Dietary counselling and food fortification in stable COPD: a randomised trial
- 1Department of Nutrition and Dietetics, Guy’s & St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
- 2Nutritional Sciences Division, King’s College London, London, UK
- 3Institute of Human Nutrition, University of Southampton, Southampton, UK
- Dr C E Weekes, Department of Nutrition and Dietetics, Guy’s & St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London SE1 7EH, UK;
- Received 12 February 2008
- Accepted 20 November 2008
- Published Online First 15 December 2008
Background: Malnutrition in chronic obstructive pulmonary disease (COPD) is associated with a poor prognosis, yet evidence to support the role of dietary counselling and food fortification is lacking. A study was undertaken to assess the impact of dietary counselling and food fortification on outcome in outpatients with COPD who are at risk of malnutrition.
Methods: A randomised controlled unblinded trial was performed in 59 outpatients with COPD (6 months intervention and 6 months follow-up). The intervention group received dietary counselling and advice on food fortification and the controls received a dietary advice leaflet. Outcome measures were nutritional status, respiratory and skeletal muscle strength, respiratory function, perceived dyspnoea, activities of daily living (ADL) and quality of life.
Results: The intervention group consumed more energy (difference 194 kcal/day; p = 0.02) and protein (difference 11.8 g/day; p<0.001) than controls. The intervention group gained weight during the intervention period and maintained weight during follow-up; the controls lost weight throughout the study. Significant differences were observed between the groups in St George’s Respiratory Questionnaire total score (difference 10.1; p = 0.02), Short Form-36 health change score (difference 19.2; p = 0.029) and Medical Research Council dyspnoea score (difference 1.0; p = 0.03); the difference in ADL score approached statistical significance (difference 1.5; p = 0.06). No differences were observed between groups in respiratory function or skeletal and respiratory muscle strength. Improvements in some variables persisted for 6 months beyond the intervention period.
Conclusion: Dietary counselling and food fortification resulted in weight gain and improvements in outcome in nutritionally at-risk outpatients with COPD, both during and beyond the intervention period.
▸ Additional Methods and Results details are published online only at http://thorax.bmj.com/content/vol64/issue4
Funding: During the conduct of this study CEW received Research Training Fellowship awards from the London Regional NHS Executive and the Guy’s and St Thomas’ Hospital Charitable Foundation.
Competing interests: None.
Ethics approval: Ethical approval was obtained from the Guy’s and St Thomas’ Hospital NHS Trust ethics committee (EC97/363) and the University Hospital Lewisham ethics committee (03/08/12).