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Title: Nutritional screening and nutritional support in chronic obstructive pulmonary disease (COPD)
Author: Collins, Peter Francis
Awarding Body: University of Southampton
Current Institution: University of Southampton
Date of Award: 2012
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Malnutrition is a common problem in chronic obstructive pulmonary disease (COPD) and associated with poorer prognosis. Currently controversies surround the importance of nutritional intervention and how best to nutritionally manage those identified as at risk of malnutrition. Dietary advice (DA) and oral nutritional supplements (ONS) are two of the most common first line treatments for malnutrition in COPD but the evidence base for DA is lacking and for ONS appears uncertain. To date there have been no randomised trials comparing these two treatments in COPD. The aims of this thesis were three-fold, firstly, to establish the local prevalence of malnutrition in UK outpatients with COPD and examine the impact of malnutrition on clinical outcomes (healthcare use, mortality). Secondly, to perform a systematic review to clarify the current evidence for nutritional support in stable COPD patients and finally, to carry out a randomised trial comparing the effectiveness of a 3-moht intervention of DA versus ONS in improving quality of life (QoL) in stable outpatients with COPD. The prevalence of malnutrition was high in outpatients with COPD (22% at risk), with a lower BMI being a strong significant independent predictor of mortality and increased emergency healthcare use. Contrary to previous reviews, the current systematic review found that nutritional support, mainly involving ONS, resulted in significant improvements in nutritional intake, body weight and anthropometry as well as several functional outcomes. For several reasons, an RCT investigating DA vs. ONS that was undertaken as part of this work was underpowered and did not find any improvements in outcomes of interest although both groups maintained weight and function possibly indicating a treatment effect. When pre- and post-intervention analysis was carried out combining both interventions (ONS + DA) significant improvements in energy and protein intakes, body weight and non-dominant handgrip strength were observed. However, with a small sample and the absence of a control group these results should be interpreted with caution. Nutrition support is effective at treating malnutrition in COPD but the results from this thesis appear to suggest that earlier intervention is required. This highlights to importance of accurate nutritional screening and assessment in this patient group.
Supervisor: Elia, Marinos ; Stratton, Rebecca J. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RC Internal medicine