Nutritional treatment of wasting in COPD

Transcription

1 Nutritional treatment of wasting in COPD Individuals with chronic obstructive pulmonary disease (COPD) and low body weight have impaired pulmonary status, reduced diaphragmatic mass, lower exercise capacity and higher mortality rate than those who are adequately nourished. Nutritional support may therefore be a useful component of their comprehensive care. Objectives: To present the evidence from recent systematic reviews on the impact of nutritional supplementation on anthropometric measures, pulmonary function tests, respiratory and peripheral muscles strength, functional exercise capacity and health related quality of life for patients with stable COPD. Methods: We updated the literature search to April Updated Cochrane methodology was used. In our previous review, we used both end of intervention results and change scores to calculate the estimate of effect. Since the results were similar, we just used end ofintervention results in this update. We used mean difference to pool data from studies that measured outcomes with the same measurement tool and standardised mean difference when the constructs were similar but the measurement tools different. We established clinical homogeneity prior to pooling and then calculated statistical heterogeneity, using the Chi² test. We presented the results with 95% confidence intervals and incorporated factors from GRADE to give an overall quality of the evidence for our findings. Other systematic reviews were identified by searching for reviews published in the past five years. Results We included 16 RCTs (541 participants) that lasted at least two weeks. Thirteen studies included only malnourished patients; three, malnourished and nourished patients. Twelve included outpatients; four had inpatient component. Four trials included an exercise component. Fourteen trials used an oral supplement; one used a nocturnal NE tube feeding; another, a fortified diet. Pooled analyses showed a statistically significant improvement in TKS and HRQOL; however, there were non statistically significant differences for all other outcomes, including weight, six minute walk test, and FEV 1. Most results were supported by poor

2 quality evidence; moderate quality evidence supported the results on weight, lean body mass, and the six minute walk test. When we pooled the results from trials that included only malnourished patients, the results were statistically significant, showing that malnourished patients (as defined in the trials) did gain weight on supplementation. Collins and colleagues used different methods for their systematic review recently published and showed significant improvement in weight, anthropometric measures and hand grip. Zhu and colleagues followed what appeared to be Cochrane methodology and concluded that nutritional supplementation did not result in statistically significance effects for weight, mid arm circumference, triceps skinfold thickness, FEV 1 or forced vital capacity (only abstract available in English). Ivone martins Ferreira MD., M. Sc., Ph. D, FRCPC

3 Nutritional supplementation in COPD References Included studies Ali 2007 Ali T, Bennoor KS, Begum N. Effects of nutritional modification on anthropometry and lung functions of COPD patients. Chest 2007;132(4):532. Bennoor KS, Ali T, Hassan MR, Begum N. Effects of nutritional modification on anthropometry and lung functions of COPD patients. In: Respirology. Vol. 11 (Supplement 5). 2006:A150. DeLetter 1991 DeLetter MC. A nutritional intervention for persons with chronic airflow limitation. PhD thesis Efthimiou 1988 Efthimiou J, Felming J, Gomes C, Spiro SG. The effect of supplementary oral nutrition in poorly nourished patients with chronic obstructive pulmonary disease. American Review of Respiratory Disease 1988;137(5): Fuenzalida 1990 Fuenzalida CE, Petty Tl, Jones ML. The immune response to short nutritional intervention in advanced COPD. American Review of Respiratory Disease 1990;142(1): Goris 2003 Goris AHC, Vermeeren MAP, Wouters EFM, Schols AMWJ, Westerterp KR. Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: The effect of physical activity and oral nutritional supplementation. British Journal of Nutrition 2003;89(5): Knowles 1988 Knowles JB, Fairbarn MS, Wiggs BJ, Chan Yan C, Pardy RL. Dietary supplementation and respiratory muscle performance in patients with COPD. Chest 1988;93(5): Lewis 1987 Lewis MI, Belman MJ, Dorr Uyemura J. Nutritional supplementation in ambulatory patients with COPD. American Review of Respiratory Disease 1987;135(5): Otte 1989 Otte KE, Ahlburg P, D'Amore F, Stellfeld M. Nutritional repletion in malnourished patients with emphysema. Journal of Parenteral & Enteral Nutrition 1989;13(2):152 6.

4 Rogers 1992 Rogers RM, Donahoe M, Constantino J. Physiologic effects of oral supplementation feeding in malnourished patients with COPD a randomized control study. American Review of Respiratory Disease 1992;146(6): Schols 1995 Schols AM, Soeters PB, Mostert R, Pluymers RJ, Wouters EF. Physiologic effects of nutritional support and anabolic steroids in patients with COPD a placebo controlled randomized trial. American Journal of Respiratory & Critical Care Medicine 1995;152(4): Steiner 2003 Steiner MC, Barton RL, Singh SJ, Morgan MDL. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: A randomised controlled trial.. In: European Respiratory Journal. Vol. 20 (Suppl 38). 2002:262s. Steiner MC, Barton RL, Singh SJ, Morgan MDL. Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: A randomised controlled trial. Thorax 2003;58(9): Steiner MC, Barton RL, Singh SJ, Morgan MDL. The effect of nutritional supplementation on body weight and composition in COPD patients participating in rehabilitation. European Respiratory Journal 2002;20(Suppl 38):211s. Sugawara 2010 Sugawara K, Takahashi H, Kasai C, Kiyokawa N, Watanabe T, Fujii S, et al. Effects of nutritional supplementation combined with low intensity exercise in malnourished patients with COPD. Respiratory Medicine 2010;104(12): Teramoto 2004 Teramoto S, Yamamoto H, Yamaguchi Y, Tomita T, Ouchi Y. Effects of Feeding a High Fat, Low Carbohydrate Nutritional Supplement (Racol R), on Lung Function, Dyspnea, HRQOL in Patients with COPD. In: :C22; Poster: 522. van Wetering 2010 Hoogendoorn M, van Wetering CR, Schols AM, Rutten van Molken MP. Is INTERdisciplinary COMmunity based COPD management (INTERCOM) cost effective? European Respiratory Journal 2010;35(1): Van Wetering CR, Hoogendoorn M, Mol SJM, Rutten Van Molken MPMH, Schols AM. Short and long term efficacy of a community based COPD management programme in less advanced COPD: A randomised controlled trial. Thorax 2010;65(1):7 13.

5 van Wetering CR, Hoogendoorn M, Broekhuizen R, Geraerts Keeris GJW, De Munck DRAJ, Rutten van Molken MPMH, et al. Efficacy and Costs of Nutritional Rehabilitation in Muscle Wasted Patients With Chronic Obstructive Pulmonary Disease in a Community Based Setting: A Prespecified Subgroup Analysis of the INTERCOM Trial. Journal of the American Medical Directors Association 2010;11(3): van Wetering CR, Hoogendoorn M, Geraerts Keeris AJ, Broekhuizen R, Rutten van Molken MP, Schols AM. Effectiveness and costs of nutritional intervention integrated in an INTERdisciplinary COMmunity based COPD management program (INTERCOM) in patients with less advanced COPD [Abstract]. In: American Thoracic Society International Conference, May 15 20, 2009, San Diego. 2009:A5375. van Wetering CR, van Nooten FE, Mol SJ, Hoogendoorn M, Rutten Van Molken MP, Schols AM. Systemic impairment in relation to disease burden in patients with moderate COPD eligible for a lifestyle program. Findings from the INTERCOM trial. International Journal of COPD 2008;3(3): Weekes 2009 Weekes CE, Bateman NT, Elia M, Emery PW. Tailored dietary advice and food fortification results in weight gain and clinical benefit in malnourished patients with chronic obstructive pulmonary disease [Abstract]. In: Thorax. Vol. 59 (Suppl II). 2004:ii4. Weekes CE, Emery PW, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 2009;64(4): Whittaker 1990 Ryan CF, Road JD, Buckley PA, Ross C, Whittaker JS. Energy balance in stable malnourished patients with chronic obstructive pulmonary disease. Chest 1993;103(4): Whittaker JS, Ryan CF, Buckley PA, Road JD. The effects of refeeding on peripheral and respiratory muscle function in malnourished chronic obstructive disease patients. American Review of Respiratory Disease 1990;142(2): Other relevant papers Broekhuizen R, Wouters EF, Creutzberg EC, Weling Scheepers CA, Schols AM. Polyunsaturated fatty acids improve exercise capacity in chronic obstructive pulmonary disease. Thorax 2005;60(5): Collins PF, Stratton R, Elia M Nutritional Support in chronic obstructive pulmonary disease: a systematic review and meta analysis Am J Clin Nutr doi: /ajcn

6 Diagnosis and Management of stable chronic Obstructive pulmonary Disease: A clinical practice Guideline update from the American College of Physicians, American College of Chest Physicians American thoracic Society and European Respiratory Society Ann Intern Med 2011; 155: Ferreira IM, Brooks D, Lacasse Y, Goldstein R White J Nutritional Supplmentation for stable chronic obstructive pulmonary disease. Cochrane Database of systematic Reviews 2005, Issue 2. Issue 2 Art N CD DOI / CD pub2 Ferreira IM, Brooks D, Lacasse Y, Goldstein R Nutritional support for individuals with COPD A meta analysis Chest 2000, 117 (3) Laviolette L, Lands LC, Dauletbaev N, Saey D, Milot J, Provencher S, et al. Combined effect of dietary supplementation with pressurized whey and exercise training in chronic obstructive pulmonary disease: A randomized, controlled, double blind pilot study. Journal of Medicinal Food 2010;13(3): Zhu PQ, Luo Y, Guo XJ, Shi R, Xu XX, Xu WG. [Meta analysis of energetic nutritional intervention for stable chronic obstructive pulmonary disease patients]. [Article in Chinese] Zhonghua Jie He He Hu Xi Za Zhi Feb;31(2):