Chronic obstructive pulmonary disease (COPD) is a leading cause of death and incapacitation in many countries. Due to its progressive nature and high prevalence, COPD imposes a considerable burden on the health system.
People with COPD often experience weight loss and muscle weakness, which lead to worsening of the condition and deterioration in the quality of life (Girón et al., 2009).
Evidence suggests that oral nutritional supplements (ONS) may be an effective means of improving COPD outcomes. Thus, a study in COPD patients aged 65 and over has reported that ONS use can significantly reduce the length of hospital stay by 1.88 days (21.5%), from 8.75 to 6.87 days (Thornton et al. abstract). Similarly, episode costs were found to be reduced by $1,570 (12.5%), from $12,523 to $10,953. Among those episodes which could be tracked for follow-up, ONS administration was associated with a lower probability of 30-day readmission of 13.1%. As such, ONS may offer an opportunity to reduce hospitalization costs while improving quality of outcomes.
Another study by Girón and colleagues (2009) has evaluated the prevalence of malnutrition among patients hospitalized with moderate to severe COPD. Disease exacerbations included tachypnea (rapid breathing), cyanosis, fever, and alterations of consciousness. The team assessed the nutritional status of 78 patients using BMI, bioelectric impedance analysis (BIA), percent weight loss, and plasma albumin levels and recorded their days of hospitalization and readmissions during the following 3 months. Malnutrition was identified through various parameters including BMI <20 or fat-free mass (FFM) index ≤16. The findings indicated that 38% of patients were malnourished. The results also highlighted that nutritional status is associated with readmissions. During the 3-month follow-up, 28 patients were readmitted and all had lower FFM and muscle mass.
It is well documented that malnutrition is common among hospitalized COPD patients, and which is linked to longer and more frequent hospitalizations. It is therefore necessary to emphasize the importance of detecting risk of malnutrition in COPD patients in the earliest phase of the disease so that adequate nutritional measures, such as oral nutritional supplement intervention can be initiated in an attempt to maintain lean body mass and reduce the risk of readmissions.
This article is intended for medical professionals.
Prepared by:
Dr Reshma Ramracheya
Diabetes UK RD Lawrence Research Fellow
Senior Research Fellow at Wolfson College
University of Oxford, UK
Reshma.ramracheya@ocdem.ox.ac.uk
References:
Weiser TG, Regenbogen SE, Thompson KD. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-44.
Ljungqvist O, Dardai E, Allison SP. Basics in clinical nutrition: perioperative nutrition. E-SPEN, the European e-Journal of Clinical Nutrition and Metabolism. 2010;e93-6.
Windsor A, Braga M, Martindale R. Fit for surgery: an expert panel review on optimizing patients prior to surgery, with a particular focus on nutrition. Surgeon. 2004;2(6):315-9.
Lawson CM, Daley BJ, Sams VG. Factors That Impact Patient Outcome: Nutrition Assessment. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):30S-8S.
Moreland SS. Nutrition screening and counseling in adults with lung cancer: a systematic review of the evidence. Clinical journal of oncology nursing. Oct 2010;14(5):609-614.
Di Sebastiano KM, Mourtzakis M. A critical evaluation of body composition modalities used to assess adipose and skeletal muscle tissue in cancer. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme. Oct 2012;37(5):811-821.
Davidson W, Teleni L, Muller J, et al. Malnutrition and chemotherapy-induced nausea and vomiting: implications for practice. Oncology nursing forum. Jul 2012;39(4):E340-345.
Chang PH, Yeh KY, Huang JS, et al. Pretreatment performance status and nutrition are associated with early mortality of locally advanced head and neck cancer patients undergoing concurrent chemoradiation. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies. May 2013;270(6):1909-1915.
Pressoir M, Desne S, Berchery D, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres.British journal of cancer. Mar 16 2010;102(6):966-971.
American College of Surgeons Commission on Cancer. Cancer Program Standards 2012: Ensuring Patient Centered Care. Chicago IACoS.
Cawood AL, Elia M, Stratton RJ. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Aging Research Reviews. 2012;11:278-296.
Evert AB, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Suppl 1):S120-S143.
Devitt AA, et al. J Diabetes Res. 2012;1:9.
Elia M, et al. Enteral nutritional support and use of diabetes–specific formulas for patients with diabetes: a systematic review and meta-analysis. Diabetes Care. 2005;28:2267-2279. 7.
Fix BM, et al. Effects of a liquid nutritional supplement containing a novel carbohydrate system on glucose tolerance in subjects with type 2 diabetes. Ann Nutr Metab. 2001;45(Suppl 1):277 (Abstract).
Lochs H, Allison SP, Meier R, et al. Clin Nutr. Apr 2006;25(2):180-86.
Oral Nutritional Supplements to Tackle Malnutrition: A Summary of the Evidence Base. Brussels, Belgium: Medical Nutrition International Industry (MNI);2012.
Hiesmayr M, Schindler K, Pernicka E, et al.Clin Nutr. 2009;28:484-91.
Cawood AL, Elia M, Stratton RJ. Ageing Res Rev. 2012;11(2):278-96.
Gariballa S, Forster S, Walters S, Powers H. Am J Med. Aug 2006;119(8):693-99.
Philipson T, Snider T, Lakdawalla D, Stryckman B, Goldman D. Am J Manag Care. 2013;19(2):121-28.
Abstract: Julia Thornton Snider, PhD1 , Mark Linthicum, MPP1 , Chris LaVallee, MS1 , Darius N. Lakdawalla, PhD2 , (1)Precision Health Economics (PHE), Los Angeles, CA, USA. (2)University of Southern California and Precision Health Economics (PHE), Los Angeles, CA, USA.
Girón R. et al, Ann Nutr Metab 2009; 54: 52-58
Houston, D.K. et al. Dietary protein intake is associated with lean mass change in older, community dwelling adults: the Health, Aging, and Body Composition (Health ABC) Study. Am J Clin Nutr 87, 150-155 (2008).
Bauer J, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542-59.
European Food Safety Authority (EFSA) in a scientific opinion in 2010: “Scientific Opinion on the substantiation of health claims related to protein and increase in satiety leading to a reduction in energy intake (ID 414, 616, 730), contribution to the maintenance or achievement of a normal body weight (ID 414, 616, 730), maintenance of normal bone (ID 416) and growth or maintenance of muscle mass (ID 415, 417, 593, 594, 595, 715) pursuant to Article 13(1) of Regulation (EC) No 1924/2006”https://www.efsa.europa.eu/en/efsajournal/pub/1811
EFSA Journal 2011; 9(4):2075. Scientific Opinion on the substantiation of health claims related to water and maintenance of normal physical and cognitive functions (ID 1102, 1209, 1294, 1331), maintenance of normal thermoregulation (ID 1208) and “basic requirement of all living things” (ID 1207) pursuant to Article 13(1) of Regulation (EC) No 1924/20061
Robinson, 2018. Conference on ‘Improving nutrition in metropolitan areas’ Symposium 4: Interventions to improve nutrition in urban areas Improving nutrition to support healthy ageing: what are the opportunities for intervention? Proceedings of the Nutrition Society (2018), 77, 257–264
