Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-17T13:54:48.969Z Has data issue: false hasContentIssue false
  • English
  • Français

Optimizing oral nutritional drink supplementation in patients with chronic obstructive pulmonary disease

Published online by Cambridge University Press:  08 March 2007

Roelinka Broekhuizen ,
Eva C. Creutzberg ,
Clarie A. P. M. Weling-Scheepers ,
Emiel F. M. Wouters  and
Annemie M. W. J. Schols
Roelinka Broekhuizen*
Affiliation:
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands
Eva C. Creutzberg
Affiliation:
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands Asthma Centre Hornerheide, Horn, The Netherlands
Clarie A. P. M. Weling-Scheepers
Affiliation:
Asthma Centre Hornerheide, Horn, The Netherlands
Emiel F. M. Wouters
Affiliation:
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands
Annemie M. W. J. Schols
Affiliation:
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands
*
*Corresponding author: Dr Roelinka Broekhuizen, fax +31 43 3875051, email r.broekhuizen@pul.unimaas.nl
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Nutritional support is indicated in some patients with chronic obstructive pulmonary disease to restore nutritional status and improve functional capacity. However, the efficacy of nutritional supplements is sometimes disappointing, partly owing to a compensatory drop in habitual food intake. We retrospectively studied the effect of nutritional drink supplements, differing in portion size and energy content, on weight gain and body composition. Thirty-nine patients with stable chronic obstructive pulmonary disease, participating in an 8-week pulmonary rehabilitation programme and eligible for nutritional support, were studied. Group A (n 19) received three portions of 125 ml (2380 kJ), whereas group B (n 20) received three portions of 200 ml (3350 kJ) daily. The macronutrient composition of the regimens was similar (20 % protein, 60 % carbohydrates and 20 % fat). Lung function, body weight, body composition (by bio-electrical impedance analysis), habitual dietary intake (by dietary history) and resting energy expenditure (by ventilated hood) were determined. Weight gain was compared with expected weight as predicted by a computer simulation model. Although patients in both groups significantly increased in weight, this increase was higher in group A (A, 3·3 (sd 1·9) kg; B, 2·0 (sd 1·2) kg; P=0·019), while receiving less energy. The observed weight gain in group A was similar to that expected, but in group B it was lower than expected (P<0·001). In both groups, fat-free mass and fat mass were gained in a ratio of 2:1, fat-free mass increasing primarily during the first 4 weeks. This study illustrates that there might be an optimum for the portion size of nutritional drink supplements in chronic obstructive pulmonary disease and that more is not always better.

Keywords

Chronic obstructive pulmonary diseaseNutritionBody compositionTherapyRehabilitation
Type
Research Article
Information
British Journal of Nutrition , Volume 93 , Issue 6 , June 2005 , pp. 965 - 971
Copyright
Copyright © The Nutrition Society 2005

References

Akrabawi, SS, Mobarhan, S, Stoltz, RR & Ferguson, PW (1996) 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 12, 260–265.CrossRefGoogle ScholarPubMed
American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med 152, S77–S121.Google Scholar
Baarends, EM, Schols, AM, Akkermans, MA & Wouters, EF (1997a) Decreased mechanical efficiency in clinically stable patients with COPD. Thorax 52, 981–986.CrossRefGoogle ScholarPubMed
Baarends, EM, Schols, AM, Mostert, R & Wouters, EF (1997b) Peak exercise response in relation to tissue depletion in patients with chronic obstructive pulmonary disease. Eur Respir J 10, 2807–2813.CrossRefGoogle ScholarPubMed
Baarends, EM, Schols, AMWJ, Pannemans, DL, Westerterp, KR & Wouters, EFM (1997c) Total free living energy expenditure in patients with severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med 155, 549–554.CrossRefGoogle ScholarPubMed
Barton, AD, Beigg, CL, Macdonald, IA & Allison, SP (2000) A recipe for improving food intakes in elderly hospitalized patients. Clin Nutr 19, 451–454.CrossRefGoogle ScholarPubMed
Bernard, S, Whittom, F, Leblanc, P, Jobin, J, Belleau, R, Berube, C, Carrier, G & Maltais, F (1999) Aerobic and strength training in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 159, 896–901.CrossRefGoogle ScholarPubMed
Braun, SR, Keim, NL, Dixon, RM, Clagnaz, P, Anderegg, A & Shrago, ES (1984) The prevalence and determinants of nutritional changes in chronic obstructive pulmonary disease. Chest 86, 558–563.CrossRefGoogle ScholarPubMed
Creutzberg, EC, Schols, AMWeling-Scheepers, CABuurman, WA & Wouters, EF (2000) Characterization of nonresponse to high caloric oral nutritional therapy in depleted patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 161, 745–752.CrossRefGoogle ScholarPubMed
Creutzberg, EC, Wouters, EF, Mostert, R, Weling-Scheepers, CA & Schols, AM (2003) Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition 19, 120–127.CrossRefGoogle ScholarPubMed
Donahoe, M & Rogers, RM (1990) Nutritional assessment and support in chronic obstructive pulmonary disease. Clin Chest Med 11, 487–504.CrossRefGoogle ScholarPubMed
Engelen, MPKJ, Schols, AMWJ, Baken, WC, Wesseling, GJ & Wouters, EFM (1994) Nutritional depletion in relation to respiratory and peripheral skeletal muscle function in out-patients with COPD. Eur Respir J 7, 1793–1797.CrossRefGoogle ScholarPubMed
Ferreira, IM, Brooks, D, Lacasse, Y, Goldstein, RS & White, J (2002) Nutritional supplementation for stable chronic obstructive pulmonary disease (Cochrane Review). In The Cochrane Library. Issue 1, CD000998. Oxford: Update Software.Google Scholar
Goris, AH, Meijer, EP & Westerterp, KR (2001) Repeated measurement of habitual food intake increases under-reporting and induces selective under-reporting. Br J Nutr 85, 629–634.CrossRefGoogle ScholarPubMed
Gosker, HR, Lencer, NH, Franssen, FM, van der Vusse, GJ, Wouters, EF & Schols, AM (2003) Striking similarities in systemic factors contributing to decreased exercise capacity in patients with severe chronic heart failure or COPD. Chest 123, 1416–1424.CrossRefGoogle ScholarPubMed
Hunter, AM, Carey, MA & Larsh, HW (1981) The nutritional status of patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 124, 376–381.Google ScholarPubMed
Jones, PW (1995) Issues concerning health-related quality of life in COPD. Chest 107, 187S–193S.CrossRefGoogle ScholarPubMed
Jones, PW, Quirk, FH & Baveystock, CM (1991) The St George's Respiratory Questionnaire. Respir Med 85, Suppl. B25–31discussion 33–37CrossRefGoogle ScholarPubMed
Knowles, JB, Fairbarn, MS, Wiggs, BJ, Chan-Yan, C & Pardy, RL (1988) Dietary supplementation and respiratory muscle performance in patients with COPD. Chest 93, 977–983.CrossRefGoogle ScholarPubMed
Lewis, MI, Belman, MJ & Dorr-Uyemura, L (1987) Nutritional supplementation in ambulatory patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 135, 1062–1068.Google ScholarPubMed
Olin, AO, Osterberg, P, Hadell, K, Armyr, I, Jerstrom, S & Ljungqvist, O (1996) Energy-enriched hospital food to improve energy intake in elderly patients. JPEN J Parenteral Enteral Nutr 20, 93–97.CrossRefGoogle ScholarPubMed
Polkey, MI (2002) Muscle metabolism and exercise tolerance in COPD. Chest 121, 131S–135S.CrossRefGoogle ScholarPubMed
Prescott, E, Almdal, T, Mikkelsen, KL, Tofteng, CL, Vestbo, J & Lange, P (2002) Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study. Eur Respir J 20, 539–544.CrossRefGoogle ScholarPubMed
Quanjer, PHE (1993) Standardized lung function testing. Official statement of the European Respiratory Society [see comments]. Eur Respir J 6, Suppl. 161–100.Google Scholar
Rettammel, AL, Marcus, MS, Farrell, PM, Sondel, SA, Koscik, RE & Mischler, EH (1995) Oral supplementation with a high-fat, high-energy product improves nutritional status and alters serum lipids in patients with cystic fibrosis. J Am Diet Assoc 95, 454–459.CrossRefGoogle ScholarPubMed
Rogers, RM, Donahoe, M & Costantino, J (1992) Physiologic effects of oral supplemental feeding in malnourished patients with chronic obstructive pulmonary disease. A randomized control study. Am Rev Respir Dis 146, 1511–1517.CrossRefGoogle ScholarPubMed
Schoeller, DA (1990) How accurate is self-reported dietary energy intake? Nutr Rev 48, 373–379.CrossRefGoogle ScholarPubMed
Schols, AM, Slangen, J, Volovics, L & Wouters, EF (1998) Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157, 1791–1797.CrossRefGoogle ScholarPubMed
Schols, AM, Soeters, PB, Dingemans, AM, Mostert, R, Frantzen, PJ & Wouters, EF (1993) Prevalence and characteristics of nutritional depletion in patients with stable COPD eligible for pulmonary rehabilitation. Am Rev Respir Dis 147, 1151–1156.CrossRefGoogle ScholarPubMed
Schols, AM, Soeters, PB, Mostert, R, Pluymers, RJ & Wouters, EF (1995) Physiologic effects of nutritional support and anabolic steroids in patients with chronic obstructive pulmonary disease. A placebo-controlled randomized trial. Am J Respir Crit Care Med 152, 1268–1274.CrossRefGoogle ScholarPubMed
Shoup, R, Dalsky, G, Warner, S, Davies, M, Connors, M, Khan, FZuWallack, R (1997) Body composition and health-related quality of life in patients with obstructive airways disease. Eur Respir J 10, 1575–1580.CrossRefGoogle ScholarPubMed
Slinde, F, Ellegard, L, Gronberg, AM, Larsson, SRossander-Hulthen, L (2003) Total energy expenditure in underweight patients with severe chronic obstructive pulmonary disease living at home. Clin Nutr 22, 159–165.CrossRefGoogle ScholarPubMed
Steiner, MC, Barton, RL, Singh, SJ & Morgan, MD (2002) Bedside methods versus dual energy X-ray absorptiometry for body composition measurement in COPD. Eur Respir J 19, 626–631.CrossRefGoogle ScholarPubMed
Vermeeren, MA, Schols, AM & Wouters, EF (1997) Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD. Eur Respir J 10, 2264–2269.CrossRefGoogle ScholarPubMed
Vermeeren, MA, Wouters, EF, Nelissen, LH, van Lier, AA, Hofman, Z & Schols, AM (2001) Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease. Am J Clin Nutr 73, 295–301.CrossRefGoogle ScholarPubMed
Weir, JB (1990) New methods for calculating metabolic rate with special reference to protein metabolism. 1949. Nutrition 6, 213–221.Google ScholarPubMed
Westerterp, KR, Donkers, JH, Fredrix, EW & Boekhoudt, P (1995) Energy intake, physical activity and body weight: a simulation model. Br J Nutr 73, 337–347.CrossRefGoogle ScholarPubMed
Young, A, Stokes, M, Round, JM & Edwards, RH (1983) The effect of high-resistance training on the strength and cross-sectional area of the human quadriceps. Eur J Clin Invest 13, 411–417.CrossRefGoogle ScholarPubMed