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Recommendations Summary

COPD: Monitor and Evaluate Serum 25(OH)D Status 2019

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    COPD: Monitor and Evaluate Serum 25(OH)D Levels

    The RDN should periodically check serum 25(OH)D levels in adults with COPD as part of a routine nutrition monitoring and evaluation. Evidence from 60% of studies reviewed found positive associations between serum 25(OH)D and lung function measures. 

    Rating: Fair
    Imperative

    • Risks/Harms of Implementing This Recommendation

      There are no potential risks or harms associated with the application of this recommendation.

    • Conditions of Application

      If necessary data are not available, the RDN should use professional judgment to request or obtain additional data.

    • Potential Costs Associated with Application

      • Costs may include expenses related to medical nutrition therapy (MNT) visits from an RDN
      • Costs may be incurred due to lab testing to evaluate serum 25(OH)D levels.

    • Recommendation Narrative

      A total of 29 papers from 28 studies provided evidence supporting the recommendation.

      • A total of 14 cross-sectional studies: One positive-quality (Romme et al, 2013),  twelve neutral-quality (Azargoon et al, 2011; El-Shafey and El-Srougy, 2014; Hashim Ali Hussein et al, 2015; Janssens et al, 2010; Jolliffee et al, 2018; Mahlin et al, 2014; Mekov et al, 2015; Monadi et al, 2012; Park et al, 2015; Park et al, 2016; Persson et al, 2012; Shaneen et al, 2011) and one negative-quality (Yang et al, 2015)
      • Six prospective cohort studies: Three positive-quality (Kunisaki et al, 2012; Persson et al, 2015; Puhan et al, 2014) and three neutral-quality (Holmgaard et al, 2013; Jung et al, 2015; Quint et al, 2012)
      • Four retrospective cohort studies: Three positive-quality (Berg et al, 2013; Malinovschi et al, 2014; Mekov et al, 2016) and one neutral-quality (Moberg et al, 2014)
      • Two randomized controlled trials (RCT): One positive-quality (Sanjari et al, 2106) and one neutral-quality (Yumrutepe et al, 2015)
      • One neutral-quality before-after study (Said and Abd-Einaeem, 2015)
      • One neutral-quality descriptive study (Gouda et al, 2016)
      • One neutral-quality case-control study (Kunisaki et al, 2011).

      The overall findings were as follows:

      • Lung Function (LF) (23 studies): A total of 14 studies found significant relationships between serum 25(OH)D and LF outcomes; i.e., as serum 25(OH)D increased, LF outcomes improved (Azargoon et al, 2011; Berg et al, 2013; El-Shafey and El-Srougy, 2014; Gouda et al, 2016; Janssens et al, 2010; Jolliffee et al, 2018; Jung et al, 2015; Park et al, 2016; Persson et al, 2012; Persson et al, 2015; Romme et al, 2013; Said and Abd-Elnaeem, 2015; Yang et al, 2015; Yumrutepe et al, 2015). Nine studies did not find significant relationships between serum 25(OH)D and LF outcomes (Hashim Ali Hussein et al, 2015; Holmgaard et al, 2013; Kunisaki et al, 2011; Mahlin et al, 2014; Malinovschi et al, 2014; Monadi et al, 2012; Park et al, 2015; Sanjari et al, 2016; Shaheen et al, 2011).
      • Acute Exacerbations (AE) (11 studies): Four studies found significant relationships between serum 25(OH)D and AE outcomes; i.e., as serum 25(OH)D increased, AE outcomes improved (Gouda et al, 2016; Malinovschi et al, 2014; Persson et al, 2015; Yang et al, 2015). Seven studies did not find significant relationships between serum 25(OH)D and AE outcomes (Jung et al, 2015; Kunisaki et al, 2011; Mekov et al, 2015; Moberg et al, 2014; Persson et al, 2012; Puhan et al, 2014; Quint et al, 2012).
      • Mortality (five studies): NS relationships were found in any of the studies (Holmgaard et al, 2013; Mekov et al, 2016; Moberg et al, 2014; Persson et al, 2015; Puhan et al, 2014).

    • Recommendation Strength Rationale

      • Conclusion statement supporting the recommendation is Grade II, Fair.
      • Synthesis of results was challenging due to lack of consistency in vitamin D dosing, dosing frequency and delivery routes, length of intervention and baseline serum 25(OH)D levels.

    • Minority Opinions

      None.