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Nutritional Support for Individuals With COPD: A Meta-analysis
Ivone M. Ferreira, Dina Brooks, Yves Lacasse and Roger S. Goldstein Chest 2000;117;672-678 DOI 10.1378/chest.117.3.672

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CHEST is the officialjournal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright 2007 by the American College of Chest Physicians, 3300 Dundee Road, Northbrook IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder (http://www.chestjournal.org/misc/reprints.shtml). ISSN:0012-3692.

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Nutritional Support for Individuals With COPD*
A Meta-analysis
Ivone M. Ferreira, MD, PhD; Dina Brooks, PhD, MSc, BSc(PT); Yves Lacasse, MD, MSc; and Roger S. Goldstein, MB, ChB, FCCP

Rationale: Malnutrition in patients with COPD is associated with an impaired pulmonarystatus, reduced diaphragmatic mass, lower exercise capacity, and higher mortality rate when compared to adequately nourished individuals with COPD. Nutritional support may therefore be a useful part of their comprehensive care. Purpose: To conduct a meta-analysis of randomized controlled trials (RCTs) to clarify whether nutritional supplementation (caloric supplementation for at least 2 weeks)improved anthropometric measures, pulmonary function, respiratory muscle strength, and functional exercise capacity in patients with stable COPD. Methods: RCTs were identified from several sources, including the Cochrane Airways Group register of RCTs, a hand search of abstracts presented at international meetings, and consultation with experts. Two reviewers independently selected trials for inclusion,assessed quality, and extracted the data. Within each trial and for each outcome, we calculated an effect size. The effect sizes were then pooled by a random-effects model. Homogeneity among the effect sizes was also tested. Results: From 272 references, nine RCTs were ultimately included. Six articles were considered as high quality. Only two studies were double blinded. For each of the outcomesstudied, the effect of nutritional support was small: the 95% confidence intervals around the pooled effect sizes all included zero. The effect of nutritional support was homogeneous across studies. Conclusion: Nutritional support had no effect on improving anthropometric measures, lung function, or functional exercise capacity among patients with stable COPD. (CHEST 2000; 117:672– 678)
Keywords: COPD; meta-analysis; nutrition; respiratory rehabilitation; systematic review Abbreviations: BMI body mass index; CI confidence interval; RCT randomized controlled trials

degree malnutrition is common S ome third ofofpatients with COPD and in about one may be severe when the disease is in the advanced stage.1 Reductions in fat-free mass can be present, even among patients in whom body weightis normal.2
*From the Departments of Medicine (Dr. Goldstein) and Physical Therapy (Dr. Brooks), University of Toronto; the Respiratory Medicine Program (Dr. Ferreira), West Park Hospital, Toronto, Ontario; and Centre de Pneumologie (Dr. Lacasse), Hopital Laval, Ste-Foy, Quebec. This study was made possible due to funding from FAPESP, Fundacao de Amparo a pesquisa do Estado de Sao Paulo, Brazil(I.M.F.), the Canadian Lung Association/MRC/Glaxo Welcome Postdoctoral fellowship (D.B.), and West Park Hospital Foundation. Manuscript received May 18, 1999; revision accepted September 9, 1999. Correspondence to: Ivone M. Ferreira, MD, PhD, Respiratory Medicine Program, West Park Hospital, 82 Buttonwood Ave, Toronto, Ontario, M6M 2J5, Canada; e-mail: ivoneferreira@ hotmail.com
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