PURPOSE: Malnutrition has been shown to affect the diaphragm strength in disease states where factors others than malnutrition might also be responsible.The affect of malnutrition in healthy individuals has not been evaluated in detail.
METHODS: 24 undernourished (BMI <18.5 kg/m2) and 26 well nourished (BMI ≥18.5 kg/m2) subjects (age group 15-60 years) were studied. Nutritional status was assessed using anthropometric measurements [weight, height, body mass index (BMI), mid arm circumference (MAC), arm muscle circumference (AMC)] and body composition analysis [fat free mass (FFM), fat mass (FM), % total body fat]. Diaphragmatic strength was measured using maximal inspiratory pressure (MIP), sniff nasal inspiratory pressure (SNIP), and sniff esophageal pressure.Ultrasonographic assessment of diaphragmatic excursion during tidal breathing (Mov.VT) and deep breathing (Mov.VC) and diaphragmatic thickness was also done.
RESULTS: Undernourished (Mean BMI 16.82 ± 0.98 kg/m2) and well nourished group(Mean BMI 21.70 ± 3.29 kg/m2)significantly differed in nutritional status(p <0.001). MIP showed positive correlation with weight(r=0.42, p<0.01), height(r=0.44, p<0.01), TSFT(r=0.38, p<0.05), MAC(r=0.39, p<0.01), FM(r=0.30, p<0.05), FFM(r=0.45, p=0.001), and albumin(r=0.33, p<0.05). Sniff esophageal pressure correlated significantly with height (r=0.45, p<0.05). Diaphragm movement at deep breathing (MOV.VC) was found to have significant positive correlation with weight(r=0.50, p<0.001), BMI(r=0.52, p<0.001), TSFT(r=0.36, p<0.05), MAC(r=0.43, p<0.01), FAT(r=0.35, p<0.05), FM(r=0.46, p=0.001), FFM(r=0.43, p<0.01), albumin(r=0.37, p=0.01), and serum protein(r=0.29, p<0.05). No significant correlation was observed for SNIP, diaphragm thickness, and diaphragm movement at quiet breathing (MOV.VT) with nutritional parameters. Diaphragm strength and thickness did not differ significantly in undernourished and well nourished groups.
CONCLUSION: Significant correlation exists between the strength of diaphragm and nutritional status. Malnutrition of mild to moderate severity did not affect the strength and thickness of diaphragm in healthy individuals to the extent of clinical significance. Whether severe malnutrition affects the diaphragmatic strength in healthy individual needs further evaluation.
CLINICAL IMPLICATIONS: Significant correlation between the strength of diaphragm and nutritional status suggests that even malnutrition of mild to moderate severity could affect the diaphragmatic strength in disease states.Nutrtional repletion can be expected to improve the diaphragm strength.
DISCLOSURE: Ishwar Malav, None.