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Recommendations Summary

Search Plan and Results

 

Evidence Analysis Question(s)

Does the macronutrient composition (percentage distribution) of the diet have an effect on outcomes in adults with COPD?

What association exists between energy intake (e.g., kcal per kg) and outcomes in adults with COPD?

What association exists between carbohydrate intake (e.g., g per kg) and outcomes in adults with COPD?

What association exists between protein intake (e.g., g per kg) and outcomes in adults with COPD?

What association exists between fat intake (e.g., g per kg) and 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.

Intervention

  • Comparison of different energy and macronutrient intakes (kcals, grams) and composition (% distribution) between groups. 
  • Energy and macronutrient intake (as the exposure) must be related to or associated with outcomes of interest.

Outcomes Includes one or more of the following outcomes:     

  • 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.

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 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.) 
  • 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:

  • Energy and macronutrient intake (kcals, grams) and/or composition (% distribution) between groups is identical or not reported between groups investigated.
  • Energy and macronutrient intake is descriptive only; not related to or associated with outcomes of interest.
  • Outcome of interest is the exposure that is related to or associated with energy/macronutrient intake,  in which energy/macronutrient intake is the outcome. 
  • Interventions that include specific types of macronutrients or evaluating efficacy of a medical food supplement (MFS) (e.g., MFS or dose with amino acids or omega 3 fatty acids, without reporting total energy and macronutrient intake or composition.    

Outcomes: Does not report on at least one outcome 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: 

  • Energy intake; dietary energy; calories; kilocalories
  • Macronutrient composition; macronutrient intake; macronutrients
  • Dietary protein; dietary fat; dietary carbohydrate. 

Electronic Databases 

Pubmed 9/12/2016
202 retrieved

Pulmonary Disease, Chronic Obstructive[mh] OR Lung Diseases, Obstructive[mh]OR COPD[tiab] OR Chronic Obstructive Pulmonary Disease[tiab]
            Energy intake[mh] OR“dietary energy”[tiab] OR“energy need”[tiab] OR"energy needs"[tiab] OR "energy estimate"[tiab] OR "energy estimation"[tiab] OR"energy requirement"[tiab] OR“energy balance”[tiab] OR “energy calculation” OR “calorie intake”[tiab] OR “calorie need”[tiab] OR "calorie needs"[tiab] OR"calorie estimate"[tiab] OR "energy estimation"[tiab] OR "calorie requirement"[tiab] OR “calorie calculation”[tiab]
            Dietary Proteins[mh] OR Dietary Proteins/administration and dosage[mh] OR Dietary Protein*[tiab] OR "protein need"[tiab] OR "protein needs"[tiab] OR "protein estimate"[tiab] OR "protein estimation"[tiab] OR "protein requirement"[tiab]
            dietary carbohydrates[mh] OR Dietary carboydrates/administration and dosage[mh]
 OR Dietary carbohydrate*[tiab] OR"carbohydrate need"[tiab] OR "carbohydrate needs"[tiab] OR "carbohydrate estimate"[tiab] OR "carbohydrate estimation"[tiab] OR "carbohydrate requirement"[tiab]
            Dietary Fats[mh] OR Dietary Fats/administration and dosage[mh] OR Dietary Fat*[tiab] OR "fat need"[tiab] OR "fat needs"[tiab] OR "fat estimate"[tiab] OR "fat estimation"[tiab] OR "fat requirement"[tiab]
            "Macronutrient composition"[tiab] OR "Macronutrient needs"[tiab] OR "Macronutrient need"[tiab] OR Macronutrient[tiab]
Limited to English; human; 2000-, adults

Cochrane CENTRAL (Wiley)  No records found, 8/29/2018; 0 records retrieved.
#1 copd or chronic obstructive pulmonary disease or chronic obstructive airway disease or chronic obstructive lung disease
#2 (protein* or fat* or carbohydrate* or energy) near2 (assess* or estimat* or need*)
#3 macronutrient*
#4 #1 and (#2 or #3)
#5 accession near2 pubmed
#6 accession near3 embase
#7 (#5 or #6)
#8 #4 not #7

Medline Ovid new search 2000/01/01-2017/12/31
524 retrieved; 355 unique

1. (Chronic Obstructive pulmonary or copd).ti, ab.    
2. exp Pulmonary Disease, Chronic Obstructive/     
3. or/1-2          
4. exp energy intake/ 
5. (diet* adj2 energy).ti, ab.    
6. (energy adj2 (intake* or need* or estimat* or require* or balance or calculat*)).ti, ab.     
7. exp energy metabolism/    
8. (calorie adj2 (intake* or need* or estimat* or calculat* or require*)).ti, ab.
9. exp dietary proteins/          
10. (protein* adj2 (dietary or need* or estimat* or require*)).ti, ab.   
11. exp dietary carbohydrates/          
12. (carbohydrat* adj2 (dietary or need* or estimat* or require*)).ti, ab.       
13. exp dietary fats/   
14. (fat* adj2 (dietary or need* or estimat* or require*)).ti, ab.           
15. macronutrient*.ti, ab.        
16. or/4-15      
17. 3 and 16   
18. exp Adult/ or adult*.ti, ab. 
19. exp Pediatrics/ or exp Adolescent/ or exp Child/ or (child* or adolescen* or pediatric* or paediatric* or infant*).ti, ab.   
20. animals/ not humans/      
21. ((17 and 18) or (17 not 19)) not 20          
22. limit 21 to (english language and yr="2000 - 2017")


CINAHL old search
(17 records retrieved in replicating this search)
MH Pulmonary Disease, Chronic Obstructive+  OR TI COPD OR TI Chronic Obstructive Pulmonary Disease OR AB COPD OR AB Chronic Obstructive Pulmonary Disease

AND

"MH Energy intake+ OR TI energy intake OR TI “energy need" OR TI“energy needs” OR TI “energy estimate” OR TI “energy estimation”OR TI “energy requirement” OR TI “energy recommendation” OR AB “energy intake” OR AB “Dietary Energy” OR AB “energy need” OR AB “energy needs” OR AB “energy estimate” OR AB “energy estimation" OR AB“energy requirement” OR AB “energy recommendation” OR "MH Dietary Proteins+ OR MH diet, high protein+ OR TI “Dietary Protein”OR TI “protein need”OR TI “protein needs”OR TI “protein estimate" OR TI“protein estimation" OR TI“protein requirement" OR TI“protein recommendation" OR AB“Dietary Protein" OR AB“protein need" OR AB“protein needs" OR AB“protein estimate" OR AB“protein estimation" OR AB“protein requirement" OR AB“protein recommendation” OR MH dietary carbohydrates+ OR MH diet, low carbohydrate+ OR TI “carbohydrate need” OR TI “carbohydrate needs” OR TI “carbohydrate estimate” OR TI “carbohydrate estimation” OR TI “carbohydrate requirement” OR TI “carbohydrate recommendation” OR AB “Dietary Carbohydrate” OR AB “carbohydrate need” OR AB “carbohydrate needs” OR AB “carbohydrate estimate” OR AB “carbohydrate estimation” OR AB “carbohydrate requirement”OR AB “carbohydrate recommendation” OR "MH Dietary Fats+ OR MH diet, fat-restricted OR TI “fat need” OR TI “fat needs” OR TI “fat estimate” OR TI “fat estimation” OR TI “fat requirement” OR TI “fat recommendation” OR AB “Dietary Fat” OR AB “fat need” OR AB “fat needs” OR AB “fat estimate” OR AB “fat estimation” OR AB “fat requirement” OR AB “fat recommendation” OR "MH macronutrients+ OR TI ""Macronutrient composition” OR TI “macronutrient need” OR TI “macronutrient needs” OR TI “macronutrient estimate” OR TI “macronutrient estimation” OR TI “macronutrient requirement” OR TI “macronutrient recommendation” OR AB “Macronutrient composition” OR AB “macronutrient need” OR AB “macronutrient needs” OR AB “macronutrient estimate” OR AB “macronutrient estimation” OR AB “macronutrient requirement” OR AB “macronutrient recommendation”

CINAHL new search
128 retrieved, 28 unique
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 (MH "Dietary Fats+") OR (MH "Dietary Carbohydrates+") OR (MH "Macronutrients") OR (MH "Energy Intake") OR (MH "Energy Metabolism") OR AB ( (protein* or fat* or carbohydrate* or energy) n2 (assess* or estimat* or need*)))OR TI ( (protein* or fat* or carbohydrate* or energy) n2 (assess* or estimat* or need*))) OR TI macronutrient* OR AB macronutrient*
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
382 retrieved, 27 unique added to Rayyan

1. (Chronic Obstructive pulmonary or copd).ti, ab.    
2. exp Pulmonary Disease, Chronic Obstructive/     
3. or/1-2          
4. (diet* adj2 energy).ti, ab.    
5. (energy adj2 (intake* or need* or estimat* or require* or balance or calculat*)).ti, ab.     
6. (calorie adj2 (intake* or need* or estimat* or calculat* or require*)).ti, ab.
7. (protein* adj2 (dietary or need* or estimat* or require*)).ti, ab.     
8. (carbohydrat* adj2 (dietary or need* or estimat* or require*)).ti, ab.         
9. (fat* adj2 (dietary or need* or estimat* or require*)).ti, ab. 
10. macronutrient*.ti, ab.        
11. exp caloric intake/ or exp protein intake/ or exp carbohydrate diet/ or exp fat intake/ or exp macronutrient/           
12. or/4-11      
13. 3 and 12   
14. exp Adult/ or adult*.ti, ab. 
15. exp Pediatrics/ or exp Adolescent/ or exp Child/ or (child* or adolescen* or pediatric* or paediatric* or infant*).ti, ab.   
16. (13 and 14) or (13 not 15)
17. animals/ not humans/      
18. 16 not 17  
19. limit 18 to (english language and yr="2000 - 2017")       

List of Included Articles  

  • Benton M, Wagner C, Alexander J. Relationship between body mass index, nutrition, strength, and function in elderly individuals with chronic obstructive pulmonary disease. J Cardioplum Rehabil Prev 2010; Jul-Aug;30(4):260-3. doi: 10.1097/HCR.0b013e3181d6f94f. PMID 20410829. 
  • Forli L, Boe J. The energy intake that is needed for weight gain in COPD candidates for lung transplantation. COPD. 2005 Dec;2(4):405-10. PMID: 17147005
  • Lee H, Kim S, Lim Y, et al. Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD). Arch Gerontol Geriatr. 2013 May-Jun;56(3):518-23. doi: 10.1016/j.archger.2012.12.011. Epub 2013 Jan 23. PMID: 23352455 
  • Planas M, Alvarez J, et al. Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients. Clin Nutr. 2005 Jun;24(3):433-41. Epub 2005 Apr 21. PMID: 15896431 
  • Renvall M, Friedman P, Ramsdell J. Predictors of body mass index in patients with moderate to severe emphysema. COPD 2009; Dec;6(6):432-6. PMID 19938965 
  • Selvi CE, Saikumar P, Kumar N. How to evaluate the risk of malnutrition in patients with COPD? Res J Pharm, Biol Chem Sci 2014; 1(1):223-227.
  • Sugawara K, Takahashi H, Kashiwagura T, Yamada K, Yanagida S, Homma M, Dairiki K, Sasaki H, Kawagoshi A, Satake M, Shioya T. Effect of anti-inflammatory supplementation with whey peptide and exercise therapy in patients with COPD. Respir Med 2012 Nov; 106(11):1526-34. PMID 22857881.
  • Tümer G, Mercanligil SM, et al. The effects of a high-fat, low-carbohydrate diet on the prognosis of patients with an acute attack of chronic obstructive pulmonary disease. Turkiye Klinikleri J Med Sci. 2009;29(4):895-904. Accession Number: 105317630. 
  • Weekes CE, Emery PW, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax. 2009 Apr;64(4):326-31. doi: 10.1136/thx.2008.097352. Epub 2008 Dec 15. PMID: 19074931. 
  • Yazdanpanah L, Shidfar F, Moosavi AJ, Heidarnazhad H, Haghani H. Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Med Iran. 2010 Nov-Dec;48(6):374-9. PMID: 21287476.

Articles Considered, but Excluded

List of Excluded Articles with Reason 

The Macronutrient topic consists of 118 excluded articles. Download the entire list of articles and reason for exclusion.

Search Methods and Results

Identification

Articles Identified Through Database Searching: 1984
Additional Articles Identified Through Other Sources: 20

Screening

Articles Screened After Removing Duplicates: 1341
Articles Excluded During the Screening Process: 1213

Eligibility

Full-text Articles Assessed for Eligibility: 128
Full-text Articles Excluded: 118

Included

Articles Included in Qualitative Synthesis: 10
Articles Included in Quantitative Synthesis (Meta-analysis): 0