Systemic inflammation and weight gain in underweight patients with advanced pulmonary disease

Weight changes influence the prognosis in patients with chronic obstructive pulmonary disease. We studied the association between systemic inflammation and weight gain in underweight patients with advanced pulmonary disease. Apart from C3, no significant differences in immunologic parameters occurred at baseline when comparing those who gained more than 2 kg (n = 17) with those who gained less (n = 17). An acute phase response (C-reactive protein > 5 mg/L) was present in 71% of the underweight patients (n = 42) and 59% of the normal-weight patients (n = 29), and it was associated with increased serum concentrations of immunoglobulins (IgG, IgM), C3, interleukin (IL)-2 sRα, soluble tumor necrosis factor α receptor (sTNF-α RI) in the underweight patients and IL-2 sRα in the normal-weight patients. After intervention, there was a significant reduction in C-reactive protein in the underweight patients with a weight gain of more than 2 kg, compared with those with a smaller weight gain, and a decrease in IgG (−0.2 [−3.4 to 1.6] vs 1.3 [−5.4 to 3.6] g/L, P = .02) and IL-2 sRα (−415 [−324 to 301] vs 45 [−619 to 1300] pg/mL, P = .005]. Our results suggest that there is some normalization of the immune activity after dietary intervention and weight gain in underweight patients with advanced pulmonary disease.