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Justel Enríquez A, Rabat-Restrepo JM, Vilchez-López FJ, Tenorio-Jiménez C, García-Almeida JM, Irles Rocamora JA, Pereira-Cunill JL, Martínez Ramírez MJ, Molina-Puerta MJ, Molina Soria JB, Rebollo-Pérez MI, Olveira G, García-Luna PP. Practical Guidelines by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) on Nutritional Management of Patients with Chronic Obstructive Pulmonary Disease: A Review. Nutrients 2024; 16:3105. [PMID: 39339705 PMCID: PMC11434837 DOI: 10.3390/nu16183105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/06/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
Malnutrition is common in chronic obstructive pulmonary disease (COPD) patients and is associated with worse lung function and greater severity. This review by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) addresses the nutritional management of adult COPD patients, focusing on Morphofunctional Nutritional Assessment and intervention in clinical practice. A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, followed by critical appraisal based on Scottish Intercollegiate Guidelines Network (SIGN) guidelines. Recommendations were graded according to the European Society for Clinical Nutrition and Metabolism (ESPEN) system. The results were discussed among GARIN members, with consensus determined using a Likert scale. A total of 24 recommendations were made: 2(A), 6(B), 2(O), and 14(GPP). Consensus exceeded 90% for 17 recommendations and was 75-90% for 7. The care of COPD patients is approached from a nutritional perspective, emphasizing nutritional screening, morphofunctional assessment, and food intake in early disease stages. Nutritional interventions include dietary advice, recommendations on food group intake, and the impact of specialized nutritional treatment, particularly oral nutritional supplements. Other critical aspects, such as physical activity and quality of life, are also analyzed. These recommendations provide practical guidance for managing COPD patients nutritionally in clinical practice.
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Affiliation(s)
- Alicia Justel Enríquez
- Servicio de Endocrinología y Nutrición, Hospital Universitario de la Princesa, 28006 Madrid, Spain
| | - Juana M. Rabat-Restrepo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
| | | | - Carmen Tenorio-Jiménez
- Endocrinology and Nutrition Clinical Management Unit, University Hospital Virgen de las Nieves, 18014 Granada, Spain
| | - José M. García-Almeida
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen de la Victoria, 29010 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga/Plataforma Bionand, 29010 Málaga, Spain
| | - José-Antonio Irles Rocamora
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
- UGC Endocrinología y Nutrición, Hospital Universitario Valme, 41014 Sevilla, Spain
| | - José L. Pereira-Cunill
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBIS), 41007 Sevilla, Spain
| | - María J. Martínez Ramírez
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario de Jaén, 23007 Jaén, Spain
- Facultad de Medicina, Universidad de Jaén, 23071 Jaén, Spain
| | - María J. Molina-Puerta
- UGC Endocrinología y Nutrición, Hospital Universitario Reina Sofía, 14004 Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), 14004 Córdoba, Spain
| | | | - María I. Rebollo-Pérez
- Servicio de Endocrinología y Nutrición, Hospital Juan Ramón Jiménez, 21005 Huelva, Spain
| | - Gabriel Olveira
- Instituto de Investigación Biomédica de Málaga/Plataforma Bionand, 29010 Málaga, Spain
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Departamento de Medicina y Dermatología, Facultad de Medicina, Universidad de Málaga, 29010 Málaga, Spain
| | - Pedro P. García-Luna
- Departamento de Medicina, Facultad de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain; (J.-A.I.R.); (P.P.G.-L.)
- Unidad de Gestión Clínica de Endocrinología y Nutrición, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
- Endocrine Diseases Research Group, Institute of Biomedicine of Seville (IBIS), 41007 Sevilla, Spain
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Liu H, Song J, Wang Z, Wu S, Qiu S, Chen B, Rao Z, Jing X. Investigation of nutrition status and analysis of 180-day readmission factors in elderly hospitalized patients with COPD. Aging Clin Exp Res 2024; 36:155. [PMID: 39085739 PMCID: PMC11291564 DOI: 10.1007/s40520-024-02820-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Malnutrition is prevalent among elderly patients with COPD, who also experience a high rate of readmission. Therefore, it is imperative to investigate the nutrition status of these patients, identify risk factors for readmission, and offer insights for clinical management. To achieve this, a cross-sectional study was conducted to investigate factors influencing nutrition status using GLIM criteria and explore the 180-day readmission factors among hospitalized elderly COPD patients. METHORDS AND RESULTS The data were collected from a hospital in Southwest China, encompassing a cohort of 319 eligible patients. Among elderly hospitalized COPD patients, the prevalence of malnutrition was 49.53% (158/319). Multivariate logistic regression revealed malnutrition (OR = 3.184), very severe airway obstruction (OR = 3.735), and Number of comorbidities ≥ 3 (OR = 5.754) as significant risk factors for 180-day readmission. CONCLUSIONS These findings suggest that malnutrition is a prevalent issue among elderly hospitalized patients with COPD and constitutes one of the risk factors contributing to the 180-day readmission rate. Therefore, timely identification and treatment for malnourished patients are crucial.
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Affiliation(s)
- Huan Liu
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Jingsi Song
- Department of Clinical Nutrition, Chengdu Shang jin Nan fu Hospital, West China Hospital, Chengdu, China
| | - Zhiqiang Wang
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China
| | - Songze Wu
- Department of Respiratory and Critical care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Shi Qiu
- Department of Medical administration, West China Hospital, Sichuan University, Chengdu, China
| | - Benhui Chen
- Department of Integrated Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyong Rao
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China.
| | - Xiaofan Jing
- Department of Clinical Nutrition, West China Hospital, Sichuan University, Chengdu, China.
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Xu Y, Yan Z, Li K, Liu L, Xu L. Association between nutrition-related indicators with the risk of chronic obstructive pulmonary disease and all-cause mortality in the elderly population: evidence from NHANES. Front Nutr 2024; 11:1380791. [PMID: 39081677 PMCID: PMC11286481 DOI: 10.3389/fnut.2024.1380791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Background This study aims to use six nutrition-related indicators to assess the relationship between nutritional status and the risk of COPD as well as the all-cause mortality rate, and to determine the most reliable predictive indicators. Methods Data from the National Health and Nutrition Examination Survey (NHANES) spanning the years 2013 to 2018 were extracted. Nutritional status was evaluated using Controlling nutritional status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), Advanced Lung Cancer Inflammation Index (ALI), Prognostic Nutritional Index (PNI), Triglycerides (TG) × Total Cholesterol (TC) × Body Weight (BW) Index (TCBI), and Albumin-to-Globulin Ratio (AGR) nutritional-related indicators. Multivariate weighted logistic and Cox regression models were employed to assess the correlation between the six nutritional-related indicators and the risk of COPD and as all-cause mortality. The restricted cubic spline tests were applied to explore potential nonlinear relationships, and ROC curves and C-index analyses were conducted to compare the predictive capabilities of different indicators. Stratified analysis and propensity score matching (PSM) to assess the robustness of the results. Results In this study, Lower ALI, lower GNRI, and higher CONUT scores were positively correlated with an increased risk of COPD (OR: 1.77, 95% CI: 1.10-2.84) (OR: 8.66, 95% CI: 2.95-25.5), and (OR: 5.11, 95% CI: 1.72-15.2), respectively. It was found that ALI and GNRI had a non-linear relationship with the risk of COPD. After propensity score matching (PSM), the associations between ALI, GNRI, CONUT scores, and COPD remained consistent. Lower ALI, PNI, and GNRI scores were positively associated with all-cause mortality in COPD patients (HR: 2.41, 95% CI: 1.10-5.27), (HR: 3.76, 95% CI: 1.89-7.48), and (HR: 4.55, 95% CI: 1.30-15.9), respectively, with GNRI displaying a non-linear relationship with all-cause mortality. ROC curve and C-index analyses indicated that ALI had the best predictive ability for both COPD risk and all-cause mortality. Conclusion ALI, GNRI, and CONUT scores are correlated with the risk of COPD, while ALI, PNI, and GNRI scores are associated with all-cause mortality in COPD patients. Compared to other nutritional scores, ALI may provide more effective predictive value for both risk and all-cause mortality.
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Affiliation(s)
- Yifeng Xu
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Zhaoqi Yan
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Keke Li
- School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China
| | - Liangji Liu
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
| | - Lei Xu
- Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang, Jiangxi, China
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Conway V, Hukins C, Sharp S, Collins PF. Nutritional Support in Malnourished Outpatients with Chronic Obstructive Pulmonary Disease (COPD): A Randomized Controlled Pilot Study. Nutrients 2024; 16:1696. [PMID: 38892629 PMCID: PMC11174753 DOI: 10.3390/nu16111696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/29/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
(1) Background: The evidence for nutritional support in COPD is almost entirely based on ready-to-drink oral nutritional supplements (ONSs). This study aimed to explore the effectiveness of powdered ONSs alongside individualized dietary counseling in the management of malnutrition. (2) Methods: Malnourished outpatients with COPD were randomized to receive either routine care (Group A: counseling + recommended to purchase powdered ONSs) or an enhanced intervention (Group B: counseling + provision of powdered ONSs at no cost to the patient) for 12 weeks. Outcomes of interest were nutritional intake, weight status, and quality of life. (3) Results: A total of 33 outpatients were included, categorized as follows: Group A (n = 21); Group B (n = 12); severely malnourished (n = 9), moderately malnourished (n = 24), mean BMI 18.0 SD 2.5 kg/m2. No differences were observed between groups at baseline or at week 12; however, analysis of the whole cohort (Group A + B) revealed nutrition intervention resulted in significant improvements in protein intake (+25.4 SD 53.4 g/d; p = 0.040), weight (+1.1 SD 2.6 kg; p = 0.032) and quality of life (-4.4 SD 10.0; p = 0.040). Only 41.2% of Group A and 58.3% of Group B reported consuming ONSs at week 12. Adherence to ONSs was associated with weight gain (+1.9 SD 2.5 kg vs. +0.4 SD 2.5 kg; p = 0.098). (4) Conclusions: Nutritional support results in significant improvements in nutrition status and quality of life in malnourished outpatients with COPD. However, improvements are associated with adherence to ONSs, suggesting the type of ONSs and how they are provided are important considerations in clinical practice and future studies.
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Affiliation(s)
- Valerie Conway
- Nutrition and Dietetics, Brisbane South Chronic Disease Service, Metro South Hospital and Health Service, Wynnum, QLD 4178, Australia;
| | - Craig Hukins
- Department of Respiratory and Sleep Medicine, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia;
| | - Stacey Sharp
- Department of Nutrition and Dietetics, Logan Hospital, Meadowbrook, QLD 4131, Australia;
| | - Peter F. Collins
- Nutrition and Dietetics, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
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Yang M, Liu Y, Zhao Y, Wang Z, He J, Wang Y, Anme T. Association of Frailty with Patient-Report Outcomes and Major Clinical Determinants in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:907-919. [PMID: 38628984 PMCID: PMC11020290 DOI: 10.2147/copd.s444580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/07/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose This study aimed to explore the correlation of frailty status with disease characteristics and patient-reported outcomes (PROs) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and determine the sensitivity and specificity of modified COPD PRO scale (mCOPD-PRO) for detecting frailty. Patients and Methods This cross-sectional study surveyed 315 inpatients with AECOPD from a tertiary hospital in China from August 2022 to June 2023. Patient frailty and PROs were assessed using the validated FRAIL scale and mCOPD-PRO, respectively. Spearman's ρ was used to assess the relevance of lung disease indicators commonly used in clinical practice, and ordinal logistic regression analyses were used to identify the variables associated with frailty status. The validity of mCOPD-PRO in discriminating frail or non-frail individuals was determined using the receiver operating characteristic curve. Results The participants (N=302, mean age 72.4±9.1 years) were predominantly males (73.2%). Among them, 43 (14.3%) patients were not frail, whereas 123 (40.7%) and 136 (45.0%) patients were pre-frail and frail, respectively. The FRAIL scale was moderately correlated with the mCOPD-PRO scores (Spearman's rank correlation coefficient [Rs]=0.52, P<0.01) for all dimensions (Rs=0.43-0.49, P<0.01). Patients residing in rural areas (odds ratio [OR], 1.67; 95% confidence interval [95% CI], 1.01-2.76) and with higher mCOPD-PRO scores (OR, 4.78; 95% CI, 2.75-8.32) were more likely to be frail. Physically active patients (OR, 0.42; 95% CI, 0.21-0.84) were less likely to be frail. In addition, mCOPD-PRO had good discriminate validity for detecting frailty (area under the curve=0.78), with a sensitivity and specificity of 84.6% and 60.8%, respectively. The optimal probability threshold for mCOPD-PRO was ≥1.52 points. Conclusion In patients with AECOPD, frailty is closely related to PROs and disease characteristics. Additionally, the mCOPD-PRO score can distinguish well between frail and non-frail patients. Our findings provide support for interventions targeting frail populations with AECOPD.
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Affiliation(s)
- Mengjiao Yang
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People’s Republic of China
| | - Yang Liu
- Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan
| | - Yangyang Zhao
- Department of Blood Transfusion, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People’s Republic of China
| | - Ziwei Wang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People’s Republic of China
| | - Jie He
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People’s Republic of China
| | - Yali Wang
- Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People’s Republic of China
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Deng M, Lu Y, Zhang Q, Bian Y, Zhou X, Hou G. Global prevalence of malnutrition in patients with chronic obstructive pulmonary disease: Systemic review and meta-analysis. Clin Nutr 2023; 42:848-858. [PMID: 37084471 DOI: 10.1016/j.clnu.2023.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/22/2023] [Accepted: 04/05/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Malnutrition is a significant comorbidity among chronic obstructive pulmonary disease (COPD), but it has been often ignored. To date, the prevalence of malnutrition and its association with clinical parameters in the patients with COPD have not been well described. We aimed to investigate the prevalence of malnutrition and the prevalence of at-risk for malnutrition among COPD and the clinical impact of malnutrition on patients with COPD in a systematic review and meta-analysis. METHODS PubMed, Embase, Cochrane Library, and Web of Science were searched for articles describing the prevalence of malnutrition and/or at-risk for malnutrition from January 2010 to December 2021. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Meta-analyses were performed to determine the prevalence of malnutrition and at-risk for malnutrition and the clinical impact of malnutrition on patients with COPD. Meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Comparisons were made between individuals with and without malnutrition according to pulmonary function, degree of dyspnea, exercise capacity, and mortality risk. RESULTS Out of the 4156 references identified, 101 were read full-text, of which 36 studies were included. The total number of involved patients included in this meta-analysis was 5289. The prevalence of malnutrition was 30.0% (95% CI 20.3 to 40.6), compared with an at-risk prevalence of 50.0% (95% CI 40.8 to 59.2). Both prevalences were associated with regions and measurement tools. The prevalence of malnutrition was associated with COPD phase (acute exacerbations and stable). COPD with malnutrition showed lower forced expiratory volume 1 s % predicted (mean difference (MD) -7.19, 95% CI -11.86 to -2.52), higher modified Medical Research Council dyspnea scores (MD 0.38, 95% CI 0.12 to 0.64), poorer exercise tolerance (standardized mean difference -0.29, 95% CI -0.54 to -0.05), and higher mortality risk (hazard ratio 2.24, 95% CI 1.23 to 4.06) compared to COPD without malnutrition. CONCLUSION Malnutrition and at-risk for malnutrition are common among COPD. Malnutrition negatively impacts important clinical outcomes of COPD.
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Affiliation(s)
- Mingming Deng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Ye Lu
- Department of Respiratory and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qin Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Yiding Bian
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoming Zhou
- Respiratory Department, Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China.
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Totland TH, Krogh HW, Smedshaug GB, Tornes RA, Bye A, Paur I. Harmonization and standardization of malnutrition screening for all adults - A systematic review initiated by the Norwegian Directorate of Health. Clin Nutr ESPEN 2022; 52:32-49. [PMID: 36513471 DOI: 10.1016/j.clnesp.2022.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS The Norwegian Directorate of Health has identified a need to harmonize and standardize the malnutrition screening practice in Norwegian hospitals and primary health care settings, in order to provide a seamless communication of malnutrition screening along the patient pathway. Our aim was to perform a systematic review of the validity and reliability of screening tools used to identify risk of malnutrition across health care settings, diagnoses or conditions and adult age groups, as a first step towards a national recommendation of one screening tool. METHODS A systematic literature search for articles evaluating validity, agreement, and reliability of malnutrition screening tools, published up to August 2020, was conducted in: MEDLINE, Embase, APA PsycInfo, Cinahl, Cochrane Databases, Web of Science, Epistemonikos, SveMed+, and Norart. The systematic review was registered in PROSPERO (CRD42022300558). For critical appraisal of each included article, the Quality Criteria Checklist by The Academy of Nutrition and Dietetics was used. RESULTS The review identified 105 articles that fulfilled the inclusion and exclusion criteria. The most frequently validated tools were Mini Nutritional Assessment short form (MNA), Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and Nutritional Risk Screening 2002 (NRS-2002). MNA, MST and NRS-2002 displayed overall moderate validity, and MUST low validity. All four tools displayed low agreement. MST and MUST were validated across health care settings and age groups. In general, data on reliability was limited. CONCLUSIONS The screening tools MST and NRS-2002 displayed moderate validity for the identification of malnutrition in adults, of which MST is validated across health care settings. In addition, MNA has moderate validity for the identification of malnutrition in adults 65 years or older.
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Affiliation(s)
- Torunn Holm Totland
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Department of Physical Health and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.
| | - Henriette Walaas Krogh
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | - Guro Berge Smedshaug
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway
| | | | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway; European Palliative Care Research Centre (PRC), Dept. of Oncology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Paur
- Department of Non-Communicable Diseases, Division of Prevention and Public Health, Norwegian Directorate of Health, Oslo, Norway; Norwegian Advisory Unit on Disease-related Undernutrition, Oslo University Hospital, Oslo, Norway; Dept. of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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Skipper A, Coltman A, Tomesko J, Charney P, Porcari J, Piemonte TA, Handu D, Cheng FW. Reprint of: Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults. J Acad Nutr Diet 2022; 122:S50-S54. [PMID: 36122959 DOI: 10.1016/j.jand.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
It is the position of the Academy of Nutrition and Dietetics that, based upon current evidence, the Malnutrition Screening Tool should be used to screen adults for malnutrition (undernutrition) regardless of their age, medical history, or setting. Malnutrition (undernutrition) screening is a simple process intended to quickly recognize individuals who may have a malnutrition diagnosis. While numerous malnutrition screening tools are in use, their levels of validity, agreement, reliability, and generalizability vary. The Academy of Nutrition and Dietetics reviewed the body of evidence supporting malnutrition screening tools and determined a single tool for identifying adults in all settings who may have malnutrition, regardless of their age or medical history. The Nutrition Screening for Adults Workgroup conducted a systematic review of the most robust evidence to promote using the highest-quality malnutrition screening tool available.
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Quncuo C, Liang Y, Li Q, She X, Cuo BM, Qiongda B, ChuTso M, Sun Y. High Prevalence of Nutritional Risk Among Pulmonary Patients Living on the Tibetan Plateau. Front Nutr 2022; 9:872457. [PMID: 35619955 PMCID: PMC9127964 DOI: 10.3389/fnut.2022.872457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nutritional risk is associated with adverse clinical outcomes and is more prevalent among pulmonology patients than among patients in other departments. High-altitude environments can affect patients with chronic respiratory diseases, but evidence of the prevalence of nutritional risk among hospitalized patients with respiratory diseases in high-altitude areas is limited. This study aimed to investigate the nutritional risk and status of inpatients with different major respiratory diagnoses permanently living on the Tibetan Plateau (≥3,000 m above sea level). Methods In this cross-sectional study, we consecutively recruited inpatients admitted to the Department of Respiratory and Critical Care Medicine at the Tibet Autonomous Region People's Hospital of Lhasa between November 2020 and May 2021. We used the Nutrition Risk Screening (NRS) 2002 tool to assess nutritional risk among these patients. An NRS 2002 score ≥3 points indicates nutritional risk; a score ≥5 indicates high nutritional risk. According to NRS-2002 scores, patients were divided into three groups (NRS-2002 0–2, 3–4, and ≥5). The differences in age, sex, major respiratory diagnoses, comorbidities, body mass index, and laboratory findings among the groups were analyzed. Results A total of 289 eligible Tibetan patients were enrolled in the study, and 46.1% (133/246) of them were at nutritional risk (NRS-2002 score ≥3). Twenty-one (7.3%) patients were at high nutritional risk (NRS-2002 score ≥5). The proportions of patients at nutritional risk were relatively high among patients with lung cancer (58.8%), interstitial lung disease (58.3%), pulmonary embolism (52.9%), and tuberculosis (50.0%). Laboratory findings showed that patients with NRS-2002 scores of 3–4 and ≥5 had lower red blood cell counts, serum albumin and hemoglobin levels, and higher C-reactive protein (CRP) levels than those with NRS-2002 scores < 3. Conclusion The prevalence of nutritional risk was high among pulmonology department inpatients permanently living on the Tibetan Plateau. Patients with lung cancer, interstitial lung disease, pulmonary embolism or tuberculosis were more likely to have nutritional risk than patients with other diagnoses. The nutritional risk of inpatients in the respiratory department in the plateau area should not be ignored, and patients at high nutritional risk should receive timely intervention.
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Affiliation(s)
- Chilie Quncuo
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Ying Liang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Qiuyu Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Xiaoli She
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Bian Ma Cuo
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Bianba Qiongda
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Meilang ChuTso
- Department of Respiratory and Critical Care Medicine, Tibet Autonomous Region People's Hospital, Lhasa, China
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
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10
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AND-ASPEN and ESPEN consensus, and GLIM criteria for malnutrition identification in AECOPD patients: a longitudinal study comparing concurrent and predictive validity. Eur J Clin Nutr 2021; 76:685-692. [PMID: 34702965 DOI: 10.1038/s41430-021-01025-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 09/09/2021] [Accepted: 10/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition in chronic obstructive pulmonary disease (COPD) patients is prevalent and usually assessed by body mass index (BMI), which can lead to misdiagnosis. The subjective global assessment (SGA) is the reference method for this diagnose in hospitalized patients. In the last decade, new tools have emerged Academy of Nutrition and Dietetics-American Society for Parenteral and Enteral Nutrition [AND-ASPEN], European Society for Clinical Nutrition and Metabolism [ESPEN], and Global Leadership Initiative on Malnutrition [GLIM]). Therefore, this study aimed to assess the concurrent and predictive validity of these tools in acute exacerbated COPD (AECOPD) patients. SUBJECTS/METHODS Prospective cohort study with hospitalized AECOPD patients. Malnutrition was diagnosed by SGA (reference method), AND-ASPEN, ESPEN, and GLIM consensus. Hospital length of stay (LOS) and mortality were the outcomes evaluated. RESULTS In 241 patients (46.5% males; 68.3 ± 10.2 years), malnutrition was found in 50.0% by SGA, 54.4% by AND-ASPEN, 20.2% by ESPEN, and 47.8% by GLIM. AND-ASPEN had the best accuracy (AUC = 0.837; 95% CI 0.783-0.841) and concordance (kappa = 0.674) with SGA and it was an independent predictor of prolonged LOS (OR = 1.73; 95% CI 1.01-3.37). ESPEN consensus did not agree with SGA, but was associated with prolonged LOS (OR = 2.57 95% CI, 1.27-5.20). The GLIM had good concordance (kappa = 0.533) and accuracy with SGA (AUC = 0.768; 95% CI 0.701-0.835), but was not associated with outcomes. CONCLUSIONS The AND-ASPEN was the most accurate tool for diagnosing malnutrition in AECOPD patients and was an independent predictor of prolonged LOS.
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11
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Dwyer JT, Gahche JJ, Weiler M, Arensberg MB. Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. J Community Health 2021; 45:640-660. [PMID: 31571022 PMCID: PMC7188699 DOI: 10.1007/s10900-019-00739-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
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Affiliation(s)
- Johanna T Dwyer
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
- Jean Mayer USDA Human Nutrition Research Center on Aging, Boston, MA, 02111, USA
- Department of Medicine and Community Health, School of Medicine and Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, USA
| | - Jaime J Gahche
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD, USA
| | - Mary Weiler
- Abbott Nutrition Division of Abbott, Columbus, OH, 43219, USA
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12
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Martins C, Saeki SL, do Nascimento MM, Lucas FM, Vavruk AM, Meireles CL, Justino S, Mafra D, Rabito EI, Schieferdecker MEM, Campos LF, van Aanholt DPJ, Hordonho AA, Fidelix MSP. Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease. J Bras Nefrol 2021; 43:236-253. [PMID: 33836040 PMCID: PMC8257272 DOI: 10.1590/2175-8239-jbn-2020-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022] Open
Abstract
This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.
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Affiliation(s)
- Cristina Martins
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Grupo de Trabalho Internacional da NCPT, Subcomitê Internacional da
Academy of Nutrition and Dietetics (Academy) para a TPCN, Curitiba, PR,
Brasil
- Instituto Cristina Martins de Educação e Pesquisa em Saúde,
Curitiba, PR, Brasil
| | - Simone L. Saeki
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Instituto Cristina Martins de Educação e Pesquisa em Saúde,
Curitiba, PR, Brasil
| | - Marcelo Mazza do Nascimento
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fernando M. Lucas
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Hospital das Clínicas da Universidade Federal de Minas Gerais/Grupo
Nefroclínicas, Belo Horizonte, MG, Brasil
| | - Ana Maria Vavruk
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Hospital e Maternidade Municipal de São José dos Pinhais, São José
dos Pinhais, PR, Brasil
| | - Christiane L. Meireles
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- University of Texas Health Science Center, School of Nursing, San
Antonio, USA
| | - Sandra Justino
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Universidade Federal do Paraná, Complexo do Hospital de Clínicas da
UFPR, Curitiba, PR, Brasil
| | - Denise Mafra
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil
| | - Estela Iraci Rabito
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba,
PR, Brasil
- Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | | | - Denise P. J. van Aanholt
- Sociedade Brasileira de Nutrição Parenteral e Enteral, Curitiba, PR,
Brasil
- Federación Latinoamericana de Terapia Nutricional, Nutrición
Clínica y Metabolismo, Ecuador
| | - Ana Adélia Hordonho
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba,
PR, Brasil
- Universidade Estadual de Ciências da Saúde, Hospital Escola Hélvio
Auto e Hospital Metropolitano de Alagoas, Maceió, AL, Brasil
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Pei H, Tian T, Fu W, Zhang G, Zhang Z, Dai J. Prevalence of, and risk factors for underweight or excess weight in patients with chronic obstructive emphysema from a multiethnic region of Xinjiang, China. Expert Rev Respir Med 2020; 14:851-858. [PMID: 32343156 DOI: 10.1080/17476348.2020.1762491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The purpose of this study is to assess the basic nutritional status (body metabolic index, BMI) and its risk factors in the patients suffering from chronic obstructive emphysema. METHODS We described their demographic characteristics and comorbidity distribution of 2812 obstructive emphysema participants. Comparative analyzes were conducted on BMI with different demographic characteristics and comorbidities status, and comprehensive analysis on risk factors of excess weight and underweight in patients with different characters. RESULTS The prevalence of underweight and excess weight was 17.57% and 31.54% respectively. There were differences in the distribution of three types of body mass index among patients with different demographic characteristics and different comorbidities. The study found that age of 50 ~ 64 (odds ratio, OR: 2.99), tuberculosis (OR: 2.41), and low TG (OR: 2.32) were the risk factors about underweight. Low HDL-C (OR: 4.15), nonalcoholic fatter liver (NAFLD) (OR: 3.96), and age of 50 ~ 64 (OR: 2.72) were closely related to the excess weight of participants. CONCLUSIONS This study highlighted the prevalence of underweight and excess weight in patients among emphysema. Comorbidities were important risk factors of underweight or excess weight among chronic emphysema patients. These findings were important for the prevention and treatment of chronic obstructive emphysema in the future.
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Affiliation(s)
- Hualian Pei
- School of Public Health, Xinjiang Medical University , Urumqi, P. R. China.,Respiratory Intensive Care Unit, Respiratory and Intensive Care Center, the First Affiliated Hospital of Xinjiang Medical University , Urumqi, P. R. China
| | - Tian Tian
- School of Public Health, Xinjiang Medical University , Urumqi, P. R. China
| | - Wenhui Fu
- School of Public Health, Xinjiang Medical University , Urumqi, P. R. China
| | - Guozhen Zhang
- School of Public Health, Xinjiang Medical University , Urumqi, P. R. China
| | - Zewen Zhang
- School of Public Health, Xinjiang Medical University , Urumqi, P. R. China
| | - Jianghong Dai
- School of Public Health, Xinjiang Medical University , Urumqi, P. R. China
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Skipper A, Coltman A, Tomesko J, Charney P, Porcari J, Piemonte TA, Handu D, Cheng FW. Position of the Academy of Nutrition and Dietetics: Malnutrition (Undernutrition) Screening Tools for All Adults. J Acad Nutr Diet 2020; 120:709-713. [DOI: 10.1016/j.jand.2019.09.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Indexed: 01/15/2023]
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15
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Skipper A, Coltman A, Tomesko J, Charney P, Porcari J, Piemonte TA, Handu D, Cheng FW. Adult Malnutrition (Undernutrition) Screening: An Evidence Analysis Center Systematic Review. J Acad Nutr Diet 2020; 120:669-708. [DOI: 10.1016/j.jand.2019.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 01/09/2023]
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16
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Cuong TQ, Banks M, Hannan-Jones M, Thi Ngoc Diep D, Gallegos D. Validity, reliability and feasibility of nutrition screening tools NRS-2002 and MST administered by trained medical doctors in routine practice. Hosp Pract (1995) 2019; 47:259-266. [PMID: 31791178 DOI: 10.1080/21548331.2019.1699760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background & aim: This study aims to prospectively assess the validity, reliability and feasibility of two nutrition screening tools NRS-2002 and MST combined with BMI (MST+BMI) after administration by medical doctors in hospitals in Ho Chi Minh City (HCMC) Viet Nam.Methods: Participants were 150 adult patients (validity study), 30 adult patients (reliability study) and 40 medical doctors (feasibility study) in three wards from three general public hospitals in HCMC. Area Under the ROC curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value and percent of correctly classified were calculated to determine validity against SGA or BMI. Cohen's kappa (κ) statistics were calculated to determine the reliability of NRS-2002 and MST+BMI. Viewpoints regarding the benefit and role of nutrition screening and the ease of use, acceptability and feasibility of NRS-2002 and MST+BMI were assessed among medical doctors using self-administered questionnaires with Likert scales to determine feasibility.Results: After completing by medical doctors the NRS-2002 and MST+BMI showed good validity (the sensitivity and specificity were 80.3% and 79.8% for NRS-2002 and were 81.8% and 84.5% for MST+BMI, respectively) and consistent reliability (κ: 0.72 & 0.75) against SGA or BMI. Medical doctors mostly agreed (93%) on the need for and benefits of nutrition screening. It took between two and 4 min to complete screening using NRS-2002 or MST+BMI. Over 82% of medical doctors indicated that the NRS-2002 and MST+BMI were easy to conduct. There was, however, lower agreement (73%), regarding the feasibility of implementing screening in their wards and hospitals.Conclusions: Both NRS-2002 and MST+BMI were valid, reliable and feasible for use by medical doctors for nutrition screening in hospitals in the resource sparse Vietnamese context. Additional activities are required to make nutrition screening more feasible.
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Affiliation(s)
- Tran Quoc Cuong
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia.,Department of Health, Nutrition Centre Ho Chi Minh City, Ho Chi Minh city, Viet Nam
| | - Merrilyn Banks
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia.,Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Mary Hannan-Jones
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia
| | - Do Thi Ngoc Diep
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia.,Department of Health, Nutrition Centre Ho Chi Minh City, Ho Chi Minh city, Viet Nam
| | - Danielle Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Queensland, Australia
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17
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Nguyen HT, Pavey TG, Collins PF, Nguyen NV, Pham TD, Gallegos D. Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. J Acad Nutr Diet 2019; 120:778-791.e1. [PMID: 31786177 DOI: 10.1016/j.jand.2019.09.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Malnutrition in patients with chronic obstructive pulmonary disease (COPD) is common and associated with poor prognosis. Nutrition interventions are necessary, but there is a lack of evidence regarding the effectiveness of tailored nutrition advice. OBJECTIVE This study investigated whether tailored nutrition counseling could improve dietary intake, nutritional status, functional outcomes, and health-related quality of life (QoL) of malnourished outpatients with COPD. DESIGN We conducted a randomized controlled trial in which participants were randomly assigned to either the intervention group (IG) or the control group (CG). PARTICIPANTS/SETTING One hundred and twenty malnourished outpatients with COPD participated in the study between May and November 2017 at the National Lung Hospital, Hanoi, Vietnam. INTERVENTION The IG received tailored nutrition counseling once per month for 3 months based on a specifically developed written nutrition resource for COPD. The CG received the same educational resource at baseline without any discussion. MAIN OUTCOME MEASURES The main outcome measures were energy and protein intakes, body weight change, nutritional status (Subjective Global Assessment score), muscle strength, and QoL. STATISTICAL ANALYSES Differences between groups before and after the intervention were assessed using two-way repeated measures analysis of variance. Generalized estimating equation modeling was used to investigate the differences between groups over time. RESULTS At baseline, there were no significant differences in outcomes of interest between the two groups. After 3 months of intervention, time-intervention interactions for energy intake, protein intake, and body weight change were significant (945 kcal/day, 95% CI 792 to 1,099 kcal/day, P<0.001; 50.0 g protein/day, 95% CI 43.9 to 56.1 g protein/day, P<0.001; and 1.0 kg, 95% CI 0.5 to 1.5 kg, P<0.001, respectively). Subjective Global Assessment scores improved in the IG and worsened in the CG. Significant improvements were found in inspiratory muscle strength in the IG (5.4 cmH2O, 95% CI 2.3 to 8.6 cmH2O, P=0.001) and significant decreases in handgrip strength were found in the CG after 3 months of the intervention (1.4 kg, 95% CI 0.4 to 2.4 kg, P=0.007). There was a significant interaction effect for all QoL scores (analysis of variance two-way repeated, P≤0.003). The IG also significantly improved all QoL scores from baseline to 3 months (P<0.004). CONCLUSIONS Tailored nutritional counseling has the potential to improve dietary intakes, nutritional status, functional outcomes, and QoL in malnourished outpatients with COPD.
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18
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Collins PF, Yang IA, Chang YC, Vaughan A. Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update. J Thorac Dis 2019; 11:S2230-S2237. [PMID: 31737350 DOI: 10.21037/jtd.2019.10.41] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) primarily affects the lungs but due to the accompanying chronic systematic inflammation and the symptoms associated with the disease there are many extrapulmonary effects which include complex physical and metabolic adaptations. These changes have been associated with reduced exercise capacity, increased nutritional requirements, altered metabolic processes and compromised nutritional intake. As a result, nutritional depletion in COPD is multi-faceted and can involve imbalances of energy (weight loss), protein (sarcopenia), and periods of markedly increased inflammation (pulmonary cachexia) which can increase nutritional losses. As a result, depletion of both fat-mass (FM) and fat-free mass (FFM) can occur. There is good evidence that nutritional support, in the form of oral nutritional supplements (ONS), can overcome energy and protein imbalances resulting in improved nutritional status and functional capacity. However, in order to treat the aetiology of sarcopenia, frailty and cachexia, it is likely that targeted multi-modal interventions are required to address energy and protein imbalance, specific nutrient deficiencies, reduced androgens and targeted exercise training. Furthermore, interventions taking a disease-course approach, are likely to hold the key to effectively managing the common and costly problem of nutritional depletion in COPD.
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Affiliation(s)
- Peter F Collins
- School of Human Movement and Nutrition Science, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Ian A Yang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Yuan-Chin Chang
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
| | - Annalicia Vaughan
- University of Queensland Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, Australia
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19
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Nguyen HT, Collins PF, Pavey TG, Nguyen NV, Pham TD, Gallegos DL. Nutritional status, dietary intake, and health-related quality of life in outpatients with COPD. Int J Chron Obstruct Pulmon Dis 2019; 14:215-226. [PMID: 30666102 PMCID: PMC6336029 DOI: 10.2147/copd.s181322] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Malnutrition is common in patients with COPD; however, little is known about its impacts on health-related quality of life (QoL) among patients with COPD. This study aimed to explore the nutritional status and dietary intake among outpatients with COPD in Vietnam and its possible associations with QoL. Methods A cross-sectional study was carried out in COPD outpatients visiting the COPD management unit at the National Lung Hospital, Hanoi, Vietnam between May 2017 and July 2017. Consecutive outpatients with a confirmed diagnosis of COPD were recruited with written inform consent. The nutritional status of participants was assessed using Subjective Global Assessment (SGA), and dietary intake via a 24-hour recall interview. The St George Respiratory Questionnaire (SGRQ) for COPD was used to investigate the participants’ QoL. Sociodemographic and clinical data were extracted from hospital records. Results Of 168 COPD outpatients involved in the study, three-quarters (74.4%) were diagnosed as malnourished (SGA B/C) and 81.5% reported unintentional weight loss. Most of the patients did not meet their estimated energy and protein requirements (85.7% and 89.9%, respectively). Malnutrition was significantly associated with disease severity (P=0.039) and ratio of protein intake to estimated requirement (P=0.005). QoL was low for all levels of malnutrition or disease severity, with well-nourished participants and those with less disease severity having better QoL (P=0.006 and P<0.001, respectively). With an extra meal per day, the odds of having malnutrition decreased 5.6 times (P<0.05) and the total SGRQ reduced 3.61 scores (P<0.05) indicating a better QoL. Conclusion Malnutrition and weight loss are prevalent among COPD outpatients. Most of the patients had inadequate dietary intake and low QoL. Nutrition counselling including increasing the number of meals per day with a focus on energy- and protein-rich foods may help improving nutritional status and QoL of patients with COPD in Vietnam.
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Affiliation(s)
- Ha Thanh Nguyen
- School of Exercise and Nutrition Sciences, Faculty of Health Queensland University of Technology, Kelvin Grove, QLD, Australia, .,Department of Nutrition and Food Safety, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
| | - Peter F Collins
- School of Exercise and Nutrition Sciences, Faculty of Health Queensland University of Technology, Kelvin Grove, QLD, Australia, .,Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Australia
| | - Toby G Pavey
- School of Exercise and Nutrition Sciences, Faculty of Health Queensland University of Technology, Kelvin Grove, QLD, Australia,
| | | | - Tuong Duy Pham
- Department of Nutrition and Food Safety, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
| | - Danielle L Gallegos
- School of Exercise and Nutrition Sciences, Faculty of Health Queensland University of Technology, Kelvin Grove, QLD, Australia,
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20
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Ingadottir AR, Beck AM, Baldwin C, Weekes CE, Geirsdottir OG, Ramel A, Gislason T, Gunnarsdottir I. Oral nutrition supplements and between-meal snacks for nutrition therapy in patients with COPD identified as at nutritional risk: a randomised feasibility trial. BMJ Open Respir Res 2019; 6:e000349. [PMID: 30687503 PMCID: PMC6326325 DOI: 10.1136/bmjresp-2018-000349] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/07/2018] [Accepted: 11/27/2018] [Indexed: 12/24/2022] Open
Abstract
Introduction Intervention studies have mainly used oral nutritional supplements (ONS) for the management of patients with chronic obstructive pulmonary disease (COPD) identified as at nutritional risk. In this 12-month randomised feasibility trial, we assessed the (1) feasibility of the recruitment, retention and provision of two interventions: ONS and between-meal snacks (snacks) and (2) the potential impact of the provision of snacks and ONS on body weight and quality of life in patients with COPD. Methods Hospitalised patients with COPD, at nutritional risk, were randomised to ONS (n=19) or snacks (n=15) providing 600 kcal and 22 g protein a day in addition to regular daily diet. The intervention started in hospital and was continued for 12 months after discharge from the hospital. Results Study recruitment rate was n=34 (45%) and retention rate at 12 months was similar for both groups: n=13 (68%) in the ONS group and n=10 (67%) in the Snacks group. Both groups gained weight from baseline to 12 months (2.3±4.6 kg (p=0.060) in the ONS group and 4.4±6.4 kg (p=0.030) in the Snacks group). The St George’s Respiratory Questionnaire total score improved from baseline to 12 months in both groups (score 3.9±11.0 (p=0.176) in the ONS group and score 8.9±14.1 (p=0.041) in the Snacks group). Discussion In patients with COPD who are at nutritional risk snacks are at least as feasible and effective as ONS, however, adequately powered trials that take account of the difficulties in recruiting this patient group are required to confirm this effect.
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Affiliation(s)
- Arora Ros Ingadottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
| | - Anne Marie Beck
- Faculty of Health, Copenhagen University College, Copenhagen, Denmark.,Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Christine Baldwin
- Department of Nutritional Sciences, King's College London, London, UK
| | | | - Olof Gudny Geirsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,The Icelandic Gerontological Research Institute, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
| | - Thorarinn Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
| | - Ingibjorg Gunnarsdottir
- Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland.,Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
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Marco E, Sánchez-Rodríguez D, Dávalos-Yerovi VN, Duran X, Pascual EM, Muniesa JM, Rodríguez DA, Aguilera-Zubizarreta A, Escalada F, Duarte E. Malnutrition according to ESPEN consensus predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease. Clin Nutr 2018; 38:2180-2186. [PMID: 30342931 DOI: 10.1016/j.clnu.2018.09.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/09/2018] [Accepted: 09/13/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nutritional disorders are frequent in patients with chronic pulmonary obstructive disease (COPD) and have negative health impacts. This study aimed to explore the value of the European Society of Clinical Nutrition and Metabolism (ESPEN) definition of malnutrition (and/or its individual components) to predict hospitalizations and mortality at 2 years, and to determine the prevalence of malnutrition in COPD patients referred to pulmonary rehabilitation. METHODS The study was a prospective analysis of 118 patients with COPD free of exacerbations and/or hospital admissions in the previous two months. Main outcome variables were mortality, hospital admissions, and length of stay at 2-year follow-up; main covariates were malnutrition assessment according to the ESPEN definition and its components: unintentional weight loss, body mass index, and fat-free mass index (FFMI). Body composition was assessed by bioimpedance analysis. Kaplan-Meier survival curves and linear regression analyses were performed, adjusting for age and airflow obstruction as potential confounders. RESULTS The observed prevalence of malnutrition was 24.6%. Malnutrition was associated with increased mortality risk (HR = 3.9 [95% CI: 1.4-10.62]). FFMI was independently associated with increased mortality (HR = 17.0 [95% CI: 2.24-129.8]), which persisted after adjustment for age and lung function (adjusted HR = 13.0 [95% CI: 1.67-101.7]). Low age-related body mass index was associated with increased risk of hospital admissions. CONCLUSIONS Malnutrition according to ESPEN criteria, highly prevalent in patients with stable COPD referred to pulmonary rehabilitation, was associated with 4 times greater mortality risk after 2 years. Low FFMI was associated with a 17-fold increase in mortality risk, suggesting independent predictive value.
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Affiliation(s)
- Ester Marco
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; School of Medicine, Universitat Internacional de Catalunya, Barcelona, Catalonia, Spain.
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Geriatrics Department, Parc de Salut Mar (Centre Fòrum - Hospital del Mar), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain
| | - Vanesa N Dávalos-Yerovi
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Xavier Duran
- Methodology & Biostatistics Support Unit, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain
| | - Eva M Pascual
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain
| | - Josep M Muniesa
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Diego A Rodríguez
- School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain; Department of Health Sciences (CEXS), Universitat Pompeu i Fabra, Barcelona, Catalonia, Spain; Respiratory Medicine Department, Parc Salut Mar (Hospital del Mar - Centre Fòrum del Hospital del Mar), Barcelona, Catalonia, Spain; Muscle and Respiratory System Research Unit (URMAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ana Aguilera-Zubizarreta
- Hospital Home-care Unit, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Ferran Escalada
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
| | - Esther Duarte
- Physical Medicine and Rehabilitation Department, Parc Salut Mar (Hospital del Mar - Hospital de l'Esperança), Barcelona, Catalonia, Spain; Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Catalonia, Spain; School of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Catalonia, Spain
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22
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Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease. Br J Nutr 2018; 119:543-551. [DOI: 10.1017/s0007114517003919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AbstractLow energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.
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23
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Keller H, Payette H, Laporte M, Bernier P, Allard J, Duerksen D, Gramlich L, Jeejeebhoy K. Patient-reported dietetic care post hospital for free-living patients: a Canadian Malnutrition Task Force Study. J Hum Nutr Diet 2017; 31:33-40. [DOI: 10.1111/jhn.12484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. Keller
- Department of Kinesiology; Schelgel-University of Waterloo Research Institute for Aging; University of Waterloo; Waterloo Ontario Canada
| | - H. Payette
- Research Centre on Aging; CIUSSS de l'Estrie-CHUS and Faculty of Medicine and Health Sciences; University of Sherbrooke; Sherbrooke Québec Canada
| | - M. Laporte
- Réseau de santé Vitalité Health Network; Campbellton Regional Hospital; Campbellton New Brunswick Canada
| | - P. Bernier
- Jewish General Hospital; Montreal Québec Canada
| | - J. Allard
- Department of Medicine; Toronto General Hospital; University of Toronto; Toronto Ontario Canada
| | - D. Duerksen
- Department of Medicine; Faculty of Health Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - L. Gramlich
- Department of Medicine & Dentistry; Royal Alexandra Hospital; University of Alberta; Edmonton Alberta Canada
| | - K. Jeejeebhoy
- Department of Medicine; University of Toronto ( emeritus ); Toronto Ontario Canada
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