## 3 Results and Discussion
### Grade of recommendation GPP, (88%) Consensus
#### 3.4.4 Is There a Specific ONS for This Group of Patients?
\begin{table}
\begin{tabular}{l l l l l l l} \hline \hline
**ONS (Scal/prot)** & **(N) and Time** & **Grade COPD** & **Comparator** & **Effects** & **References** \\ \hline Normo/Normo & & & & \(\uparrow\) weight & \\ Omega-3/6 & (99) 3 months & Stable outpatient & & \(\uparrow\) FEV1 & & \\ DHA & Mild/moderate/severe & & & \(\uparrow\) Grip strength & & \\ POS (Pheicote fiber) & & & & \(\uparrow\) GMWT & \\ \hline High/High & & & & \(\uparrow\) Vit D, EPA, DHA, Omega-3 & \\ Leucine & (81) 4 months [108, 111] & Stable outpatient & & \(\uparrow\) Weight \(\uparrow\) FM & \\ Omega-3[111] & (45) 3 months [92] & Moderate/severe & & PCB [108, 111] & \(\uparrow\) FEV1 & \\ UFAs [108] & (45) 3 months [92] & +High-intensity exercise & & & \(\downarrow\) Depression Score & \\ Vitamin D & & & & & \\  & & & & \(\downarrow\) 30-40-90 days mortality (NNT 20) & \\ High/High & (652) 3 months [68, 69] & Hospital COPD \(>\) 65 years + & PCB & \(\uparrow\) SGA scale & \\ HMB & (214) 3 months [93] & Other pathologies. & P (comp form 48 kcal & \(\uparrow\) Vei B & \\  & & Up to 90 days post-H & & standard + Vit C) [68] & \(\uparrow\) Vit D & (sub-analysis of [68]) \\  & & & & \(\uparrow\) Grig strength & \\  & & & & \(\uparrow\) nutritional markers & \\  & & & & \(\downarrow\) Inflammatory markers & \\  & & & & & \(\uparrow\) GdWT & \\ Normo/High & & & & & \(\uparrow\) Weight \(\uparrow\) FM & \\ Wipe protein & (36) 3 months & Stable outpatient & & PCB [112] & \(\uparrow\) Quadridges strength & \\ Omega-3 & (12) 2 weeks & (12) & Hydolved casein [113] & \(\uparrow\) Inspiratory pressure max & \\ Vitamins A,C,E & & +Low-intensity exercise & & & \(\uparrow\) Emotional Function and Quality of \\  & & & & & \\  & & & & & \\  & & & & & \\  & & & & & \\ Low (0.45)/High & & & & \(\uparrow\) Vit C & \\ Wipe protein & (44) 2 months & Stable outpatient & & \(\uparrow\) St. George’s Respiratory & [PERSON] et al. [67] \\ Magensium + Vitamin C & & Moderate/severe & & Questionnaire & \\  & & & & \(\downarrow\) Inflammatory markers & \\ \hline \hline \end{tabular} \
\begin{tabular}{l l} \hline \hline  & & \(\uparrow\) FM \\  & & \(\uparrow\) Vit C & \\ Wipe protein & (44) 2 months & Moderate/severe & & \(\uparrow\) St. George’s Respiratory \\  & & & & Questionnaire \\  & & & \(\downarrow\) Inflammatory markers & \\ \hline \hline \end{tabular}
\begin{tabular}{l l} \hline \hline  & & \(\downarrow\) Effectiveness of ONS - oral nutritional supplementment N - number of patients included, PCB - placebo (underestimool as delivery advice); DHA + deconbaseneo: acid; GdWT + \(\epsilon\) min walking test; EPA + acceptance; acid; FM = fit mars; PPM + fits-new mass. * milk-based comparator that continued no 25-hydroxy-vitamin D3, milk protein instead of pure whey protein, and sunflower oil in place of omega-3 polyunsaturated fatty acid (PUEA) containing fish oil. + \(\epsilon\) Increase; + decrease. \\ \hline \hline \end{tabular}
\end{table} 
Table 7: Studies analyzing oral supplementation in patients with COPD. A published clinical trial in 50 hospitalized patients showed that EPA administration at a dose of 1 g/day was not associated with significant benefits in terms of muscle mass preservation or hospital stay [118]. There is insufficient evidence to make specific recommendations on the use of glutamine, branched-chain amino acids, vitamins, or antioxidants in this group of acutely decompensated patients. 4.6 Is There Sufficient Evidence to Recommend Any Form of Micronutrient or Trace Element Supplementation? **Recommendation 18**. : _Grade of recommendation according to GARIN's position on supplementation with micronutrients and trace elements (Table 8)._