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Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Abstract

BACKGROUND

The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes.

OBJECTIVE

The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD.

DESIGN

Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD.

RESULTS

Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups.

CONCLUSION

This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials.

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  • Authors+Show Affiliations

    ,

    Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.

    ,

    Source

    MeSH

    Body Weight
    Counseling
    Diet
    Dietary Proteins
    Dietary Supplements
    Energy Intake
    Enteral Nutrition
    Hand Strength
    Humans
    Malnutrition
    Outcome Assessment (Health Care)
    Patient Education as Topic
    Pulmonary Disease, Chronic Obstructive

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    22513295

    Citation

    Collins, Peter F., et al. "Nutritional Support in Chronic Obstructive Pulmonary Disease: a Systematic Review and Meta-analysis." The American Journal of Clinical Nutrition, vol. 95, no. 6, 2012, pp. 1385-95.
    Collins PF, Stratton RJ, Elia M. Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Am J Clin Nutr. 2012;95(6):1385-95.
    Collins, P. F., Stratton, R. J., & Elia, M. (2012). Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. The American Journal of Clinical Nutrition, 95(6), pp. 1385-95. doi:10.3945/ajcn.111.023499.
    Collins PF, Stratton RJ, Elia M. Nutritional Support in Chronic Obstructive Pulmonary Disease: a Systematic Review and Meta-analysis. Am J Clin Nutr. 2012;95(6):1385-95. PubMed PMID: 22513295.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. AU - Collins,Peter F, AU - Stratton,Rebecca J, AU - Elia,Marinos, Y1 - 2012/04/18/ PY - 2012/4/20/entrez PY - 2012/4/20/pubmed PY - 2012/7/28/medline SP - 1385 EP - 95 JF - The American journal of clinical nutrition JO - Am. J. Clin. Nutr. VL - 95 IS - 6 N2 - BACKGROUND: The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes. OBJECTIVE: The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD. DESIGN: Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD. RESULTS: Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups. CONCLUSION: This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/22513295/Nutritional_support_in_chronic_obstructive_pulmonary_disease:_a_systematic_review_and_meta_analysis_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.3945/ajcn.111.023499 DB - PRIME DP - Unbound Medicine ER -