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Recommendations Summary

COPD: Macronutrient Composition 2019

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    COPD: Macronutrient Composition (Percentage Distribution)

    The RDN should individualize the macronutrient composition of the diet based on nutrition assessment. Limited evidence examining the impact of macronutrient distribution did not confirm an ideal percentage distribution of carbohydrates, protein and fat, or if macronutrient distribution should be different for adults with COPD. 

    Rating: Fair

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      • Comorbid conditions such as cardiovascular disease, diabetes, etc. should be considered when individualizing the macronutrient distribution
      • Lifestyle, financial barriers and personal preferences should be considered when individualizing the macronutrient distribution.

    • Potential Costs Associated with Application

      Costs may include expenses related to medical nutrition therapy (MNT) visits from an RDN.

    • Recommendation Narrative

      One negative-quality non-randomized trial (Tümer et al, 2009) was included in the evidence analysis supporting the recommendation.

      The study provided a comparison between COPD subjects' post-acute exacerbation (N=30 men) who consumed ~1, 800kcals [28% carbohydrate (CHO), 50% fat, 16% protein)] and COPD controls who consumed ~1, 800kcals (57% CHO, 30% fat, 16% protein). After 10 days, subjects showed an improvement in forced vital capacity (P=0.033) and tidal volume (P=0.002), and the change was not significant in the controls. Neither group experienced significant differences in forced expiratory volume in one second or vital capacity change after 10 days. 

    • Recommendation Strength Rationale

      • Conclusion statement supporting the recommendation is Grade III, Limited/Weak
      • One study (all men) of short duration.

    • Minority Opinions