Nutritional Therapy in Patients at Risk for Malnutrition and Sarcopenia in Pulmonary Rehabilitation

Study Overview
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Brief Summary
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Malnutrition and sarcopenia (muscle wasting) are common in health care settings and represent a health and economic burden due to associated increased mortality and prolonged hospital stays. Nutritional therapy co-management is recommended for both diagnoses. This study investigates the efficacy of individualized nutrition therapy (iNT) in pulmonary rehabilitation. Patients at significant risk for malnutrition already receive iNT within clinical routine during rehabilitation. The investigators will investigate if patients with only mild to moderate risk of malnutrition and possible sarcopenia also benefit from iNT.

Detailed Description
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The participating patients are randomly assigned to two groups after giving written consent. The intervention group receives individual counseling by nutrition therapists twice a week in addition to the usual rehabilitation program. The iNT determines the energy and protein needs of the patients and creates targeted individual measures to achieve them. Measures may include, for example, adjustments to the meal plan or nutritional supplementation. The measures are continuously adapted to the patients' needs. The control group also receives soup fortified with a standard amount of protein and fat and, if needed, an energy- and protein-rich dessert option as part of the rehabilitation routine care for patients at risk for malnutrition. However, patients from the control group do not receive additional counseling or adjustment by the iNT. Patients' energy and protein intake will be recorded on three subsequent days at start of rehabilitation and at three subsequent days before discharge. Average duration of rehabilitation is expected to be three weeks. As primary outcome, change in energy intake will be compared between groups. Additionally, change in protein intake and other follow-up parameters of nutritional status and sarcopenia will be examined.

Official Title
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Effect of Individual Nutritional Therapy in Patients at Risk for Malnutrition and Sarcopenia in Pulmonary Rehabilitation - a Randomized Controlled Trial

Conditions
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Sarcopenia, Malnutrition

Intervention / Treatment
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* Other: individual nutritional therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: admission to rehab due to chronic obstructive pulmonary disease or after a pneumonia light to moderate risk of malnutrition (Nutritional Risk Score-2002: 3-4 Points) risk of sarcopenia (sarc-f >=4) signed informed consent Exclusion Criteria: medically described nutritional support reasons (cognitive, language) that prevent a informed consent enteral or parenteral nutrition after bariatric surgery
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: individual nutrition therapy<br>Individualized nutrition therapy: Specialists in nutritional counseling determine the patient's individual energy and protein needs and create targeted individual measures to achieve them. Measures can include, for example, adjustments to the menu, food enrichment or supplementation. The measures are discussed with the patients on an ongoing basis and adjusted as necessary. | Other: individual nutritional therapy<br>* Intervention arm: Usual care + individualized nutritional therapy. Patients at risk for malnutrition and sarcopenia will receive a counselling by the nutritional therapist twice a week. The therapists will assess the patient's energy and protein demand in order to develope appropriate individual measures (e.g additional meals or supplements) to increase patients' energy and protein intake. Individual nutritional therapy is already usual care in patients with high risk for malnutrition, but not for patients with only light to moderate risk of malnutrition and risk of sarcopenia.<br>|
| No Intervention: usual care<br>Usual care: Participants in the control group receive a standardized food fortification of the soups with fat and protein, as well as an energy- and protein-rich dessert. No additional advice or adjustments are made by the iNT. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Energy intake | Change in energy intake [kcal] from start to end of rehabilitation. | From admission to discharge (2-3 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| protein intake | Change in protein intake [g] from start to end of rehabilitation. | From admission to discharge (2-3 weeks) | 
| grip strength | Change in grip strength (muscle strength) from start to end of rehabilitation. | From admission to discharge (2-3 weeks) | 
| lean body mass | Change in lean body mass (muscle mass) from start to end of rehabilitation. | From admission to discharge (2-3 weeks) | 
| time up and go | Change in time up an go time (muscle function) from start to end of rehabilitation | From admission to discharge (2-3 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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individual nutrition therapy