Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial.
OBJECTIVE
Previous studies reported a severely impaired energy balance in COPD patients during the first days of an acute exacerbation, mainly due to a decreased energy and protein intake. The aim of the study was to investigate the feasibility and effectiveness of energy- and protein-rich nutritional supplements during hospitalization for an acute exacerbation in nutritionally depleted COPD patients.


METHODS
In a randomized double-blind, placebo-controlled two-center trial, 56 COPD patients were randomized and 47 patients completed the study. Nutritional intervention consisted of 3 x 125 ml (2.38 MJ/day) and the placebo group received similar amounts of a non-caloric fluid. Medical therapy and dietetic consultation were standardized and dietary intake was measured daily. Body composition, respiratory and skeletal muscle strength, lung function and symptoms were measured on admission and on days 4 and 8 of hospitalization.


RESULTS
Forty-seven percent of the patients had experienced recent involuntary weight loss prior to admission. The degree of weight loss was inversely related to resting arterial oxygen tension (r = 0.31; P < 0.05). Nutritional intervention resulted in a significant increase in energy (16% vs. placebo) and protein intake (38% vs. placebo). Mean duration of hospitalization was 9 +/- 2 days. Relative to usual care, no additional improvements in lung function or muscle strength were seen after nutritional intervention.


CONCLUSIONS
Oral nutritional supplementation during hospitalization for an acute exacerbation is feasible in nutritionally depleted COPD patients and does not interfere with normal dietary intake.
Vermeeren
M A P
MA
Department of Respiratory Medicine, University Hospital Maastricht, The Netherlands. vermeeren.marja@zonnet.nl
Wouters
E F M
EF
Geraerts-Keeris
A J W
AJ
Schols
A M W J
AM
D000368:Aged; D001823:Body Composition / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D019587:Dietary Supplements; D004311:Double-Blind Method; D002149:Energy Intake / Q000187:drug effects; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D005526:Food, Formulated; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D011502:Protein-Energy Malnutrition / Q000209:etiology / Q000628:therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*; D012720:Severity of Illness Index