Oral nutrition supplements and between-meal snacks for nutrition therapy in patients with COPD identified as at nutritional risk: a randomised feasibility trial

Arora Ros Ingadottir, Anne Marie Beck, Christine Baldwin, Christine Elizabeth Weekes, Olof Gudny Geirsdottir, Alfons Ramel, Thorarinn Gislason, Ingibjorg Gunnarsdottir, Arora Ros Ingadottir, Anne Marie Beck, Christine Baldwin, Christine Elizabeth Weekes, Olof Gudny Geirsdottir, Alfons Ramel, Thorarinn Gislason, Ingibjorg Gunnarsdottir

Abstract

Introduction: Intervention studies have mainly used oral nutritional supplements (ONS) for the management of patients with chronic obstructive pulmonary disease (COPD) identified as at nutritional risk. In this 12-month randomised feasibility trial, we assessed the (1) feasibility of the recruitment, retention and provision of two interventions: ONS and between-meal snacks (snacks) and (2) the potential impact of the provision of snacks and ONS on body weight and quality of life in patients with COPD.

Methods: Hospitalised patients with COPD, at nutritional risk, were randomised to ONS (n=19) or snacks (n=15) providing 600 kcal and 22 g protein a day in addition to regular daily diet. The intervention started in hospital and was continued for 12 months after discharge from the hospital.

Results: Study recruitment rate was n=34 (45%) and retention rate at 12 months was similar for both groups: n=13 (68%) in the ONS group and n=10 (67%) in the Snacks group. Both groups gained weight from baseline to 12 months (2.3±4.6 kg (p=0.060) in the ONS group and 4.4±6.4 kg (p=0.030) in the Snacks group). The St George's Respiratory Questionnaire total score improved from baseline to 12 months in both groups (score 3.9±11.0 (p=0.176) in the ONS group and score 8.9±14.1 (p=0.041) in the Snacks group).

Discussion: In patients with COPD who are at nutritional risk snacks are at least as feasible and effective as ONS, however, adequately powered trials that take account of the difficulties in recruiting this patient group are required to confirm this effect.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) diagram. Study flow chart. ONS, oral nutritional supplements.
Figure 2
Figure 2
Mean weight change (%) from baseline. Intention-to-treat analysis. Groups: ONS, oral nutritional supplements (n=16), Snacks (n=13).
Figure 3
Figure 3
(A) Energy and (B) protein intake/day during hospitalisation and in follow-up. Total energy and protein intake per kg actual body weight at baseline, during hospitalisation versus follow-up. ONS: 28 kcal v 39 kcal, p=0.002 and 1.2 g vs 1.4 g, p=0.213. Snacks: 32 kcal vs 40 kcal, p=0.009 and 1.4 g vs 1.8 g, p=0.048. ONS, oral nutritional supplements.

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