COPD: Determination of Energy Needs (2007)
- Individuals with severe emphysema who were weight stable, screened for advanced emphysema by pulmonary function tests and CT scanning of lungs
- None had a >10% change in weight within the 6 months prior to enrollment
Cases:
- Smoked within 6 months of evaluation
- Previously diagnosed pulmonary vascular disease, ischemic heart disease, or congestive heart failure
- None were hospitalized during 6 months prior to inclusion
- None had other illnesses known to affect either BMI, soluble tumor necrosis factor receptors, or leptin levels, such as infection, thyroid disease, cancer or collagen vascular disease
- None had abnormalities in fluid balance manifested by congestive heart failure, ascites, or pleural effusion
Controls:
- History of smoking, concomitant lung disease, or other serious medical illness
Recruitment
Patients were participants of the National Emphysema Treatment Trial. Recruitment of healthy controls not described.
Design
Case-Control Study.
Blinding used (if applicable)
Not applicable.
Intervention (if applicable)
Not applicable.
Statistical Analysis
Data were tested for normality using Kolmogorov-Smirnov test and groups compared using two sample t test. Univariate regression analysis and multiple backward stepwise regression analyses were performed. Least-square technique was used to obtain the line that best fit the data. Within-group analyses also examined for gender-related differences in leptin, BMI, fat mass percentage, and other characteristics.
Timing of Measurements
Measurements made in both cases and controls and compared.
Dependent Variables
- Weight measured with beam scale
- Pulmonary function tests included spirometry, lung volumes by plethysmography, and single-breath diffusing capacity for carbon monoxide
- Body composition assessed by bioelectrical impedance
- Serum leptin levels assessed with ELISA
- Serum tumor necrosis factor receptors (s-TNF-Rs) assessed with radioimmunoassay
- Resting oxygen consumption normalized to kg (RVO2/kg) and fat free mass (RVO2/FFM), measured using indirect calorimetry
Independent Variables
- Severe emphysema
Control Variables
- Age
Initial N: 79 patients with severe emphysema (43 men, 36 women), 20 age-matched healthy controls (10 women, 10 men)
Attrition (final N): 79 cases, 20 controls
Age: mean age cases: 68 +/- 5 years, controls: 66 +/- 6 years
Ethnicity: not mentioned
Other relevant demographics:
Anthropometrics: Patient group and healthy group had similar age, BMI and body composition.
Location: New York
Characteristic |
Cases (n=79) |
Controls (n=20) | P value |
BMI |
25.7 +/- 4.7 | 26.0 +/- 2.2 | NS |
FFM, kg |
56.1 +/- 10.3 |
57.6 +/- 9.0 |
NS |
Percent FM |
21.8 +/- 5.7 |
20.1 +/- 3.9 |
NS |
Leptin, ng/ml | 14.4 +/- 11.5 | 11.5 +/- 6.5 | NS |
sTNF-R 55, ng/ml | 1.7 +/- 0.5 | 1.4 +/- 0.5 | 0.02 |
sTNF-R 75, ng/ml | 3.2 +/- 0.7 | 2.8 +/- 0.6 | 0.02 |
RVO2, ml | 242.1 +/- 43.5 | 181.5 +/- 30.4 | <0.001 |
RVO2/kg, ml/kg | 3.34 +/- 0.67 | 2.52 +/- 0.24 | <0.001 |
RVO2/FFM, ml/kg | 4.29 +/- 0.75 | 3.16 +/- 0.35 | <0.001 |
Other Findings
RVO2/kg, RVO2/FFM and sTNF-R levels were higher in patients compared to healthy subjects.
There were no differences in serum leptin levels between emphysematous and healthy subjects, and there was no correlation between leptin and s-TNF-R and RVO2/kg.
Furthermore, both groups had similar gender-related differences in FFM, percentage of body fat, and serum leptin levels.
Patients with lower BMI showed the greatest differences from control subjects in RVO2/kg.
Recruitment of controls not described, controls not matched for gender, and groups not equally sized.
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | N/A | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | N/A | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | ??? | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | ??? | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | ??? | |
3. | Were study groups comparable? | ??? | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | N/A | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | Yes | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | Yes | |
3.4. | If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? | N/A | |
3.5. | If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) | ??? | |
3.6. | If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? | N/A | |
4. | Was method of handling withdrawals described? | Yes | |
4.1. | Were follow-up methods described and the same for all groups? | Yes | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | Yes | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | Yes | |
4.4. | Were reasons for withdrawals similar across groups? | N/A | |
4.5. | If diagnostic test, was decision to perform reference test not dependent on results of test under study? | N/A | |
5. | Was blinding used to prevent introduction of bias? | Yes | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | N/A | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | N/A | |
5.3. | In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? | N/A | |
5.4. | In case control study, was case definition explicit and case ascertainment not influenced by exposure status? | Yes | |
5.5. | In diagnostic study, were test results blinded to patient history and other test results? | N/A | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | Yes | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | N/A | |
6.2. | In observational study, were interventions, study settings, and clinicians/provider described? | Yes | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | N/A | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | N/A | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | Yes | |
6.6. | Were extra or unplanned treatments described? | N/A | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | Yes | |
6.8. | In diagnostic study, were details of test administration and replication sufficient? | N/A | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | Yes | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | Yes | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | Yes | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | N/A | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | Yes | |
7.5. | Was the measurement of effect at an appropriate level of precision? | Yes | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | Yes | |
7.7. | Were the measurements conducted consistently across groups? | Yes | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | Yes | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | Yes | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | Yes | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | Yes | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | N/A | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | Yes | |
8.6. | Was clinical significance as well as statistical significance reported? | Yes | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | N/A | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | Yes | |
9.1. | Is there a discussion of findings? | Yes | |
9.2. | Are biases and study limitations identified and discussed? | No | |
10. | Is bias due to study's funding or sponsorship unlikely? | Yes | |
10.1. | Were sources of funding and investigators' affiliations described? | Yes | |
10.2. | Was the study free from apparent conflict of interest? | Yes | |