Increased energy and/or protein intake improves anthropometry and muscle strength in chronic obstructive pulmonary disease patients: a systematic review with meta-analysis on randomised controlled clinical trials

Abstract

Compromised nutritional status is associated with a poor prognosis in COPD patients. However, the impact of nutritional support in this group of patients is controversial. The present study systematically reviewed the effect of energy and or protein supplements or food fortification on anthropometry and muscle strength of COPD patients. We searched MEDLINE (PubMed), EMBASE, Cochrane Library, and Scopus for all published randomized clinical trials (RCTs) without language restriction up to May 2021. Three reviewers performed study selection and data extraction independently. We judged the risk of bias by RoB 2 and the certainty of evidence by the GRADE approach. We included thirty-two randomized controlled trials and compiled 31 of them (1,414 participants) in the random-effects model meta-analyses. Interventions were energy and/or protein oral nutritional supplements or food fortification added to the diet for at least one week. Pooled analysis revealed that nutritional interventions increased body weight (MD=1.44 kg, 95%CI 0.81 to 2.08, I2=73%), lean body mass (SMD=0.37; 95%CI 0.15 to 0.59, I2=46%), midarm muscle circumference (MD= 0.29 mm2, 95% CI 0.02 to 0.57, I2=0%), triceps skinfold (MD= 1.09 mm, 95% CI 0.01 to 2.16, I2=0%), and handgrip strength (SMD= 0.39, 95% CI 0.07 to 0.71, I2=62%) compared to control diets. Certainty of evidence ranged from very low to low, and most studies were judged with some concerns or at high risk of bias. This meta-analysis revealed, with limited evidence, that increased protein and/or energy intake positively impacts anthropometric measures and handgrip strength of COPD patients.. PROSPERO CRD: 42020207577

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

“…On the other hand, physical activity plays a pivotal role in maintaining bone health given the role of mechanical stress stimuli on bone tropism and the positive effects of physical activity on skeletal muscle and bone–muscle crosstalk [ 24 , 26 , 27 ]. Moreover, it has been estimated that approximately 45% of COPD patients might have a compromised nutritional status related to the imbalance between energy expenditure and energy intake [ 28 ]. In this scenario, low body weight has been a widely recognized independent risk factor for low bone mineral density (BMD), fragility fractures, and sarcopenia [ 21 , 29 ].…”

“…It has been estimated that approximately 45% of COPD patients might have compromised nutritional status mainly related to chronic systemic inflammation, oxidative stress and corticosteroid therapies characterizing the disease [ 112 , 113 ]. As a result, almost 50% of the patients with severe COPD might experience unintentional weight loss [ 28 ]. Due to the high prevalence of malnutrition and unintentional weight loss and its role as an independent risk factor for fragility fracture, a comprehensive approach including nutritional counseling and supplementation should be considered to improve the outcomes in frail COPD patients [ 28 , 112 , 113 , 114 ].…”

“…As a result, almost 50% of the patients with severe COPD might experience unintentional weight loss [ 28 ]. Due to the high prevalence of malnutrition and unintentional weight loss and its role as an independent risk factor for fragility fracture, a comprehensive approach including nutritional counseling and supplementation should be considered to improve the outcomes in frail COPD patients [ 28 , 112 , 113 , 114 ]. In this scenario, a previous meta-analysis supported the positive effects of nutritional supplementation on weight gain, body composition and physical performance [ 115 ].…”

Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation?

“…Approximately 45% of COPD patients might have compromised nutritional status related to the imbalance between energy expenditure and energy intake. As a result, almost 50% of patients with severe COPD might experience unintentional weight loss [ 82 ]. Several factors might contribute to malnutrition, including dyspnoea, gastrointestinal problems, and anxiety, which contribute to poor appetite and reduced dietary intake [ 46 ].…”

“…In accordance, a personalized nutritional assessment and management should be considered in patients with COPD due to the high prevalence of malnutrition and the detrimental effects on skeletal muscle health [ 82 ]. In this context, attention should be paid to energy intake, vitamin D, calcium, proteins, amino acids, probiotics, and prebiotics in order to avoid catabolic states and the downregulation of systemic inflammation that frequently characterizes COPD patients [ 7 , 109 ].…”