Prospective study on body composition measured by bioelectrical impedance analysis after endoscopic lung volume reduction with valves

<bold>Background:</bold> Patients with chronic obstructive pulmonary disease (COPD) and pulmonary emphysema often suffer from malnutrition. Endoscopic lung volume reduction (ELVR) with endobronchial valves has been shown to cause weight gain in patients with body-mass-index (BMI) <21kg/m² and weight loss in patients with BMI ≥21kg/m² in a retrospective study (Fernandez-Bussy et al. 2023). The effects of ELVR on body weight and body composition have never been studied prospectively. <bold>Methods:</bold> This is a single-center prospective analysis of COPD patients undergoing ELVR with endobronchial valves. Parameters to assess ELVR success, dietary behaviour, activity level and body composition were analyzed before and 3-6 months after ELVR. Body composition was analyzed by bioelectrical impedance analysis. <bold>Results:</bold> A total of 23 patients (mean emphysema index 37.2 ± 7.5 %, BMI 23.4 ± 4.3 kg/m²) were included in the analysis. ELVR showed clinically meaningful improvements in lung function and six-minute walking-distance and an atelectasis rate of 39.1%. 34.8% of the patients lost weight, 60.9% gained weight, one patient remained stable. However, 69.6% of all patients showed a worsening of their body composition (ECM/BCM ↑, cell percentage ↓, phase angle ↓) after ELVR. Patients with complete lobar atelectasis had greater functional improvements, but body composition also worsened in 66.7%. <bold>Conclusion:</bold> Weight gain after ELVR may not be beneficial, as it often means a worsening of body composition. The progressive course of COPD may outweigh the benefits of ELVR in terms of body composition. Nutritional behaviour strategies need to be impemented for advanced COPD patients.