Effects of adherence to the Mediterranean diet on fatigue and activities of daily living in geriatric individuals with COPD

Arslan S., Bozkurt C., ARSLAN M., Bulut H.

Clinical Nutrition ESPEN, vol.54, pp.436-442, 2023 (ESCI) identifier

  • Publication Type: Article / Article
  • Volume: 54
  • Publication Date: 2023
  • Doi Number: 10.1016/j.clnesp.2023.02.019
  • Journal Name: Clinical Nutrition ESPEN
  • Journal Indexes: Emerging Sources Citation Index (ESCI), Scopus, CAB Abstracts, EMBASE, Food Science & Technology Abstracts, MEDLINE, Veterinary Science Database
  • Page Numbers: pp.436-442
  • Keywords: Activities of daily living, Chronic obstructive, Diet, Fatigue, Geriatrics, Mediterranean, Pulmonary disease
  • Sivas Cumhuriyet University Affiliated: Yes


Background & aims: Fatigue is a commonly diagnosed symptom in cancers and many other chronic debilitating diseases. The second most important complaint after dyspnea in patients with Chronic Obstructive Pulmonary Disease (COPD) is the feeling of fatigue. Fatigue can have significant consequences on health status as it can limit patients' activities of daily living, lead to worsening prognosis, and is an indicator of mortality. It remains unclear how fatigue affects the daily life of COPD patients and what physical, social, and emotional challenges it brings. Some studies are showing that adhering to the Mediterranean diet significantly improves fatigue. In this study, the relationship between fatigue and adherence to a Mediterranean diet in COPD patients was investigated. Methods: The present study is a descriptive, cross-sectional, and correlational study. The study population included ≥65-year-old patients with a diagnosis of COPD who were hospitalized in Chest Diseases Clinics of İzmir Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital and Chest Diseases Clinic of Sivas Cumhuriyet University Hospital. The Personal Information Form, Mediterranean Diet Adherence Screener (MEDAS), COPD and Asthma Fatigue Scale (CAFS), and KATZ Activities of Daily Living Scale (Katz ADL) were used as data collection tools. Results: Of the total 526 participants, 58.7% were men, 52.1% were overweight, 54.3% were ex-smokers, and 65.8% were non-drinkers. In the variables related to the disease, the mean duration of having COPD was 16.41 (SD 5.26) years. According to the GOLD classification of the participants, the severity of the disease was determined as Stage III in 57.4% of them, and the severity of dyspnea was determined as “3” (moderate severity) in 54.5% of them according to the mMRC scale. According to the results of the analysis, the mean MEDAS score was 7.84 (SD: 2.76). According to the participants' levels of adherence to the MD, of them, 43.8% had high adherence to MD and 29% had low adherence to MD. The mean CAFS score indicating the level of disease-related fatigue was 69.17 (SD: 15.73), and the lowest and highest scores were 25 and 100 respectively. According to the independence in activities of daily living of the participants, 77.3% were semi-dependent and 6.4% were independent. The comparison of the level of the participant's adherence to the MD according to their mean CAFS scores demonstrated that those who had high adherence to the MD obtained significantly lower scores than the participants in the other groups (p < 0.05). The comparison of the participants' mean MEDAS scores according to their KATZ ADL independence status demonstrated that there was a significant difference (p < 0.001). Conclusions: Adherence to the MD was associated with fatigue and independence in older COPD patients. It was found that high adherence to MD is associated with decreased fatigue and increased independence in activities of daily living in older COPD patients.