Multimodal nutritional rehabilitation improves clinical outcomes of malnourished patients with chronic respiratory failure: a randomised controlled trial

Background In chronic respiratory failure (CRF), body composition strongly predicts survival. Methods A prospective randomised controlled trial was undertaken in malnourished patients with CRF to evaluate the effects of 3 months of home rehabilitation on body functioning and composition. 122 patients with CRF on long-term oxygen therapy and/or non-invasive ventilation (mean (SD) age 66 (10) years, 91 men) were included from eight respiratory units; 62 were assigned to home health education (controls) and 60 to multimodal nutritional rehabilitation combining health education, oral nutritional supplements, exercise and oral testosterone for 90 days. The primary endpoint was exercise tolerance assessed by the 6-min walking test (6MWT). Secondary endpoints were body composition, quality of life after 3 months and 15-month survival. Results Mean (SD) baseline arterial oxygen tension was 7.7 (1.2) kPa, forced expiratory volume in 1 s 31 (13)% predicted, body mass index (BMI) 21.5 (3.9) kg/m2 and fat-free mass index (FFMI) 15.5 (2.4) kg/m2. The intervention had no significant effect on 6MWT. Improvements (treatment effect) were seen in BMI (+0.56 kg/m2, 95% CI 0.18 to 0.95, p=0.004), FFMI (+0.60 kg/m2, 95% CI 0.15 to 1.05, p=0.01), haemoglobin (+9.1 g/l, 95% CI 2.5 to 15.7, p=0.008), peak workload (+7.2 W, 95% CI 3.7 to 10.6, p<0.001), quadriceps isometric force (+28.3 N, 95% CI 7.2 to 49.3, p=0.009), endurance time (+5.9 min, 95% CI 3.1 to 8.8, p<0.001) and, in women, Chronic Respiratory Questionnaire (+16.5 units, 95% CI 5.3 to 27.7, p=0.006). In a multivariate Cox analysis, only rehabilitation in a per-protocol analysis predicted survival (HR 0.27, 95% CI 0.07 to 0.95, p=0.042). Conclusions Multimodal nutritional rehabilitation aimed at improving body composition increased exercise tolerance, quality of life in women and survival in compliant patients, supporting its incorporation in the treatment of malnourished patients with CRF. Clinical Trial number NCT00230984.

[1]  菅原 慶勇.  Effects of nutritional supplementation combined with low-intensity exercise in malnourished patients with COPD , 2012 .

[2]  A. Jette,et al.  Adverse events associated with testosterone administration. , 2010, The New England journal of medicine.

[3]  J. Maurer.  Effects of Home-Based Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Trial , 2010 .

[4]  M. Hoogendoorn,et al.  Short- and long-term efficacy of a community-based COPD management programme in less advanced COPD: a randomised controlled trial , 2009, Thorax.

[5]  M. Elia,et al.  Dietary counselling and food fortification in stable COPD: a randomised trial , 2008, Thorax.

[6]  P. Ponikowski,et al.  Cachexia: a new definition. , 2008, Clinical nutrition.

[7]  M. Decramer,et al.  A 4-year trial of tiotropium in chronic obstructive pulmonary disease. , 2008, The New England journal of medicine.

[8]  Bartolome Celli,et al.  Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease. , 2007, The New England journal of medicine.

[9]  C. Mathers,et al.  Projections of Global Mortality and Burden of Disease from 2002 to 2030 , 2006, PLoS medicine.

[10]  Thierry Troosters,et al.  American Thoracic Society/European Respiratory Society statement on pulmonary rehabilitation. , 2006, American journal of respiratory and critical care medicine.

[11]  B. Nordestgaard,et al.  Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study. , 2006, American journal of respiratory and critical care medicine.

[12]  R. Wolfe.  Optimal nutrition, exercise, and hormonal therapy promote muscle anabolism in the elderly. , 2006, Journal of the American College of Surgeons.

[13]  E. Wouters,et al.  Optimizing oral nutritional drink supplementation in patients with chronic obstructive pulmonary disease. , 2005, The British journal of nutrition.

[14]  E. Wouters,et al.  Body composition and mortality in chronic obstructive pulmonary disease. , 2005, The American journal of clinical nutrition.

[15]  R. Casaburi,et al.  Effects of testosterone and resistance training in men with chronic obstructive pulmonary disease. , 2004, American journal of respiratory and critical care medicine.

[16]  F. Maltais,et al.  French-Canadian version of the Chronic Respiratory and St George's Respiratory questionnaires: an assessment of their psychometric properties in patients with chronic obstructive pulmonary disease. , 2004, Canadian respiratory journal.

[17]  A. Cuvelier,et al.  C-reactive protein and body mass index predict outcome in end-stage respiratory failure. , 2004, Chest.

[18]  Ciro Casanova,et al.  The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. , 2004, The New England journal of medicine.

[19]  E. Wouters,et al.  A role for anabolic steroids in the rehabilitation of patients with COPD? A double-blind, placebo-controlled, randomized trial. , 2003, Chest.

[20]  M. Steiner,et al.  Nutritional enhancement of exercise performance in chronic obstructive pulmonary disease: a randomised controlled trial , 2003, Thorax.

[21]  Matthew T. Haren,et al.  Oral testosterone supplementation increases muscle and decreases fat mass in healthy elderly males with low-normal gonadal status. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[22]  Steven Piantadosi,et al.  A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. , 2003, The New England journal of medicine.

[23]  J. Laaban,et al.  Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory. , 2003, Chest.

[24]  A. Cuvelier,et al.  Nutritional depletion in patients on long-term oxygen therapy and/or home mechanical ventilation , 2002, European Respiratory Journal.

[25]  Y Schutz,et al.  Fat-free mass index and fat mass index percentiles in Caucasians aged 18–98 y , 2002, International Journal of Obesity.

[26]  D. Brooks,et al.  Nutritional supplementation for stable chronic obstructive pulmonary disease. , 2002, The Cochrane database of systematic reviews.

[27]  C. Pichard,et al.  Single prediction equation for bioelectrical impedance analysis in adults aged 20--94 years. , 2001, Nutrition.

[28]  E. Wouters,et al.  Acute effects of different nutritional supplements on symptoms and functional capacity in patients with chronic obstructive pulmonary disease. , 2001, The American journal of clinical nutrition.

[29]  A. Vermeulen,et al.  A critical evaluation of simple methods for the estimation of free testosterone in serum. , 1999, The Journal of clinical endocrinology and metabolism.

[30]  M. Decramer,et al.  Six minute walking distance in healthy elderly subjects. , 1999, The European respiratory journal.

[31]  P. Jones,et al.  Analysis of factors that characterize health impairment in patients with chronic respiratory failure , 1999 .

[32]  P. Jones,et al.  Analysis of factors that characterize health impairment in patients with chronic respiratory failure. Quality of Life in Chronic Respiratory Failure Group. , 1999, The European respiratory journal.

[33]  E. Wouters,et al.  Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. , 1999, American journal of respiratory and critical care medicine.

[34]  R. Hume,et al.  Hypothalamic-pituitary dysfunction in respiratory hypoxia. , 1981, Thorax.

[35]  Cotes Je,et al.  LONG TERM DOMICILIARY OXYGEN THERAPY IN CHRONIC HYPOXIC COR PULMONALE COMPLICATING CHRONIC BRONCHITIS AND EMPHYSEMA Report of the Medical Research Council Working Party , 1981, The Lancet.