Dietary Support to Underweight Patients with End-Stage Pulmonary Disease Assessed for Lung Transplantation

Abstract

Background: Undernutrition in hospitalized patients is often not recognized and nutritional support neglected. Chronic obstructive pulmonary disease is frequently characterized by weight loss. No data exist on the effects of nutritional supplementation in underweight lung transplantation candidates during hospitalization. Objective: To evaluate the effects on energy intake and body weight of an intensified nutritional support compared to the regular support during hospitalization. Methods: The participants were underweight (n = 42) and normal-weight (n = 29) patients with end-stage pulmonary disease assessed for lung transplantation. The underweight patients were randomized to receive either an energy-rich diet planned for 10 MJ/day and 45–50 energy percentage fat and offered supplements (group 1), or the normal hospital diet planned for 8.5–9 MJ/day and 30–35 energy percentage fat and regular support (group 2, control group). The normal-weight control patients (group 3) received the normal diet. Food intake was recorded for 3 days. Results: During a mean hospital stay of 12 days, the energy intake was significantly greater for the patients on intensified nutritional support (median 11.2 MJ) than for the underweight patients on the regular support (8.4 MJ; p < 0.02) and the normal-weight patients (7.0 MJ; p < 0.001). The increase in energy intake in group 1 resulted in a significant weight gain (median 1.2 kg) compared with group 2 (p < 0.01) and group 3 (p < 0.001). Conclusions: In a group of underweight patients with lung disease assessed for lung transplantation, it was possible to increase energy intake by an intensified nutritional support which was associated with a significant weight gain, compared to the regular nutritional support during a short hospital stay.

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

“…Sixteen patients in group A, 15 in group B and 28 in control group received dietary support at the hospital [14] prior to outpatient support and the part of the weight change that occurred during hospitalization was 1.2 kg (95% CI 0.8; 1.7, p ! 0.03 com- pared with group B), 0.3 kg (-0.4; 1.0) and -0.3 kg (-0.7; 0), respectively.…”

“…Those who were readmitted to the hospital for assessment did not receive inpatient dietary support at the hospital. The dietary support during the hospitalization period has previously been reported [14]. The normalweight patients were included as a control (control group).…”

Reversibility of cachexia after bilateral lung transplantation

“…We suggest that the cession of cachexia is due to the increased lung function, but untreated systemic processes as malabsorption in CF, hepatic congestion due to right heart insufficiency, and immunosuppression may counteract. The recovery of body composition should be supported by liquid nutritional supplements [20] or individual dietary counselling [21] to gain weight even before LTx.…”

Predictors for Reporting of Dietary Assessment Methods in Food-based Randomized Controlled Trials over a Ten-year Period

“…Similarly, 87.3% of studies also failed to report the manner in which the assessment was conducted while 5.3% reported it being telephone based. (Keyserling et al, 1999, Kris-Etherton et al, 2002Pierce et al, 2002;Ammerman et al, 2003, Appel et al, 2003Maskarinec et al, 2003;Acharya et al, 2004, Malaveille et al, 2004, Rock et al, 2004b, Rock et al, 2004a, Vincent et al, 2004, Gann et al, 2005Barnard et al, 2006, Chlebowski et al, 2006, Segovia-Siapco et al, 2007, Turner-McGrievy et al, 2008Barnard et al, 2009, Gold et al, 2009, Hoy et al, 2009), 4.9% paper based (Djuric et al, 1999b;Campbell et al, 2000, Glasgow and Toobert, 2000, Forli et al, 2001a, Forli et al, 2001b, Djuric et al, 2002a, De Mendonca et al, 2003, Djuric et al, 2003, Nydahl et al, 2003, Sondergaard et al, 2003, Wu et al, 2005, Marfella et al, 2006, Hawkes et al, 2009) and 2.5% computerised. (Berrino et al, 2001, Heath et al, 2001, Schatzkin et al, 2000a, Kaaks et al, 2003, He et al, 2004…”