Macronutrient preferences in patients with chronic obstructive pulmonary disease and hypoxemia

To the Editor: Cachexia represents a major clinical problem in patients with advanced chronic obstructive pulmonary disease (COPD), which is difficult to reverse, has negative prognostic value, and is associated with serious comorbidities. [...]we read with great interest the review article in Nutrition by Raguso and Luthy [1] on the profound implications of chronic hypoxia on three key elements involved in cachexia and energy homeostasis in such patients, namely energy intake, muscle function, and hormonal control of energy balance. The OmniHeart study demonstrated that partial replacement of carbohydrate with protein or with unsaturated fat can decrease blood pressure, low-density lipoprotein cholesterol, and coronary heart disease risk [7].