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A randomised trial of dietary counselling and food fortificatiuon in stable chronic obstructive pulmonary disease
  1. Christine Elizabeth Weekes (elizabeth.weekes{at}gstt.nhs.uk)
  1. Guy's & St Thomas' NHS Foundation Trust, United Kingdom
    1. Peter William Emery (peter.emery{at}kcl.ac.uk)
    1. King's College, London, United Kingdom
      1. Marinos Elia (elia{at}soton.ac.uk)
      1. University of Southampton, United Kingdom

        Abstract

        Background: Malnutrition in chronic obstructive pulmonary disease (COPD) is associated with poor prognosis yet evidence to support the role of dietary counselling and food fortification is lacking.

        Objective: To assess the impact of dietary counselling and food fortification on outcome in outpatients with COPD who are at risk of malnutrition.

        Methods: Randomised, controlled trial (unblinded) in 59 outpatients with COPD (6 months intervention:6 months follow-up). Intervention group received dietary counselling and advice on food fortification; controls received a dietary advice leaflet. Outcome measures: nutritional status, respiratory and skeletal muscle strength, respiratory function, perceived dyspnoea, activities of daily living (ADL) and quality of life.

        Results: Intervention group consumed more energy (Difference 194 kcal/day; p = 0.02) and protein (Difference 11.8 g/day; p < 0.001) than controls. Intervention group gained weight during the intervention period and maintained weight during follow-up. Controls lost weight throughout the study. Significant differences were observed between 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); 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.

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