Chronic Obstructive Pulmonary Disease

COPD: Energy and Macronutrient Intake (2019)

Nine studies reported energy intake and related energy intake to outcomes. Seven of these studies also reported intake of either protein or all three macronutrients (protein, carbohydrate, fat). Five studies reported intake of protein (Forli and Boe, 2005; Renvall et al, 2009, Sugawara et al, 2012; Weekes et al, 2009; Yazdanapah et al, 2010) and two studies reported intake of all three macronutrients (Benton et al, 2010; Lee et al, 2013). Out of these seven studies, only four reported macronutrient intake in relation to outcomes of interest (Benton et al, 2010; Sugawara et al, 2012; Weekes et al, 2009; Yazdanapah et al, 2010). The evidence analysis for macronutrient intake (carbohydrate, protein, fat) is examined in separate questions.

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

  • Conclusion

    Evidence suggests an association between energy intake and some outcomes in adults with COPD. There was improvement in dyspnea scores with higher energy intakes, with less robust evidence supporting a beneficial relationship with functional status, healthcare utilization or duration of illness. The findings for the impact of energy intake on exacerbations, quality of life, weight status and body composition were mixed, with the majority supportive of an association. The evidence for a relationship between energy intake and lung function, systemic inflammation or exercise capacity was inconsistent. Outcomes varied among these studies, making synthesis of the findings challenging.

  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What association exists between energy intake (e.g., kcal per kg) and outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Benton M, Wagner C, Alexander J. Relationship between body mass index, nutrition, strength, and function in elderly individuals with chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation and Prevention 2010; 30:260-3
      • Froli L, Boe J. The energy intake that is needed for weight gain in COPD candidates for lung transplantation. COPD 2005; 2:405-10
      • Lee H, Kim S, Lim Y, Gwon H, Kim Y, Ahn J, Park H. Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD). Archives of Gerontology and Geriatrics 2013; 56:518-23
      • Planas M, Alvarez J, García-Peris P, de la Cuerda C, de Lucas P, Castella M, Canseco F, Reyes L. Nutritional support and quality of life in stable chronic obstructive pulmonary disease (COPD) patients. Clinical Nutrition (Edinburgh, Scotland) 2005; 24:433-41
      • Renvall M, Friedman P, Ramsdell J. Predictors of body mass index in patients with moderate to severe emphysema. COPD 2009; 6:432-6
      • Selvi EC, Saikumar P, Kumar N. How to evaluate the risk of malnutrition in patients with COPD?. Global Journal of Medical Research: F Diseases 2014; 14:21-25
      • 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. Respiratory Medicine 2012; 106:1526-34
      • Weekes C, Emery P, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 2009; 64:326-31
      • Yazdanpanah L, Shidfar F, Moosavi A, Heidarnazhad H, Haghani H. Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Medica Iranica 2010; 48:374-9
  • Search Plan and Results: COPD: Energy and Macronutrient Intake and Composition 2017
     
  What association exists between carbohydrate intake (e.g., g per kg) and outcomes in adults with COPD?

  • Conclusion

    Very limited evidence suggests an association between carbohydrate (CHO) intake and upper and lower body strength or six-minute walking distance in adults with COPD. No association was found between CHO intake and body mass index.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What association exists between carbohydrate intake (e.g., g/kg) and outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Benton M, Wagner C, Alexander J. Relationship between body mass index, nutrition, strength, and function in elderly individuals with chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation and Prevention 2010; 30:260-3
  • Search Plan and Results: COPD: Energy and Macronutrient Intake and Composition 2017
     
  What association exists between protein intake (e.g., g per kg) and outcomes in adults with COPD?

  • Conclusion

    Limited evidence suggests an association between protein intake and some outcomes in adults with COPD. There was improvement in respiratory symptoms, quality of life and functional status with higher protein intakes. A beneficial, but less consistent effect was seen between protein intake and lung function, weight status, body composition or exercise capacity. The relationship between protein intake and systemic inflammation was inconsistent. Outcomes varied among the studies, making synthesis of the findings challenging.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What association exists between protein intake (e.g., g per kg) and outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Benton M, Wagner C, Alexander J. Relationship between body mass index, nutrition, strength, and function in elderly individuals with chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation and Prevention 2010; 30:260-3
      • 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. Respiratory Medicine 2012; 106:1526-34
      • Weekes C, Emery P, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 2009; 64:326-31
      • Yazdanpanah L, Shidfar F, Moosavi A, Heidarnazhad H, Haghani H. Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Medica Iranica 2010; 48:374-9
  • Search Plan and Results: COPD: Energy and Macronutrient Intake and Composition 2017
     
  What association exists between fat intake (e.g., g per kg) and outcomes in adults with COPD?

  • Conclusion

    Very limited evidence suggests an association between fat intake and upper body strength in adults with COPD, but not between fat intake and body mass index.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What association exists between fat intake (e.g., g per kg) and outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Benton M, Wagner C, Alexander J. Relationship between body mass index, nutrition, strength, and function in elderly individuals with chronic obstructive pulmonary disease. Journal of Cardiopulmonary Rehabilitation and Prevention 2010; 30:260-3
  • Search Plan and Results: COPD: Energy and Macronutrient Intake and Composition 2017