Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial.
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.
['Nguyen|Ha Thanh|HT|', 'Pavey|Toby G|TG|', 'Collins|Peter F|PF|', 'Nguyen|Nhung Viet|NV|', 'Pham|Tuong Duy|TD|', 'Gallegos|Danielle|D|']
D000368:Aged D000553:Ambulatory Care D003376:Counseling D002149:Energy Intake D005260:Female D018737:Hand Strength D006801:Humans D008297:Male D044342:Malnutrition D008875:Middle Aged D015596:Nutrition Assessment D044623:Nutrition Therapy D009752:Nutritional Status D029424:Pulmonary Disease, Chronic Obstructive D011788:Quality of Life D016896:Treatment Outcome
Randomized controlled trial Malnutrition COPD Tailored nutritional counseling