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.

中文翻译：

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量身定制的饮食咨询治疗慢性阻塞性肺疾病门诊患者的有效性：一项随机对照试验

背景 慢性阻塞性肺疾病 (COPD) 患者的营养不良很常见，并且与预后不良有关。营养干预是必要的，但缺乏关于量身定制的营养建议有效性的证据。目的 本研究调查了量身定制的营养咨询是否可以改善营养不良的 COPD 门诊患者的饮食摄入、营养状况、功能结果和健康相关的生活质量 (QoL)。设计 我们进行了一项随机对照试验，参与者被随机分配到干预组 (IG) 或对照组 (CG)。参与者/设置 120 名患有 COPD 的营养不良门诊患者于 2017 年 5 月至 11 月期间在越南河内国立肺科医院参加了这项研究。干预 IG 根据专门为 COPD 开发的书面营养资源，每月接受一次量身定制的营养咨询，持续 3 个月。CG 在没有任何讨论的情况下接受了相同的基线教育资源。主要结局指标 主要结局指标是能量和蛋白质摄入量、体重变化、营养状况（主观总体评估评分）、肌肉力量和 QoL。统计分析 使用双向重复测量方差分析评估干预前后组之间的差异。广义估计方程模型用于调查组间随时间的差异。结果 在基线时，两组之间感兴趣的结果没有显着差异。经过3个月的干预，能量摄入、蛋白质摄入和体重变化的时间干预相互作用显着（945 kcal/天，95% CI 792 至 1,099 kcal/天，P<0.001；50.0 g 蛋白质/天，95% CI 43.9 至 56.1 g蛋白质/天，P<0.001；和 1.0 kg，95% CI 分别为 0.5 至 1.5 kg，P<0.001）。IG 中的主观总体评估分数有所提高，而 CG 中则恶化。发现 IG 的吸气肌力量显着改善（5.4 cmH2O，95% CI 2.3 至 8.6 cmH2O，P=0.001），并且在干预 3 个月后发现 CG 的握力显着降低（1.4 kg，95% CI 0.4 至 2.4 kg，P=0.007)。所有 QoL 得分都存在显着的交互作用（双向重复方差分析，P≤0.003）。IG 还显着提高了从基线到 3 个月的所有 QoL 评分（P<0.004）。