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Recommendations Summary

Search Plan and Results

 

Evidence Analysis Question(s)

OVERALL: If measurements are not available, what are the best methods to predict energy needs in adults with COPD?

In adults with COPD, how does the WHO (including height) equation relate to measured energy expenditure?

In adults with COPD, how does the Nordic Nutrition Recommendation equation (NNRE) relate to measured energy expenditure?

In adults with COPD, how does the Harris-Benedict equation (HBE) relate to measured energy expenditure?

In adults with COPD, how does the Moore and Angellilo equation (MAE) relate to measured energy expenditure?

In adults with COPD, how does the Westerterp equation relate to measured energy expenditure?

In adults with COPD, how does the Nordenson equation relate to measured energy expenditure?

In adults with COPD, how does the Mifflin St. Jeor equation (MSJE) relate to measured energy expenditure?

In adults with COPD, how does the Owen equation relate to measured energy expenditure?

In adults with COPD, how does the de Oliveira equation relate to measured energy expenditure?

In adults with COPD, how does the WHO (omitting height) equation relate to measured energy expenditure?

In adults with COPD, how does the Schofield equation relate to measured energy expenditure?

What is the best method to estimate protein needs 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 non-randomized observational studies
  • Cohort, case-control studies.

Intervention

  • Comparison between estimated energy needs [resting metabolic rate (RMR)] using a predictive equation (calculation or formula) and measured energy needs using a reference standard [indirect calorimetry (IC) or doubly labeled water (DLW)]
  • Comparison between estimated energy needs [total energy expenditure (TEE)] using a predictive equation (calculation or formula) and activity factor and measured energy needs using a reference standard (accelerometer or other device used to measure TEE)
  • Comparison between estimated protein needs using a predictive equation (calculation or formula) and measured protein needs
  • For studies measuring RMR, IC protocol must meet resting and fasting criteria for adults, as described in the EAL energy expenditure 2014 project:
    • If the study refers to the protocol "described elsewhere, " then that reference will be obtained to determine the actual protocol
    • Rest period: Must state 20-minute minimum rest period (in controlled research environment it is implied that researchers have ensured study subjects are not moving during rest period), or a 15-minute rest period is acceptable, as long as the paper also described discarding the first five minutes of measurement
    • Fasting period: Must state a minimum seven-hour fast (or overnight).

Outcomes

Includes one or more of the following agreement outcomes: 

  • Precision (e.g., description of root mean square error as a percentage of RMR)
  • Bias (e.g., 95% CI, Bland-Altman analysis) 
  • Prediction accuracy (i.e., percentage of individuals in a study group whose RMR was predicted to within an acceptable range of measured RMR)
  • Limits of agreement.

Year Range

2005 to December 31, 2017. Original year range included studies published from 2001 through December 31, 2017. Studies published prior to 2005 were later excluded by the workgroup.

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).

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 one 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, 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 (pertinent review articles will be hand-searched) 
  • 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.

Intervention

  • No comparison between estimated energy needs [resting metabolic rate (RMR)] using a predictive equation (calculation or formula) and measured energy needs using a reference standard [indirect calorimetry (IC) or doubly labeled water (DLW)]
  • No comparison between estimated energy needs [total energy expenditure (TEE)] using a predictive equation (calculation or formula) and activity factor and measured energy needs using a reference standard (e.g., accelerometer or other validated device designed to measure TEE)
  • Comparison of a physical activity monitor (PAM) or hand-held device to another measured device
  • No comparison between estimated protein needs using a predictive equation (calculation or formula) and measured protein needs
  • For studies measuring RMR, IC protocol does not meet resting and fasting criteria for adults, as described in the EAL energy expenditure project: 
    • Fasting or resting criteria are not described in the paper
    • Rest period: Less than 20-min total rest period
    • Fasting period: Less than seven-hour fast.

Outcomes

Does not include one more 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 or Treatment

  • Energy requirement; energy metabolism; energy expenditure; resting metabolic rate; basal metabolism; RMR
  • Calorimetry; indirect calorimetry
  • Dietary proteins; proteins; estimated; needs; assess.

Electronic Databases 

Pubmed
("Energy (Oxf)"[Journal] OR "energy"[All Fields])

  • AND ("methods"[MeSH Terms] OR "methods"[All Fields] OR "method"[All Fields])
  • AND ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields])    

("Energy (Oxf)"[Journal] OR "energy"[All Fields])

  • AND ("Assessment"[Journal] OR "assessment"[All Fields])
  • AND ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields])    

("Energy (Oxf)"[Journal] OR "energy"[All Fields]) AND estimation[All Fields] AND ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields])           

("Energy (Oxf)"[Journal] OR "energy"[All Fields]) AND need[All Fields] AND ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields])

  • ("Energy (Oxf)"[Journal] OR "energy"[All Fields]) AND requirement[All Fields] AND ("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields])       

("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "pulmonary disease, chronic obstructive"[All Fields]) AND ("energy metabolism"[MeSH Terms] OR ("energy"[All Fields] AND "metabolism"[All Fields]) OR "energy metabolism"[All Fields])         

("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields]) AND ((("Regen Med Res"[Journal] OR "rmr"[All Fields]) OR REE[All Fields] OR ("energy metabolism"[MeSH Terms] OR ("energy"[All Fields] AND "metabolism"[All Fields]) OR "energy metabolism"[All Fields] OR ("energy"[All Fields] AND "expenditure"[All Fields]) OR "energy expenditure"[All Fields]) OR (("Energy (Oxf)"[Journal] OR "energy"[All Fields]) AND requirement[All Fields]) OR ("calorimetry"[MeSH Terms] OR "calorimetry"[All Fields]) OR ("basal metabolism"[MeSH Terms] OR ("basal"[All Fields] AND "metabolism"[All Fields]) OR "basal metabolism"[All Fields]))

  • (("pulmonary disease, chronic obstructive"[MeSH Terms] OR ("pulmonary"[All Fields] AND "disease"[All Fields] AND "chronic"[All Fields] AND "obstructive"[All Fields]) OR "chronic obstructive pulmonary disease"[All Fields] OR "copd"[All Fields]) AND (("Regen Med Res"[Journal] OR "rmr"[All Fields]) OR REE[All Fields] OR ("energy metabolism"[MeSH Terms] OR ("energy"[All Fields] AND "metabolism"[All Fields]) OR "energy metabolism"[All Fields] OR ("energy"[All Fields] AND "expenditure"[All Fields]) OR "energy expenditure"[All Fields]) OR (("Energy (Oxf)"[Journal] OR "energy"[All Fields]) AND requirement[All Fields]) OR ("calorimetry"[MeSH Terms] OR "calorimetry"[All Fields]) OR ("basal metabolism"[MeSH Terms] OR ("basal"[All Fields] AND "metabolism"[All Fields]) OR "basal metabolism"[All Fields]))) AND exacerbation[All Fields]

Cochrane CENTRAL (Wiley)
August 29, 2018
No records found

  1. copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease
  2. (energy or metabolism) near2 (assess* or estimat* or need* or requir* or expenditure*)
  3. protein* near2 (assess* or estimat* or need* or diet*)
  4. #1 and (#2 or #3)
  5. accession near2 pubmed
  6. accession near3 embase
  7. (#5 or #6)
  8. #4 not #7.

Updated Medline Ovid search
301 retrieved, unique articles added to rayyan

  1. (Chronic Obstructive pulmonary or copd).ti, ab.        
  2. exp Pulmonary Disease, Chronic Obstructive/     
  3. 1 or 2          
  4. exp Energy Metabolism/    
  5. exp CALORIMETRY/        
  6. ((energy or metabolism) adj2 (assess* or estimat* or need* or requir* or expenditure*)).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 10)) not 11
  13. limit 12 to (english language and yr="2005 - 2017").

Medline Medline Ovid
65 new

  1. (Chronic Obstructive pulmonary or copd).ti, ab.    
  2. exp Pulmonary Disease, Chronic Obstructive/     
  3. 1 or 2
  4. exp Dietary Proteins/         
  5. (diet* adj2 protein*).ti, ab.   
  6. (protein* adj2 (assess* or estimat* or need*)).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 10)) not 11
  13. limit 12 to (english language and yr="2005 - 2017").

CINAHL
Old search
(COPD AND energy methods ) OR ( COPD AND energy assessment ) OR ( COPD AND energy estimation ) OR ( COPD AND energy needs ) OR ( COPD AND energy requirement ) OR ( COPD AND energy metabolism).

CINAHL new search
Published Date: 2000 to 2017
English Language
27 total retrieved, 17 new compared to old search

  • 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  AB ( ((energy or metabolism) n2 (assess* or estimat* or need* or requir* or expenditure*)) ) OR TI ( ((energy or metabolism) n2 (assess* or estimat* or need* or requir* or expenditure*)) )
  • 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*) )
  • (S1 and S2 and S3) or ((S1 and S2) not S4).

CINAHL new search
12 retrieved (no new)

  • 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 "Dietary Proteins+") OR AB ( (protein* n2 (assess* or estimat* or need*))) OR AB (diet* n2 protein*) OR TI ( (protein* n2 (assess* or estimat* or need*)) ) OR TI(diet* n2 protein*)
  • 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*) )
  • (S1 and S2 and S3) or ((S1 and S2) not S4).

Embase energy and protein searches combined (40 retrieved)

  1. (Chronic Obstructive pulmonary or copd).ti, ab.    
  2. exp Pulmonary Disease, Chronic Obstructive/     
  3. 1 or 2          
  4. exp protein intake/ 
  5. (diet* adj2 protein*).ti, ab.   
  6. (protein* adj2 (assess* or estimat* or need*)).ti, ab.          
  7. exp energy metabolism/ or exp calorimetry/         
  8. ((energy or metabolism) adj2 (assess* or estimat* or need* or requir* or expenditure*)).ti, ab.   
  9. or/4-8          
  10. 3 and 9     
  11. exp Adult/ or adult*.ti, ab. 
  12. exp Pediatrics/ or exp Adolescent/ or exp Child/ or (child* or adolescen* or pediatric* or paediatric* or infant*).ti, ab.   
  13. (10 and 11) or (10 not 12)
  14. animals/ not humans/      
  15. 13 not 14  
  16. limit 15 to (english language and yr="2000 - 2017")       
  17. limit 16 to exclude medline journals.

List of Included Articles  

  • Farooqi N, Slinde F, Carlsson M, Håglin L, Sandström T. Predicting energy requirement with pedometer-determined physical-activity level in women with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015 Jun 15; 10: 1, 129-1, 137. doi: 10.2147/COPD.S80616. eCollection 2015. PMID: 26109854 
  • Nordenson A, Grönberg AM, Hulthén L, Larsson S, Slinde F. A validated disease specific prediction equation for resting metabolic rate in underweight patients with COPD. Int J Chron Obstruct Pulmon Dis. 2010 Sep 7; 5: 271-276. Review. PMID: 20856826
  • Ramos FM, Rossato LT, Ramires BR, Pimentel GD, Venâncio LS, Orsatti FL, de Oliveira EP. Comparison of predictive equations of resting energy expenditure in older adults with chronic obstructive pulmonary disease. Rev Port Pneumol (2006). 2017 Jan-Feb; 23 (1): 40-42. doi: 10.1016/j.rppnen.2016.08.005. Epub 2016 Oct 19. No abstract available. PMID: 27771344 
  • Slinde F, Grönberg AM, Svantesson U, Hulthén L, Larsson S. Energy expenditure in chronic obstructive pulmonary disease-evaluation of simple measures. Eur J Clin Nutr. 2011 Dec; 65 (12): 1, 309-1, 313. doi: 10.1038/ejcn.2011.117. Epub 2011 Jun 22. PMID: 21697822
  • Slinde F, Svensson A, Hulthén L, Grönberg A, Nordenson A and Larsson S. Reproducibility of indirect calorimetry in underweight patients with chronic obstructive pulmonary disease. e-SPEN. 2008; 3 (2): e40-e45. Accession Number: edselc.2-52.0-41349090090 DOI: 10.1016/j.eclnm.2007.11.001.

Articles Considered, but Excluded

List of Excluded Articles with Reason 

The Methods to Estimate Energy and Protein Requirements topic consists of 163 excluded articles.
Download the entire list of articles and reason for exclusion.

Search Methods and Results

Identification

Articles Identified Through Database Searching: 1535
Additional Articles Identified Through Other Sources: 19

Screening

Articles Screened After Removing Duplicates: 908
Articles Excluded During the Screening Process: 740

Eligibility

Full-text Articles Assessed for Eligibility: 168
Full-text Articles Excluded: 163

Included

Articles Included in Qualitative Synthesis: 5
Articles Included in Quantitative Synthesis (Meta-analysis): 0