The effect of individualized nutrition intervention in malnourished, ambulatory patients with chronic obstructive pulmonary disease (COPD)
Creators: name: Le Patourel, Janet Anne
Publisher: name: University of British Columbia
Year: 2008

description: Protein calorie malnutrition is prevalent among patients with chronic obstructive pulmonary disease (COPD). Nutritional interventions directed toward improving nutritional status in malnourished COPD patients appear warranted because malnutrition in these patients is associated with impaired respiratory muscle function and depressed immunocompetence. These impairments are associated with increased morbidity and mortality. One objective of this study was to identify factors contributing to weight loss in COPD patients. Another objective was to assess the effect of individualized nutrition counselling in the home environment on nutrient intake, body weight, body composition, pulmonary function and perceived well-being in COPD patients. Eleven malnourished, ambulatory COPD patients were randomized to a treatment group (n=6) or to a control group (n=5). The treatment group received individualized nutrition counselling from a dietitian and were provided with access to a nutritional supplement (Pulmocare™). The control group received no nutrition counselling or supplement. Nutritional status, pulmonary function, respiratory muscle strength, and quality of life were assessed at baseline and after six months. Evaluation of the nutrition education provided was completed at six months. There were no significant differences in body weight, body composition, nutrient intake, maximal expiratory pressure, maximal inspiratory pressure, or distance walked in six minutes between groups or over time. The treatment group had a significantly lower forced expiratory volume in one second percent predicted (FEV₁%) and forced expiratory volume in one second/forced vital capacity percent predicted (FEV₁/FVC%) than the control group. There was no significant change in FEV₁% or FEV₁/FVC% over time. When analyzed as a whole (n=11), these COPD patients perceived their general well-being to be poorer than that of the general elderly population. Physical well-being was the component of well-being that was compromised. At six months, there was a significant decrease in overall perceived well-being and physical well-being. The majority of these COPD patients indicated that hospitalization for exacerbation of COPD was a time of significant weight loss. Dyspnea, fatigue, poor appetite, early satiety, gastrointestinal discomfort and intolerance to Pulmocare™ appeared to contribute to difficulties in augmenting intake to promote weight gain. All patients agreed that the dietitian provided useful information that was suited to their needs. All also, agreed that COPD patients should see a dietitian. Although individualized nutrition counselling was not successful in improving nutrient intake to promote weight gain, the patients perceived that it was beneficial. The patients' declining physical well-being limited the ability to intervene successfully. Earlier nutrition intervention and more aggressive nutrition support may be required for these patients.