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Association of energy and protein intakes with length of stay, readmission and mortality in hospitalised patients with chronic obstructive pulmonary disease

  • Arora R. Ingadottir (a1) (a2), Anne M. Beck (a3) (a4), Christine Baldwin (a5), C. Elizabeth Weekes (a5), Olof G. Geirsdottir (a1) (a6), Alfons Ramel (a1), Thorarinn Gislason (a7) (a8) and Ingibjorg Gunnarsdottir (a1) (a2)...

Abstract

Low energy and protein intakes have been associated with an increased risk of malnutrition in outpatients with chronic obstructive pulmonary disease (COPD). We aimed to assess the energy and protein intakes of hospitalised COPD patients according to nutritional risk status and requirements, and the relative contribution from meals, snacks, drinks and oral nutritional supplements (ONS), and to examine whether either energy or protein intake predicts outcomes. Subjects were COPD patients (n 99) admitted to Landspitali University Hospital in 1 year (March 2015–March 2016). Patients were screened for nutritional risk using a validated screening tool, and energy and protein intake for 3 d, 1–5 d after admission to the hospital, was estimated using a validated plate diagram sheet. The percentage of patients reaching energy and protein intake ≥75 % of requirements was on average 59 and 37 %, respectively. Malnourished patients consumed less at mealtimes and more from ONS than lower-risk patients, resulting in no difference in total energy and protein intakes between groups. No clear associations between energy or protein intake and outcomes were found, although the association between energy intake, as percentage of requirement, and mortality at 12 months of follow-up was of borderline significance (OR 0·12; 95 % CI 0·01, 1·15; P=0·066). Energy and protein intakes during hospitalisation in the study population failed to meet requirements. Further studies are needed on how to increase energy and protein intakes during hospitalisation and after discharge and to assess whether higher intake in relation to requirement of hospitalised COPD patients results in better outcomes.

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Corresponding author

* Corresponding author: A. R. Ingadottir, email aroraros@landspitali.is

References

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1. Collins, PF, Elia, M, Kurukulaaratchy, RJ, et al. (2016) The influence of deprivation on malnutrition risk in outpatients with chronic obstructive pulmonary disease (COPD). Clin Nutr (epublication ahead of print 11 November 2016).
2. Vermeeren, MA, Creutzberg, EC, Schols, AM, et al. (2006) Prevalence of nutritional depletion in a large out-patient population of patients with COPD. Respir Med 100, 13491355.
3. Thorsdottir, I, Gunnarsdottir, I & Eriksen, B (2001) Screening method evaluated by nutritional status measurements can be used to detect malnourishment in chronic obstructive pulmonary disease. J Am Diet Assoc 101, 648654.
4. Hogan, D, Lan, LT, Diep, DT, et al. (2016) Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease. J Hum Nutr Diet 30, 8389.
5. Hoong, JM, Ferguson, M, Hukins, C, et al. (2016) Economic and operational burden associated with malnutrition in chronic obstructive pulmonary disease. Clin Nutr 36, 11051109.
6. Hallin, R, Gudmundsson, G, Suppli Ulrik, C, et al. (2007) Nutritional status and long-term mortality in hospitalised patients with chronic obstructive pulmonary disease (COPD). Respir Med 101, 19541960.
7. Cederholm, T, Bosaeus, I, Barazzoni, R, et al. (2015) Diagnostic criteria for malnutrition – an ESPEN Consensus Statement. Clin Nutr 34, 335340.
8. Hiesmayr, M, Schindler, K, Pernicka, E, et al. (2009) Decreased food intake is a risk factor for mortality in hospitalised patients: the NutritionDay survey 2006. Clin Nutr 28, 484491.
9. Sullivan, DH, Sun, S & Walls, RC (1999) Protein–energy undernutrition among elderly hospitalized patients: a prospective study. JAMA 281, 20132019.
10. Thibault, R, Chikhi, M, Clerc, A, et al. (2011) Assessment of food intake in hospitalised patients: a 10-year comparative study of a prospective hospital survey. Clin Nutr 30, 289296.
11. Ingadottir, AR, Hilmisdottir, HB, Ramel, A, et al. (2015) Energy- and protein intake of surgical patients after the implementation of energy dense hospital menus. Clin Nutr ESPEN 10, e107e111.
12. Agarwal, E, Ferguson, M, Banks, M, et al. (2013) Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clin Nutr 32, 737745.
13. Vermeeren, MA, Schols, AM & Wouters, EF (1997) Effects of an acute exacerbation on nutritional and metabolic profile of patients with COPD. Eur Respir J 10, 22642269.
14. Sundwall, P, Grönberg, AM, Hulthén, L, et al. (2005) Energy and nutrient intake in patients with chronic obstructive pulmonary disease hospitalized owing to an acute exacerbation. Scand J Nutr 49, 116121.
15. Vermeeren, MA, Wouters, EF, Geraerts-Keeris, AJ, et al. (2004) Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial. Clin Nutr 23, 11841192.
16. Thorsdottir, I & Gunnarsdottir, I (2002) Energy intake must be increased among recently hospitalized patients with chronic obstructive pulmonary disease to improve nutritional status. J Am Diet Assoc 102, 247249.
17. Kondrup, J (2001) Can food intake in hospitals be improved? Clin Nutr 20, 153160.
18. Johansen, N, Kondrup, J, Plum, LM, et al. (2004) Effect of nutritional support on clinical outcome in patients at nutritional risk. Clin Nutr 23, 539550.
19. Yazdanpanah, L, Shidfar, F, Moosavi, AJ, et al. (2010) Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Med Iran 48, 374379.
20. Folstein, MF, Folstein, SE & McHugh, PR (1975) ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12, 189198.
21. Friðriksdóttir, AJ & Möller, PH (2011) Clinical guidelines on patients nutrition. http://www.landspitali.is/lisalib/getfile.aspx?itemid=28242 (accessed May 2017).
22. Collins, PF, Stratton, RJ & Elia, M (2012) Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Am J Clin Nutr 95, 13851395.
23. Bjornsdottir, R, Oskarsdottir, ES, Thordardottir, FR, et al. (2013) Validation of a plate diagram sheet for estimation of energy and protein intake in hospitalized patients. Clin Nutr 32, 746751.
24. Vilhjalmsdottir, DO, Hinriksdottir, HH, Pordardottir, FR, et al. (2013) [Energy and protein intake of patients at the Department of Cardiothoracic surgery, Landspitali – the National University Hospital of Iceland]. Laeknabladid 99, 7175.
25. Ingadottir, AR, Beck, AM, Baldwin, C, et al. (2017) Two components of the new ESPEN diagnostic criteria for malnutrition are independent predictors of lung function in hospitalized patients with chronic obstructive pulmonary disease (COPD). Clin Nutr (epublication ahead of print version 8 June 2017).
26. Pauwels, RA, Buist, AS, Calverley, PM, et al. (2001) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med 163, 12561276.
27. Celli, B, Vestbo, J, Jenkins, CR, et al. (2011) Sex differences in mortality and clinical expressions of patients with chronic obstructive pulmonary disease. The TORCH experience. Am J Respir Crit Care Med 183, 317322.
28. Gudmundsson, G, Ulrik, CS, Gislason, T, et al. (2012) Long-term survival in patients hospitalized for chronic obstructive pulmonary disease: a prospective observational study in the Nordic countries. Int J Chron Obstruct Pulmon Dis 7, 571576.
29. Schols, AM (2013) Nutrition as a metabolic modulator in COPD. Chest 144, 13401345.
30. Schols, AM, Soeters, PB, Mostert, R, et al. (1991) Energy balance in chronic obstructive pulmonary disease. Am Rev Respir Dis 143, 12481252.
31. Schols, AM, Slangen, J, Volovics, L, et al. (1998) Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 157, 17911797.
32. Hubbard, GP, Elia, M, Holdoway, A, et al. (2012) A systematic review of compliance to oral nutritional supplements. Clin Nutr 31, 293312.
33. Laudisio, A, Costanzo, L, Di Gioia, C, et al. (2016) Dietary intake of elderly outpatients with chronic obstructive pulmonary disease. Arch Gerontol Geriatr 64, 7581.
34. van de Bool, C, Mattijssen-Verdonschot, C, van Melick, PP, et al. (2014) Quality of dietary intake in relation to body composition in patients with chronic obstructive pulmonary disease eligible for pulmonary rehabilitation. Eur J Clin Nutr 68, 159165.
35. Weekes, CE, Emery, PW & Elia, M (2009) Dietary counselling and food fortification in stable COPD: a randomised trial. Thorax 64, 326331.
36. Yilmaz, D, Capan, N, Canbakan, S, et al. (2015) Dietary intake of patients with moderate to severe COPD in relation to fat-free mass index: a cross-sectional study. Nutr J 14, 35.
37. Khan, NA, Daga, MK, Ahmad, I, et al. (2016) Evaluation of BODE index and its relationship with systemic inflammation mediated by proinflammatory biomarkers in patients with COPD. J Inflamm Res 9, 187198.
38. Ehsan, M, Khan, R, Wakefield, D, et al. (2013) A longitudinal study evaluating the effect of exacerbations on physical activity in patients with chronic obstructive pulmonary disease. Ann Am Thorac Soc 10, 559564.
39. Pitta, F, Troosters, T, Probst, VS, et al. (2006) Physical activity and hospitalization for exacerbation of COPD. Chest 129, 536544.
40. Moore, JA & Angelillo, VA (1988) Equations for the prediction of resting energy expenditure in chronic obstructive lung disease. Chest 94, 12601263.
41. Nordenson, A, Gronberg, AM, Hulthen, L, et al. (2010) A validated disease specific prediction equation for resting metabolic rate in underweight patients with COPD. Int J Chron Obstruct Pulmon Dis 5, 271276.
42. Creutzberg, EC, Schols, AM, Bothmer-Quaedvlieg, FC, et al. (1998) Prevalence of an elevated resting energy expenditure in patients with chronic obstructive pulmonary disease in relation to body composition and lung function. Eur J Clin Nutr 52, 396401.
43. Schols, AM, Broekhuizen, R, Weling-Scheepers, CA, et al. (2005) Body composition and mortality in chronic obstructive pulmonary disease. Am J Clin Nutr 82, 5359.
44. Almagro, P, Calbo, E, Ochoa de Echaguen, A, et al. (2002) Mortality after hospitalization for COPD. Chest 121, 14411448.
45. Roberts, MH, Clerisme-Beaty, E, Kozma, CM, et al. (2016) A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC Pulm Med 16, 68.
46. Steer, J, Norman, E, Gibson, GJ, et al. (2010) P117 Comparison of indices of nutritional status in prediction of in-hospital mortality and early readmission of patients with acute exacerbations of COPD. Thorax 65, A127A127.
47. Ferreira, IM, Brooks, D, White, J, et al. (2012) Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev, issue 12, CD000998.
48. Collins, PF, Elia, M & Stratton, RJ (2013) Nutritional support and functional capacity in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Respirology 18, 616629.
49. Lee, H, Kim, S, Lim, Y, et al. (2013) Nutritional status and disease severity in patients with chronic obstructive pulmonary disease (COPD). Arch Gerontol Geriatr 56, 518523.
50. Luo, Y, Zhou, L, Li, Y, et al. (2016) Fat-free mass index for evaluating the nutritional status and disease severity in COPD. Respir Care 61, 680688.
51. Slinde, F, Gronberg, A, Engstrom, CP, et al. (2005) Body composition by bioelectrical impedance predicts mortality in chronic obstructive pulmonary disease patients. Respir Med 99, 10041009.
52. Lainscak, M, Gosker, HR & Schols, AM (2013) Chronic obstructive pulmonary disease patient journey: hospitalizations as window of opportunity for extra-pulmonary intervention. Curr Opin Clin Nutr Metab Care 16, 278283.

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