COPD: Medical Nutrition Therapy (2019)

COPD: Medical Nutrition Therapy (2019)

The provision of medical nutrition therapy (MNT) is limited to RDNs. Registered dietitian nutritionist (RDN) is a credential granted to nutrition professionals in the United States, who have met all requirements for credentialing through the Commission on Dietetic Registration (CDR), the credentialing agency of the Academy of Nutrition and Dietetics. 

The term “RD/RDN (or international equivalent)” is used on the Evidence Analysis Library (EAL) to allow for studies conducted outside the U.S. to be considered in evaluating the effectiveness of MNT.

To qualify as “international equivalent” for international studies, the country of study’s origin should be a member of International Confederation of Dietetic Associations (ICDA). The credentials for international studies should represent the recognized credentials as stated on ICDA’s website (http://www.internationaldietetics.org/) for that particular country. In addition, international equivalents include nutrition professionals in countries with reciprocity agreements with the CDR (https://www.cdrnet.org/certifications/registration-eligibility-requirements-for-dietitians).

• Intervention
  What is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on body weight, quality of life and exercise capacity outcomes in adults with COPD?

  • Conclusion

    As part of a multidisciplinary program, medical nutrition therapy (MNT) intervention provided by a registered dietitian nutritionist (RDN) (or international equivalent) was effective in improving body weight status, quality of life and exercise capacity outcomes in adults with COPD. 

  • Grade: I
    • 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 is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on body weight, quality of life and exercise capacity outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Farooqi N, Nordström L, Lundgren R, Sandström T, Håglin L. Changes in body weight and physical performance after receiving dietary advice in patients with chronic obstructive pulmonary disease (COPD): 1-year follow-up. Archives of Gerontology and Geriatrics 2011; 53:70-5
      • Gale N, Duckers J, Enright S, Cockcroft J, Shale D, Bolton C. Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?. BMC Pulmonary Medicine 2011; 11:20
      • McDonald V, Gibson P, Scott H, Baines P, Hensley M, Pretto J, Wood L. Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology (Carlton, Vic.) 2016; 21:875-82
      • McLoughlinh RE, McDonald VM, Gibson PG, Scott HA, Hensley MJ, MacDonald-Wicks L, and Wood LG. The Impact of a Weight Loss Intervention on Diet Quality and Eating Behaviours in People with Obesity and COPD. Nutrients 2017; 9:1147
      • Norrhall M, Nilsfelt A, Varas E, Larsson R, Curiac D, Axelsson G, Månsson J, Brisman J, Söderström A, Björkelund C, Thorn J. A feasible lifestyle program for early intervention in patients with chronic obstructive pulmonary disease (COPD): a pilot study in primary care. Primary Care Respiratory Journal 2009; 18:306-12
      • van Wetering C, Hoogendoorn M, Broekhuizen R, Geraerts-Keeris G, De Munck D, Rutten-van Mölken M, Schols A. Efficacy and costs of nutritional rehabilitation in muscle-wasted patients with chronic obstructive pulmonary disease in a community-based setting: a prespecified subgroup analysis of the INTERCOM trial. Journal of the American Medical Directors Association 2010; 11:179-87
  • Search Plan and Results: COPD: Medical Nutrition Therapy 2017
     
  What is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on body composition and lung function outcomes in adults with COPD?

  • Conclusion

    As part of a multidisciplinary program, medical nutrition therapy (MNT) intervention provided by a registered dietitian nutritionist (RDN) (or international equivalent) was effective in improving body composition outcomes in adults with COPD. Findings for certain lung function parameters (including forced vital capacity and maximum inspiratory mouth pressure) were mixed. No improvements, nor negative outcomes were found in other lung function parameters measured.

  • 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 is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on body composition and lung function outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • McDonald V, Gibson P, Scott H, Baines P, Hensley M, Pretto J, Wood L. Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology (Carlton, Vic.) 2016; 21:875-82
      • McLoughlinh RE, McDonald VM, Gibson PG, Scott HA, Hensley MJ, MacDonald-Wicks L, and Wood LG. The Impact of a Weight Loss Intervention on Diet Quality and Eating Behaviours in People with Obesity and COPD. Nutrients 2017; 9:1147
      • Norrhall M, Nilsfelt A, Varas E, Larsson R, Curiac D, Axelsson G, Månsson J, Brisman J, Söderström A, Björkelund C, Thorn J. A feasible lifestyle program for early intervention in patients with chronic obstructive pulmonary disease (COPD): a pilot study in primary care. Primary Care Respiratory Journal 2009; 18:306-12
      • van Wetering C, Hoogendoorn M, Broekhuizen R, Geraerts-Keeris G, De Munck D, Rutten-van Mölken M, Schols A. Efficacy and costs of nutritional rehabilitation in muscle-wasted patients with chronic obstructive pulmonary disease in a community-based setting: a prespecified subgroup analysis of the INTERCOM trial. Journal of the American Medical Directors Association 2010; 11:179-87
  • Search Plan and Results: COPD: Medical Nutrition Therapy 2017
     
  What is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on functional status, exacerbations, systemic inflammation, respiratory symptoms, hospital costs and admissions outcomes in adults with COPD?

  • Conclusion

    As part of a multi-disciplinary program, medical nutrition therapy (MNT) intervention provided by a registered dietitian nutritionist (RDN) (or international equivalent) was effective in improving functional status, dyspnea scores, reducing hospital admissions and lowering hospital admissions costs in adults with COPD. No improvements nor negative outcomes were found in the frequency or severity of exacerbations or inflammatory markers.

  • 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 is the effectiveness of medical nutrition therapy as part of a multidisciplinary program on functional status, exacerbations, systemic inflammation, respiratory symptoms, hospital costs and admissions outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Gale N, Duckers J, Enright S, Cockcroft J, Shale D, Bolton C. Does pulmonary rehabilitation address cardiovascular risk factors in patients with COPD?. BMC Pulmonary Medicine 2011; 11:20
      • McDonald V, Gibson P, Scott H, Baines P, Hensley M, Pretto J, Wood L. Should we treat obesity in COPD? The effects of diet and resistance exercise training. Respirology (Carlton, Vic.) 2016; 21:875-82
      • van Wetering C, Hoogendoorn M, Broekhuizen R, Geraerts-Keeris G, De Munck D, Rutten-van Mölken M, Schols A. Efficacy and costs of nutritional rehabilitation in muscle-wasted patients with chronic obstructive pulmonary disease in a community-based setting: a prespecified subgroup analysis of the INTERCOM trial. Journal of the American Medical Directors Association 2010; 11:179-87
  • Search Plan and Results: COPD: Medical Nutrition Therapy 2017
     
  What is the effectiveness of medical nutrition therapy on outcomes in adults with COPD?

  • Conclusion

    Medical nutrition therapy (MNT) intervention provided by a registered dietitian nutritionist (RDN) (or international equivalent) was effective in improving body weight status, quality of life, body composition, lung function (forced vital capacity), dyspnea scores, and functional status outcomes in adults with COPD. No improvements, nor negative outcomes were found in other lung function parameters measured or in exercise capacity (hand grip strength).

  • 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 is the effectiveness of medical nutrition therapy on outcomes in adults with COPD?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Weekes C, Emery P, Elia M. Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 2009; 64:326-31
  • Search Plan and Results: COPD: Medical Nutrition Therapy 2017