title: Dietary counselling and food fortification in stable COPD: a randomised trial.
abstract: BACKGROUND
  Malnutrition in chronic obstructive pulmonary disease (COPD) is associated with a poor prognosis, yet evidence to support the role of dietary counselling and food fortification is lacking. A study was undertaken to assess the impact of dietary counselling and food fortification on outcome in outpatients with COPD who are at risk of malnutrition.
  
  
  METHODS
  A randomised controlled unblinded trial was performed in 59 outpatients with COPD (6 months intervention and 6 months follow-up). The intervention group received dietary counselling and advice on food fortification and the controls received a dietary advice leaflet. Outcome measures were nutritional status, respiratory and skeletal muscle strength, respiratory function, perceived dyspnoea, activities of daily living (ADL) and quality of life.
  
  
  RESULTS
  The intervention group consumed more energy (difference 194 kcal/day; p = 0.02) and protein (difference 11.8 g/day; p<0.001) than controls. The intervention group gained weight during the intervention period and maintained weight during follow-up; the controls lost weight throughout the study. Significant differences were observed between the groups in St George's Respiratory Questionnaire total score (difference 10.1; p = 0.02), Short Form-36 health change score (difference 19.2; p = 0.029) and Medical Research Council dyspnoea score (difference 1.0; p = 0.03); the difference in ADL score approached statistical significance (difference 1.5; p = 0.06). No differences were observed between groups in respiratory function or skeletal and respiratory muscle strength. Improvements in some variables persisted for 6 months beyond the intervention period.
  
  
  CONCLUSIONS
  Dietary counselling and food fortification resulted in weight gain and improvements in outcome in nutritionally at-risk outpatients with COPD, both during and beyond the intervention period.
authors.affiliation: Department of Nutrition and Dietetics, Guy's & St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK. elizabeth.weekes@gstt.nhs.uk
authors.forename: C E
authors.initials: CE
authors.lastname: Weekes
authors.forename: P W
authors.initials: PW
authors.lastname: Emery
authors.forename: M
authors.initials: M
authors.lastname: Elia
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001835:Body Weight / Q000502:physiology; D003376:Counseling; D002149:Energy Intake; D005260:Female; D005527:Food, Fortified; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000178:diet therapy / Q000378:metabolism / Q000517:prevention & control*; D008875:Middle Aged; D018802:Patient-Centered Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000178:diet therapy* / Q000378:metabolism; D011788:Quality of Life; D016896:Treatment Outcome