Nutritional Status and Dietary intake in patients with Non Cystic Fibrosis Bronchiectasis

Bronchiectasis is a heterogeneous complex disease, characterised by persistent cough, purulent sputum and abnormal thickening and dilation of the bronchial wall. Inflammation, both lung and systemic, and phenotypic presentation continues to compound research challenges. Worsening symptoms and lung function lead to increased severity of disease. Within this thesis, in study 1, the narrative review revealed Body Mass Index (BMI) is associated with morbidity and mortality in bronchiectasis. There is a lack of data on body composition and its influence, but an emerging role of vitamin D.
Characterisation of a bronchiectasis population (study 2) revealed a novel measure [Hand grip Strength (HGS)] was impaired within 70% of the regional population and in 96% of a younger cohort with primary ciliary dyskinesia (PCD). BMI was a significant predictor of lung function in bronchiectasis, with HGS and weight a statistically significant predictor of lung function in PCD.
Energy intakes are suboptimal, with 71-81% of estimated average requirement (EAR). Dietary intakes have identified important micronutrients, vitamin E, zinc and vitamin D with consumption consistently <35% of the Reference Nutrient Intake (RNI). Those with PCD have lower overall intakes compared with other aetiological groups.
HGS impairment (study 3) was reported retrospectively, over one year, and was associated with lung function (r = (84) 0.234, p=0.04). Feasibility (study 4) implies consumption of a leucine oral supplement gel is manageable, with 60% consumption despite poorer reported palatability and does not impact dietary intakes. Energy and protein intakes are impaired compared with calculated requirements and failed to reach calculated requirements even with supplementation. Supplementation showed improvements in HGS and serum vitamin D levels over 3 months. Key outcomes and future study have been identified including HGS, micronutrients, dietary intakes, quality of life and exacerbations.