Efficacy and Costs of Nutritional Rehabilitation in Muscle-Wasted Patients With Chronic Obstructive Pulmonary Disease in a Community-Based Setting: A Prespecified Subgroup Analysis of the INTERCOM Trial

Wetering, C.R. van; Hoogendoorn, Martine; Broekhuizen, R.; Geraerts-Keeris, Gonnie J.W.; Munck, Dirk R.A.J. de; Mölken, Maureen P.M.H. Rutten-van; Schols, A.M.W.J.

doi:10.1016/j.jamda.2009.12.083

Cited by 119 publications

(106 citation statements)

References 14 publications

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“…Still, the increase in CET exceeded the proposed minimal clinically important difference of 100–105 s 21. No changes were observed in 6MWD in the current study, but average 6MWD did not seem rigorously impaired at baseline (almost 500 m) and also in the INTERCOM trial, investigating a comparable group of COPD patients with less advanced disease, 6MWD maintained similar in the intervention group but deteriorated in muscle wasted patients receiving usual care 11. That was also the reason why 6MWD was only included as exploratory outcome in this trial.…”

Section: Discussioncontrasting

confidence: 59%

“…The target sample size (alpha 0.05, power 80%) was based on data from the INTERCOM‐study11 assuming a 10% difference in peak torque between the groups assuming maintenance of skeletal muscle strength in PLACEBO during follow‐up and a SD of 5 Nm in peak torque, revealing n = 60 in each group including 25% drop‐out. Patient inclusion was prematurely discontinued because the test product could not be produced within the appropriate quality specifications due to discontinuation of the supply of one of the ingredients, but justifiable based on other RCTs published in the meantime as argued in the discussion.…”

Section: Methodsmentioning

confidence: 99%

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A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Bool

Rutten

Helvoort

et al. 2017

J cachexia sarcopenia muscle

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112

111

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BackgroundEvidence regarding the efficacy of nutritional supplementation to enhance exercise training responses in COPD patients with low muscle mass is limited.The objective was to study if nutritional supplementation targeting muscle derangements enhances outcome of exercise training in COPD patients with low muscle mass.MethodsEighty‐one COPD patients with low muscle mass, admitted to out‐patient pulmonary rehabilitation, randomly received oral nutritional supplementation, enriched with leucine, vitamin D, and omega‐3 fatty acids (NUTRITION) or PLACEBO as adjunct to 4 months supervised high intensity exercise training.ResultsThe study population (51% males, aged 43–80) showed moderate airflow limitation, low diffusion capacity, normal protein intake, low plasma vitamin D, and docosahexaenoic acid. Intention‐to‐treat analysis revealed significant differences after 4 months favouring NUTRITION for body mass (mean difference ± SEM) (+15 ± 06 kg, P = 001), plasma vitamin D (+24%, P = 0004), eicosapentaenoic acid (+91%,P < 0001), docosahexaenoic acid (+31%, P < 0001), and steps/day (+24%, P = 0048). After 4 months, both groups improved skeletal muscle mass (+04 ± 01 kg, P < 0001), quadriceps muscle strength (+123 ± 23 Nm,P < 0001), and cycle endurance time (+1914 ± 343 s, P < 0001). Inspiratory muscle strength only improved in NUTRITION (+05 ± 01 kPa, P = 0001) and steps/day declined in PLACEBO (−18%,P = 0005).ConclusionsHigh intensity exercise training is effective in improving lower limb muscle strength and exercise performance in COPD patients with low muscle mass and moderate airflow obstruction. Specific nutritional supplementation had additional effects on nutritional status, inspiratory muscle strength, and physical activity compared with placebo.

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Section: Discussioncontrasting

confidence: 59%

Section: Methodsmentioning

confidence: 99%

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Bool

Rutten

Helvoort

et al. 2017

J cachexia sarcopenia muscle

Self Cite

112

111

View full text Add to dashboard Cite

show abstract

“…The studies showed that being undernourished in COPD is likely to be associated with longer in-patient hospital stays [107,108], a higher probability of being readmitted [62,109] and an increase in healthcare utilisation [110] in comparison with normally nourished patients. Three randomised controlled trials in COPD investigated the effects of nutritional supplementation on healthcare utilisation and/or costs [65,76,111]. Two studies did not find a difference in hospital admissions.…”

Section: Cost-effectiveness Issuesmentioning

confidence: 99%

“…It is, however, likely that in these studies, the duration of follow-up of f6 months was too short to detect an effect on healthcare utilisation. The only full economic evaluation, which was the pre-specified subgroup analysis of the 24-month Interdisciplinary Community-Based COPD Management Program trial, comparing nutritional rehabilitation with usual care in COPD patients with low muscle mass, did find a significant reduction in hospital costs [76]. The mean total COPD and non-COPD related costs per patient after 2 years were J12 830 for the intervention group and J14 025 for the usual care group, resulting in net savings of J1195 (95% CI -7905-5759).…”

Section: Cost-effectiveness Issuesmentioning

confidence: 99%

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

et al. 2014

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Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of costeffectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk. @ERSpublications Metabolism and nutrition: shifting paradigms in COPD management

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“…Alvin L. Barach (67) and Thomas Petty (68) were the first to suggest that exercise was a key component of pulmonary rehabilitation. It has been shown that exercise together with protein supplementation is the most efficacious management for COPD (69)(70)(71)(72). An exercise intervention prescribed in 58 frail older patients after hospital admission for acute COPD exacerbation in improved muscle strength, balance, and exacerbation (73,74).…”

Section: Figure 2 Mechanisms Of Sarcopenia In Persons With Copdmentioning

confidence: 99%

Frailty, Comorbidity, and COPD

Charbek

Espiritu

Nayak

et al. 2018

The Journal of nutrition, health and aging

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Efficacy and Costs of Nutritional Rehabilitation in Muscle-Wasted Patients With Chronic Obstructive Pulmonary Disease in a Community-Based Setting: A Prespecified Subgroup Analysis of the INTERCOM Trial

Cited by 119 publications

References 14 publications

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

A randomized clinical trial investigating the efficacy of targeted nutrition as adjunct to exercise training in COPD

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

Frailty, Comorbidity, and COPD

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