title: Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis.
abstract: BACKGROUND
  The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes.
  
  
  OBJECTIVE
  The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD.
  
  
  METHODS
  Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD.
  
  
  RESULTS
  Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups.
  
  
  CONCLUSIONS
  This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials.
authors.affiliation: Institute of Human Nutrition, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Collins
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stratton
authors.forename: Marinos
authors.initials: M
authors.lastname: Elia
mesh_terms: D001835:Body Weight; D003376:Counseling; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D002149:Energy Intake; D004750:Enteral Nutrition; D018737:Hand Strength; D006801:Humans; D044342:Malnutrition / Q000150:complications / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000628:therapy*
chemical_list: D004044:Dietary Proteins