in the first second nor severity of dyspnoea and health status impairment correlate with loss of free fat mass, as if systemic factors play a primary role in the development of nutritional status impairment (Di Marco et al., 2006). While inflammatory and procatabolic status have been variously related to fat mass depletion in COPD, poor attention Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, global initiative for chronic obstructive lung disease; EPIC, European prospective investigation into cancer and nutrition; RDA, recommended daily allowance. * Corresponding author. Fax: +39 0622541456. E-mail address: lavoralice@gmail.com (A. Laudisio). http://dx.doi.org/10.1016/j.archger.2016.01.006 0167-4943/ ã 2016 Elsevier Ireland Ltd. All rights reserved. Archives of Gerontology and Geriatrics 64 (2016) 75–81 Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal home page: www.elsevier.com/locat e/archger