Chest
Volume 117, Issue 3, March 2000, Pages 672-678
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Clinical Investigations
COPD
Nutritional Support for Individuals With COPD

https://doi.org/10.1378/chest.117.3.672Get rights and content

Rationale

Malnutrition in patients with COPD is associated with an impaired pulmonary status, reduced diaphragmatic mass, lower exercise capacity, and higher mortality rate when compared to adequately nourished individuals with COPD. Nutritional support may therefore be a useful part of their comprehensive care.

Purpose

To conduct a meta-analysis of randomized controlled trials (RCTs) to clarify whether nutritional supplementation (caloric supplementation for at least 2 weeks) improved anthropometric measures, pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with stable COPD.

Methods

RCTs were identified from several sources, including the Cochrane Airways Group register of RCTs, a hand search of abstracts presented at international meetings, and consultation with experts. Two reviewers independently selected trials for inclusion, assessed quality, and extracted the data. Within each trial and for each outcome, we calculated an effect size. The effect sizes were then pooled by a random-effects model. Homogeneity among the effect sizes was also tested.

Results

From 272 references, nine RCTs were ultimately included. Six articles were considered as high quality. Only two studies were double blinded. For each of the outcomes studied, the effect of nutritional support was small: the 95% confidence intervals around the pooled effect sizes all included zero. The effect of nutritional support was homogeneous across studies.

Conclusion

Nutritional support had no effect on improving anthropometric measures, lung function, or functional exercise capacity among patients with stable COPD.

Section snippets

Search Strategy

RCTs were identified from several sources. Through the Cochrane Airways Group registry of RCTs in COPD, we searched MEDLINE (National Library of Medicine, from 1966 to 1998), EMBASE, and CINAHL (Cumulated Index to Nursing and Allied Health, from 1982 to 1998) for original articles published in all languages. The following terms were used to uncover trials related to nutritional support in COPD: Nutrit*, Malnutrit*, Undernourish*, Weight loss, Food, Feed, Diet*, Lean body mass, BMI, Depletion,

Results

A total of 272 abstracts were identified. After the two primary reviewers assessed the abstracts, the number was reduced to 55 reports closely related to nutrition and COPD (κ = 0.89; 95% CI, 0.82 to 0.96). These were read in detail. Of these studies, 34 were excluded (κ = 0.94; 95% CI, 0.85 to 1.00). Both reviewers agreed on all except four reports that were therefore sent to a third reviewer (Y.L.) for arbitration. Reports were excluded for the following reasons: uncontrolled study,9, 1123, 24

Discussion

Interest regarding weight loss among those with COPD has resulted in several trials of nutritional support, administered orally or by percutaneous gastrostomy.23 Unfortunately, some reported studies were not randomized or controlled.23, 2425, 26 We used a broad definition of nutritional support (any caloric supplementation> 2 weeks) to enable us to include as many trials as possible. In the nine interventions that were both randomized and controlled, we found the effect size to be consistently

ACKNOWLEDGMENT

We thank the authors of the original articles who provided data beyond that included in their published articles. We also thank the staff of the Cochrane “Airways Group” for their invaluable support and assistance.

References (76)

  • CF Ryan et al.

    Energy balance in stable malnourished patients with chronic obstructive pulmonary disease

    Chest

    (1993)
  • IM Ferreira et al.

    The influence of oral anabolic steroids on body mass and respiratory muscles in undernourished COPD patients

    Chest

    (1998)
  • SS Akrabawi et al.

    Gastric emptying, pulmonary function, gas exchange, and respiratory quotient after feeding a moderate versus high fat enteral formula meal in chronic obstructive pulmonary disease patients

    Nutrition

    (1996)
  • JS Frankfort et al.

    Effects of high and low carbohydrate meals on maximum exercise performance in chronic airflow obstruction

    Chest

    (1991)
  • DA Redelmeier et al.

    Spirometry and dyspnea in patients with COPD: when small differences mean little

    Chest

    (1996)
  • D Moher et al.

    Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?

    Lancet

    (1998)
  • J Pogue et al.

    Overcoming the limitations of current meta-analysis of randomised controlled trials

    Lancet

    (1998)
  • DF Rochester

    Nutritional depletion

    Semin Respir Med

    (1992)
  • AMWJ Schols et al.

    Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation

    Am Rev Respir Dis

    (1993)
  • DR Openbrier et al.

    Nutritional status and lung function in patients with emphysema and chronic bronchitis

    Chest

    (1993)
  • VA Angelillo

    Nutrition and the pulmonary patient

  • AMWJ Schols et al.

    Evidence for a relation between metabolic derangement and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease

    Thorax

    (1996)
  • I De Godoy et al.

    Elevated TNF-alpha production by peripheral blood monocytes of weight-losing COPD patients

    Am J Respir Crit Care Med

    (1996)
  • M Di Francia et al.

    Tumor necrosis factor-alpha levels and weight loss in chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1994)
  • DO Wilson et al.

    Body weight in chronic obstructive pulmonary disease: the National Institutes of Health Intermittent Positive Pressure Breathing Trial

    Am Rev Respir Dis

    (1989)
  • NS Arora et al.

    Respiratory muscle strength and maximal voluntary ventilation in undernourished patients

    Am Rev Respir Dis

    (1982)
  • DK Gray et al.

    Nutritional status and mortality in chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1996)
  • E Fiaccadori et al.

    A preliminary report on the effects of malnutrition on the skeletal muscle composition in chronic obstructive pulmonary disease

  • MP Donahoe

    Nutrition in end stage pulmonary disease

    Monaldi Arch Chest Dis

    (1995)
  • J Efthimiou et al.

    The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease

    Am Rev Respir Dis

    (1988)
  • JS Whittaker et al.

    The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive disease patients

    Am Rev Respir Dis

    (1990)
  • MI Lewis et al.

    Nutritional supplementation in ambulatory patients with COPD

    Am Rev Respir Dis

    (1987)
  • AMWJ Schols et al.

    Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease

    Am J Respir Crit Care Med

    (1998)
  • M Lewis

    Nutrition and chronic obstructive pulmonary disease: a clinical overview

  • JL Fleiss

    The statistical basis of meta-analysis

    Stat Methods Med Res

    (1993)
  • Y Lacasse et al.

    Meta-analysis of respiratory rehabilitation in chronic obstructive pulmonary disease

    Lancet

    (1996)
  • M Donahoe et al.

    The effect of an aggressive nutritional support regimen on body composition in patients with severe COPD and weight loss [abstract]

    Am J Respir Crit Care Med

    (1994)
  • MK Sridhar et al.

    An out patient nutritional supplementation programme in COPD patients

    Eur Respir J

    (1994)
  • Cited by (0)

    This study was made possible due to funding from FAPESP, Fundacao de Amparo a pesquisa do Estado de Sao Paulo, Brazil (I.M.F.), the Canadian Lung Association/MRC/Glaxo Welcome Postdoctoral fellowship (D.B.), and West Park Hospital Foundation.

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