Weight gain after lung reduction surgery is related to improved lung function and ventilatory efficiency

Victor Kim, Dana M. Kretschman, Alice L Sternberg, Malcolm M. DeCamp, Gerard J. Criner

Research output: Contribution to journalArticle

Abstract

Rationale: Lung volume reduction surgery (LVRS) is associated with weight gain in some patients, but the group that gains weight after LVRS and the mechanisms underlying this phenomenon have not been well characterized. Objectives: To describe the weight change profiles of LVRS patients enrolled in the National Emphysema Treatment Trial (NETT) and to correlate alterations in lung physiological parameters with changes in weight. Methods: We divided 1,077 non-high-risk patients in the NETT into groups according to baseline body mass index (BMI): underweight (2), normal weight (21-25 kg/m2), overweight (25-30 kg/m2), and obese (>30 kg/m2). We compared BMI groups and LVRS andmedical groups within each BMI stratum with respect to baseline characteristics and percent change in BMI (%ΔBMI) from baseline. We examined patients with (ΔBMI ≥ 5%) and without (ΔBMI <5%) significant weight gain at 6 months and assessed changes in lung function and ventilatory efficiency (V̇E/ V̇CO2). Measurements and Main Results: The percent change in BMI was greater in the LVRS arm than in the medical arm in the underweight and normal weight groups at all follow-up time points, and at 12 and 24 months in the overweight group. In the LVRS group, patients with ΔBMI ≥ 5% at 6 months had greater improvements in FEV1 (11.53 ± 9.31 vs. 6.58 ± 8.68%; P <0.0001), FVC (17.51 ± 15.20 vs. 7.55 ± 14.88%; P <0.0001), residual volume (-66.20 ± 40.26 vs. -47.06 ± 39.87%; P <0.0001), 6-minute walk distance (38.70 ± 69.57 vs. 7.57 ± 73.37 m; P <0.0001), maximal expiratory pressures (12.73 ± 49.08 vs. 3.54 ± 32.22; P = 0.0205), and V̇E/ V̇CO2 (-1.58 ± 6.20 vs. 0.22 ± 8.20; P = 0.0306) at 6 months than patients with ΔBMI <5% at 6 months. Conclusions: LVRS leads to weight gain in nonobese patients, which is associated with improvement in lung function, exercise capacity, respiratory muscle strength, and ventilatory efficiency. These physiological changes may be partially responsible for weight gain in patients who undergo LVRS.

Original languageEnglish (US)
Pages (from-to)1109-1116
Number of pages8
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume186
Issue number11
DOIs
StatePublished - Dec 1 2012

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Pneumonectomy
Weight Gain
Body Mass Index
Lung
Weights and Measures
Thinness
Emphysema
Respiratory Muscles
Residual Volume
Muscle Strength
Exercise
Therapeutics

Keywords

  • Cachexia
  • Chronic obstructive
  • Lung volume reduction surgery
  • Pulmonary disease
  • Ventilatory efficiency

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Weight gain after lung reduction surgery is related to improved lung function and ventilatory efficiency. / Kim, Victor; Kretschman, Dana M.; Sternberg, Alice L; DeCamp, Malcolm M.; Criner, Gerard J.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 186, No. 11, 01.12.2012, p. 1109-1116.

Research output: Contribution to journalArticle

Kim, Victor ; Kretschman, Dana M. ; Sternberg, Alice L ; DeCamp, Malcolm M. ; Criner, Gerard J. / Weight gain after lung reduction surgery is related to improved lung function and ventilatory efficiency. In: American Journal of Respiratory and Critical Care Medicine. 2012 ; Vol. 186, No. 11. pp. 1109-1116.
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abstract = "Rationale: Lung volume reduction surgery (LVRS) is associated with weight gain in some patients, but the group that gains weight after LVRS and the mechanisms underlying this phenomenon have not been well characterized. Objectives: To describe the weight change profiles of LVRS patients enrolled in the National Emphysema Treatment Trial (NETT) and to correlate alterations in lung physiological parameters with changes in weight. Methods: We divided 1,077 non-high-risk patients in the NETT into groups according to baseline body mass index (BMI): underweight (2), normal weight (21-25 kg/m2), overweight (25-30 kg/m2), and obese (>30 kg/m2). We compared BMI groups and LVRS andmedical groups within each BMI stratum with respect to baseline characteristics and percent change in BMI ({\%}ΔBMI) from baseline. We examined patients with (ΔBMI ≥ 5{\%}) and without (ΔBMI <5{\%}) significant weight gain at 6 months and assessed changes in lung function and ventilatory efficiency (V̇E/ V̇CO2). Measurements and Main Results: The percent change in BMI was greater in the LVRS arm than in the medical arm in the underweight and normal weight groups at all follow-up time points, and at 12 and 24 months in the overweight group. In the LVRS group, patients with ΔBMI ≥ 5{\%} at 6 months had greater improvements in FEV1 (11.53 ± 9.31 vs. 6.58 ± 8.68{\%}; P <0.0001), FVC (17.51 ± 15.20 vs. 7.55 ± 14.88{\%}; P <0.0001), residual volume (-66.20 ± 40.26 vs. -47.06 ± 39.87{\%}; P <0.0001), 6-minute walk distance (38.70 ± 69.57 vs. 7.57 ± 73.37 m; P <0.0001), maximal expiratory pressures (12.73 ± 49.08 vs. 3.54 ± 32.22; P = 0.0205), and V̇E/ V̇CO2 (-1.58 ± 6.20 vs. 0.22 ± 8.20; P = 0.0306) at 6 months than patients with ΔBMI <5{\%} at 6 months. Conclusions: LVRS leads to weight gain in nonobese patients, which is associated with improvement in lung function, exercise capacity, respiratory muscle strength, and ventilatory efficiency. These physiological changes may be partially responsible for weight gain in patients who undergo LVRS.",
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AU - Kretschman, Dana M.

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N2 - Rationale: Lung volume reduction surgery (LVRS) is associated with weight gain in some patients, but the group that gains weight after LVRS and the mechanisms underlying this phenomenon have not been well characterized. Objectives: To describe the weight change profiles of LVRS patients enrolled in the National Emphysema Treatment Trial (NETT) and to correlate alterations in lung physiological parameters with changes in weight. Methods: We divided 1,077 non-high-risk patients in the NETT into groups according to baseline body mass index (BMI): underweight (2), normal weight (21-25 kg/m2), overweight (25-30 kg/m2), and obese (>30 kg/m2). We compared BMI groups and LVRS andmedical groups within each BMI stratum with respect to baseline characteristics and percent change in BMI (%ΔBMI) from baseline. We examined patients with (ΔBMI ≥ 5%) and without (ΔBMI <5%) significant weight gain at 6 months and assessed changes in lung function and ventilatory efficiency (V̇E/ V̇CO2). Measurements and Main Results: The percent change in BMI was greater in the LVRS arm than in the medical arm in the underweight and normal weight groups at all follow-up time points, and at 12 and 24 months in the overweight group. In the LVRS group, patients with ΔBMI ≥ 5% at 6 months had greater improvements in FEV1 (11.53 ± 9.31 vs. 6.58 ± 8.68%; P <0.0001), FVC (17.51 ± 15.20 vs. 7.55 ± 14.88%; P <0.0001), residual volume (-66.20 ± 40.26 vs. -47.06 ± 39.87%; P <0.0001), 6-minute walk distance (38.70 ± 69.57 vs. 7.57 ± 73.37 m; P <0.0001), maximal expiratory pressures (12.73 ± 49.08 vs. 3.54 ± 32.22; P = 0.0205), and V̇E/ V̇CO2 (-1.58 ± 6.20 vs. 0.22 ± 8.20; P = 0.0306) at 6 months than patients with ΔBMI <5% at 6 months. Conclusions: LVRS leads to weight gain in nonobese patients, which is associated with improvement in lung function, exercise capacity, respiratory muscle strength, and ventilatory efficiency. These physiological changes may be partially responsible for weight gain in patients who undergo LVRS.

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KW - Cachexia

KW - Chronic obstructive

KW - Lung volume reduction surgery

KW - Pulmonary disease

KW - Ventilatory efficiency

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