Dietary Supplementation and Respiratory Muscle Performance in Patients with COPD

Knowles, Jarol B.; Fairbarn, Mary Sue; Wiggs, Barry; Chan-Yan, C; Pardy, Richard L.

doi:10.1378/chest.93.5.977

Cited by 114 publications

(82 citation statements)

References 15 publications

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“…Following ONS, weight gain varied considerably and depended on the duration and amount of supplementation, and the disease status of patients. Mean percentage weight change in supplemented patients compared with unsupplemented control patients could be calculated in twenty-two randomized controlled studies of adults (duration of ONS 10 d-1 year, n 900 patients; Douglass et al 1978;Foster et al 1980;Elkort et al 1981;Simko, 1983;Lewis et al 1987;Norregaard et al 1987;Efthimiou et al 1988;Knowles et al 1988;Arnold & Richter, 1989;Donahoe et al 1989;Otte et al 1989;Fuenzalida et al 1990;Nayel et al 1992;Rogers et al 1992;Hirsch et al 1993;Fiatarone et al 1994;Woo et al 1994;Gray-Donald et al 1995;Volkert et al 1996;Jensen & Hessov, 1997;Keele et al 1997;Rabeneck et al 1998). The mean percentage weight change of patients receiving ONS (2·93 %) was greater than that of the unsupplemented control patients (1·15 %, mean difference 1·77, range −2·69 to 9·2 %; weighted for the number of subjects in each category).…”

Section: Outcome Measuresmentioning

confidence: 99%

“…Of the twenty-seven randomized controlled trials that assessed total energy intake, all showed an increase during ONS. The increase was evaluated to be statistically significant in only eighteen studies: surgery (Jensen & Hessov, 1997;Keele et al 1997); liver disease (Simko, 1983;Hirsch et al 1993); cancer (Evans et al 1987;Ovesen & Allingstrup, 1992); the elderly (Meredith et al 1992;Fiatarone et al 1994;Woo et al 1994); cystic fibrosis (Sondel et al 1987) and Crohn's disease (Harries et al 1983); COPD (Lewis et al 1987;Norregaard et al 1987;Efthimiou et al 1988;Knowles et al 1988;Fuenzalida et al 1990;Rogers et al 1992); other diseases (Kuhlmann et al 1997). Although fourteen of sixteen non-randomized trials that assessed total energy intake showed an increase, in only seven was this increase statistically significant (Lynch et al 1983;Parsons et al 1983;Stauffer et al 1986;Welch et al 1991;Gray-Donald et al 1994;Tolia, 1995;Skypala et al 1998).…”

Section: Outcome Measuresmentioning

confidence: 99%

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Summary of a systematic review on oral nutritional supplement use in the community

Stratton

2000

Proc. Nutr. Soc.

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Despite a marked increase in the prescription of oral nutritional supplements (ONS) in the community (Department of Health, 1991–7), there is still uncertainty about the value of their use in patients with different diseases. To answer questions about the effects on ONS on body weight and structure, spontaneous food intake and body function, a critical systematic review was undertaken (Stratton & Elia, 1999a). Eighty-four trials were reviewed (forty-five randomized, thirty-nine non-randomized; 2570 patients; diagnoses including chronic obstructive pulmonary disease, Crohn’s disease, cystic fibrosis, human immunodeficiency virus and acquired immune deficiency syndrome and cancer). Most studies (83 %) were conducted in patients living at home. The supplements were typically mixed macronutrients in liquid form, providing < 0.42–10.5 MJ/d for 1 week–2 years. The studies reviewed in patients with predominantly chronic conditions living in the community suggested that: (1) ONS produce demonstrable clinical (including functional) benefits, but the nature and extent of these benefits varies with the underlying chronic condition; (2) ONS increase total energy intake with > 50 % of the energy from ONS typically additional to that from habitual food intake; (3) improvements in body weight, total energy intake and body function following ONS appear to occur more frequently in individuals with a BMI < 20 kg/m2 than in those with a BMI > 20 kg/m2.

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Section: Outcome Measuresmentioning

confidence: 99%

Section: Outcome Measuresmentioning

confidence: 99%

Summary of a systematic review on oral nutritional supplement use in the community

Stratton

2000

Proc. Nutr. Soc.

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“…All the previous nutritional intervention studies of some duration have been performed with regular followups and closely monitored dietary intake and have mainly been performed in COPD patients [6][7][8][9][10][11][12][13]. Continued support is believed to increase compliance, but this has not yet been investigated.…”

Section: Introductionmentioning

confidence: 99%

A Study of Intensified Dietary Support in Underweight Candidates for Lung Transplantation

Førli¹,

Bjørtuft²,

Vatn³

et al. 2001

Ann Nutr Metab

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Background: No data is available on dietary intervention in candidates for lung transplantation and on the effect of different strategies for dietary support in this cohort. Aim: We therefore wanted to evaluate the effects of intensified nutritional support compared with simple support on energy intake and nutritional status. Method: Our participants were underweight (n = 42) and normal-weight (control group, n = 29) candidates for lung transplantation. The underweight patients were randomized into two groups. Group A received intensified dietary counselling, ready-made liquid nutritional supplements free of charge and regular follow-ups, while group B received only one session of individual dietary counselling, no supplements and no follow-ups. Results: The mean intervention time was 21 weeks. Groups A and B both increased their energy intake and gained weight. Group A increased their energy intake from a median of 8.7 to 10.1 MJ (p < 0.01 compared with the control group after intervention) and gained a mean of 2.9 kg body weight (95% CI 1.2; 4.7, p = 0.005 compared with the control group), while group B increased from 7.4 to 10.8 MJ (p = 0.005) and gained 2.3 kg (1.2; 3.3, p = 0.002). Only group B increased their fat-free mass. In this group, an increase in O₂ saturation and a decrease in PaCO₂ were suggested. None of the groups improved its physical performance. Conclusion: In candidates for lung transplantation we were unable to confirm the hypothesis that intensified nutritional support compared with a simple support increased compliance. Both groups achieved the goal for energy intake and gained weight.

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“…Consequently, nutritional support has been advocated as a useful part of the care of COPD patients with low BMI. A number of nutritional intervention studies with pulmonary function, exercise capacity or weight increase as outcome have been performed [4][5][6][7]. However, a recent meta-analysis reviewed the effect of these studies and concluded that the studies did not document a beneficial effect of nutritional support in patients with COPD [8].…”

mentioning

confidence: 99%

Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study

Prescott¹,

Almdal²,

Mikkelsen³

et al. 2002

European Respiratory Journal

233

159

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An association between low body mass index (BMI) and poor prognosis in patients with chronic obstructive pulmonary disease (COPD) has been found in a number of studies. The prevalence and prognostic importance of weight change in unselected subjects with COPD was examined.Subjects with COPD, defined as forced expiratory volume in one second/forced vital capacityv0.7 in the Copenhagen City Heart Study and who attended two examinations 5 yrs apart, were followed for 14 yrs for COPD-related and all-cause mortality.The proportion of subjects who lost w1 unit BMI (y3.8 kg) between the two examinations was significantly associated with level of COPD, reaching y30% in subjects with severe COPD. After adjusting for age, smoking habits, baseline BMI and lung function, weight loss was associated with higher mortality in both persons with and without COPD (rate ratio (RR) for weight loss w3 BMI units 1.71 (95% confidence interval (CI): 1.32-2.23) and 1.63 (95% CI 1.38-1.92), respectively). Weight gain was associated with increased mortality, but not significantly so in subjects with COPD. Risk of COPD-related death increased with weight loss (RR 2.14 (95% CI 1.18-3.89)), but not with weight gain (RR 0.95 (95% CI 0.43-2.08)). In subjects without COPD or with mild-to-moderate COPD, the effect of weight change was the same irrespective of initial weight. In subjects with severe COPD, there was a significant risk ratio modification (p=0.045) between effect of baseline BMI and weight change: in the normal-to-underweight (BMIv25), best survival was seen in those who gained weight, whereas for the overweight and obese (BMIo25), best survival was seen in stable weight.A high proportion of subjects with chronic obstructive pulmonary disease experienced a significant weight loss, which was associated with increased mortality. The results support further intervention studies that aim at avoiding weight loss in normal-tounderweight chronic obstructive pulmonary disease patients. In patients with chronic obstructive pulmonary disease (COPD), a number of observational studies have shown that a low body mass index (BMI) is associated with a poor prognosis independent of the degree of ventilatory impairment [1][2][3]. Consequently, nutritional support has been advocated as a useful part of the care of COPD patients with low BMI. A number of nutritional intervention studies with pulmonary function, exercise capacity or weight increase as outcome have been performed [4][5][6][7]. However, a recent meta-analysis reviewed the effect of these studies and concluded that the studies did not document a beneficial effect of nutritional support in patients with COPD [8]. So far, no controlled intervention study with mortality as outcome has tested the effect of nutritional support in these patients.A different way of addressing this question is in an epidemiological setting to study mortality rates of subjects with COPD and relate these to changes in body weight. In a previous study, the present authors have shown that low BMI was an inde...

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Dietary Supplementation and Respiratory Muscle Performance in Patients with COPD

Cited by 114 publications

References 15 publications

Summary of a systematic review on oral nutritional supplement use in the community

Summary of a systematic review on oral nutritional supplement use in the community

A Study of Intensified Dietary Support in Underweight Candidates for Lung Transplantation

Prognostic value of weight change in chronic obstructive pulmonary disease: results from the Copenhagen City Heart Study

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