EAL

Recommendations Summary

Search Plan and Results

Evidence Analysis Question(s)

What is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on body weight, quality of life and exercise capacity outcomes in adults with COPD?

What is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on body composition and lung function outcomes in adults with COPD?

What is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on functional status, exacerbations, systemic inflammation, respiratory symptoms, hospital costs and admissions outcomes in adults with COPD?

What is the effectiveness of medical nutrition therapy on outcomes in adults with COPD?

Date of Literature Review

December 2017

Inclusion Criteria

Age: Adults 18 years and older.

Setting: All settings, except critical care.

Health Status

With or without supplemental oxygen

With or without home bilevel positive airway pressure (BiPAP).

Nutrition-Related Problem or Condition

COPD, COPD with comorbid conditions (Studies that include COPD with comorbidities must focus on COPD).

All COPD stages and source of diagnosis.

Study Design Preferences

Randomized controlled trials (RCT) or Clinical Controlled Studies

Large nonrandomized observational studies

Cohort, case-control studies.

Nutrition Intervention
MNT intervention provided by a Registered Dietitian Nutritionist (RDN) (or international equivalent); Intervention may include counseling, education, multi-disciplinary program, etc. or other intervention measuring the effectiveness of the MNT intervention.

International Equivalent Definition: The provision of MNT is limited to RDNs. RDN is a credential granted to nutrition professionals in the U.S., who have met all requirements for credentialing through the Commission on Dietetic Registration (CDR), the credentialing agency of the Academy of Nutrition and Dietetics. The term “RD/RDN (or international equivalent)” is used on the EAL to allow for studies conducted outside the U.S. to be considered in evaluating the effectiveness of MNT. To qualify as “international equivalent” for international studies, the country of study’s origin should be a member of International Confederation of Dietetic Associations (ICDA). The credentials for international studies should represent the recognized credentials as stated on ICDA’s website for that particular country. In addition, international equivalents include nutrition professionals in countries with reciprocity agreements with the CDR.

Outcomes: Includes one or more of the following:

Mortality

Lung function / Respiratory Impairment

Acute Exacerbations

Respiratory Symptoms

Severity, Duration, or Course of Illness

Systemic Inflammation / Oxidative Stress

Weight Status

Body Composition

Quality of Life (QOL)

Functional Status

Exercise Capacity

Healthcare Utilization

Admissions / Readmissions

Length of Stay (LOS)

Emergency Department (ED) Visits.

Size of Study Groups: Sample size must equal 10 for each study group (e.g., 10 patients in intervention group and 10 patients in control or comparison group).

Year Range: 2005 to December 31, 2017. (Original year range included studies published in 2001 through December 31, 2017. Studies published prior to 2005 were later excluded by the workgroup.)

Authorship

If an author is included on more than one review article or primary research article that is similar in content, the most recent review or article will be accepted and earlier versions will be rejected

If an author is included on more than on review article or primary research article and the content is different, then both reviews may be accepted.

Language: English.

Subjects: Human.

Publication: Published in peer-reviewed journal.

Exclusion Criteria

Age: Young adults up to 18 years of age, infants, children and adolescents.

Setting: Critical care (e.g. intensive care unit).

Health Status: Mechanical ventilation.

Nutrition-Related Problem or Condition:

Fibrosis (without COPD)

Sarcoidosis (without COPD)

Asthma (without COPD)

Asthma-COPD Overlap Syndrome

Chronic Systemic Inflammatory Syndrome (without COPD)

Lung condition that is not COPD

Prevention of COPD in cohort of patients with no COPD

No comorbid conditions excluded. Studies that include COPD with comorbidities that do not focus on COPD are excluded.

Study Designs:

Review article; meta-analysis (Relevant review articles will be hand searched for primary research.)

Not a research study: Poster session, commentary, letter to editor, “grey” literature: technical reports from government agencies or scientific research groups, working papers from research groups or committees, white papers, position papers, abstracts, conference reports or pre-prints.

Nutrition Intervention:

Does not measure effectiveness of MNT intervention (counseling, education); Measures effect of a specific diet or food/oral nutrition supplement only

Country origin of dietitian is not an active member of ICDA.

No dietitian involved in the intervention; Dietitian only provides nutrition assessment to collect data (i.e., interview, survey).

No mention of credentials of the intervention provider.

Outcomes: Does not report at least one of the outcomes of interest.

Size of Study Groups:

Less than 10 subjects for each study group

Subject number is unclear or not reported.

Year Range: Published prior to 2005.

Authorship: Studies by same author similar in content.

Language: Not in English.

Subjects: Animal studies.

Publication: Not published in peer-reviewed journal.

Search Terms: Search Vocabulary

Condition: COPD

Population: Adults

Intervention/treatment:

Diet therapy; nutrition therapy; nutritionist; dietitian; dietary services; nutrition counseling

Registered dietitian nutritionist; dietician; nutritionist; registered dietitian.

Electronic Databases

Original pubmed search, 1, 446 retrieved; 976 unique
((copd) AND (((((dietary services) OR dietitian) OR nutritionist) OR diet therapy) OR nutrition therapy)) OR (COPD AND nutrition counseling) OR (COPD AND dietary services) OR (COPD AND diet therapy) OR (COPD AND nutritionist) OR (COPD AND nutrition therapy)
Limited to English, Humans, Adults (19+), 20010101-20160629

New Medline OVID search,   326 retrieved; 265 unique 7/25/2018
1 (Chronic Obstructive pulmonary or copd).ti, ab.
2 exp Pulmonary Disease, Chronic Obstructive/
3 or/1-2
4 exp NUTRITION THERAPY/ or exp NUTRITION ASSESSMENT/
5 (nutritionist* or dietitian*).ti, ab.
6 ((diet* or nutrition*) adj1 (counsel* or exam* or assess* or therap*)).ti, ab.
7 or/4-6
8 3 and 7
9. exp Adult/ or adult*.ti, ab.
10. exp Pediatrics/ or exp Adolescent/ or exp Child/ or (child* or adolescen* or pediatric* or paediatric* or infant*).ti, ab.
11. animals/ not humans/
12. ((8 and 9) or (8 not 12)) not 11
13. limit 12 to (english language and ed="20010101-20180725")

Cochrane CENTRAL (Wiley) 18 records retrieved; 18 unique, 8/29/2018
#1 copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease
#2 (diet* or nutrition*) near (counsel* or exam* or assess* or therap*)
#3 nutritionist* or dietitian*
#4 #1 and (#2 or #3)
#5 accession near2 pubmed
#6 accession near3 embase
#7 (#5 or #6)
#8 #4 not #7

EMBASE (Ovid) 1, 721 retrieved; 183 unique, 6/28/2018
1. (Chronic Obstructive pulmonary or copd).ti, ab.
2. exp chronic obstructive lung disease/
3. 1 or 2
4. exp diet therapy/ or exp NUTRITION ASSESSMENT/
5. (nutritionist* or dietitian*).ti, ab. or exp dietitian/
6. ((diet* or nutrition*) adj1 (counsel* or exam* or assess* or therap*)).ti, ab.
7. or/4-6
8. 3 and 7
9. exp Adult/ or adult*.ti, ab.
10. exp Pediatrics/ or exp Adolescent/ or exp Child/ or (child* or adolescen* or pediatric* or paediatric* or infant*).ti, ab.
11. animal/ not human/
12. ((8 and 9) or (8 not 10)) not 11
13. limit 12 to (english language and yr="2001 -Current")

CINAHL (Ebsco) 169 retrieved; 49 unique, 6/28/2018
S1    (MH "Pulmonary Disease, Chronic Obstructive+") OR TI ( copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease ) OR AB ( copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease )
S2 ( (MH "Dietitians") OR (MH "Diet Therapy+") OR (MH "Nutritional Assessment") ) OR TI ( (nutritionist* or dietitian*) OR ((diet* or nutrition*) n1 (counsel* or exam* or assess* or therap*)) ) OR AB ( (nutritionist* or dietitian*) OR ((diet* or nutrition*) n1 (counsel* or exam* or assess* or therap*)) )
S3 (MH "Adult+") OR ( TI adult* OR AB adult* )
S4 ( (MH "Pediatrics+") OR (MH "Child+") OR (MH "Adolescence+") ) OR TI ( (child* or adolescen* or pediatric* or paediatric* or infant*) ) OR AB ( (child* or adolescen* or pediatric* or paediatric* or infant*) )
S5 (S1 and S2 and S3) or ((S1 and S2) not S4)

List of Included Articles

Farooqi N, Nordström L, et al. Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD): 1-year follow-up. Arch Gerontol Geriatr 2011; 53:70-75. Epub 2010 Jul 8. PMID: 20619471.
Gale N, Duckers J, et al. Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?. BMC Pulm Med 2011; 11:20. PMID: 21510856.
McDonald V, Gibson P, et al. Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology 2016; Jul;21(5):875-882. Epub 2016 Feb 24. PMID: 26916174.
McLoughlin RE, McDonald VM, et al. The impact of a weight loss intervention on diet quality and eating behaviours in people with obesity and COPD. Nutrients 2017; Oct 20;9(10) pii E1147. PMID: 29053575.
Norrhall M, Nilsfelt A, et al. A feasible lifestyle program for early intervention in patients with chronic obstructive pulmonary disease (COPD): a pilot study in primary care. Prim Care Respir J l 2009 Dec; 18(4):306-312. PMID: 19597690.
van Wetering CR, Hoogendoorn M, et al. 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. Am Med Dir Assoc 2010 Mar; 11(3):179-187. Epub 2010 Feb4. PMID: 20188315.
Weekes C, Emery P, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 2009 Apr;64(4):326-331. Epub 2008 Dec 15. PMID: 19074931

Articles Considered, but Excluded

List of Excluded Articles with Reason

The MNT topic consists of 149 excluded articles. Download the entire list of articles and reason for exclusion.

Search Methods and Results

Identification

Articles Identified Through Database Searching: 3680
Additional Articles Identified Through Other Sources: 13

Screening

Articles Screened After Removing Duplicates: 1489
Articles Excluded During the Screening Process: 1333

Eligibility

Full-text Articles Assessed for Eligibility: 156
Full-text Articles Excluded: 149

Included

Articles Included in Qualitative Synthesis: 7
Articles Included in Quantitative Synthesis (Meta-analysis): 0