Oral supplements as adjunctive treatment to nutritional counseling in malnourished HIV-infected patients: randomized controlled trial

AIMS:To compare nutritional counseling with and without oral supplements in HIV-infected patients with recent weight loss. DESIGN: Randomized non-blinded controlled trial, stratified for change in antiretroviral treatment at baseline. PATIENTS: HIV-infected patients with recent weight loss (> 5% of total, and >3% in the last month). INTERVENTION: Nutritional counseling to increase dietary intake by 600 kcal/day over 8 weeks; in group A (n=24) by normal food, and in group B (n=26) by a range of fortified drink supplements with a calorific value of 0.6 to 1.5 kcal/ml. METHODS: Body composition by bioelectrical impedance analysis, dietary intake by 24 h recall. RESULTS: Fat free mass increased from baseline to week 8 (P<0.05) with no difference between groups A and B (P=0.97). Body cell mass and weight gain were not significant and equal between groups. Assessed at weeks 2 and 4, group B patients consumed 11 +/- 6 kcal/kg as supplements, and their total energy intake was 6 kcal/kg higher than in group A (P<0.01). Total energy intake was not different between groups at weeks 6 and 8. DISCUSSION: Nutritional counseling and oral supplements are both feasible methods to restore food energy intake in malnourished HIV-infected patients. Although normal food intake is partially replaced, oral supplements may improve the adherence to a weight gain regimen.     

Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial

BACKGROUND & AIMS: Previous studies reported a severely impaired energy balance in COPD patients during the first days of an acute exacerbation, mainly due to a decreased energy and protein intake. The aim of the study was to investigate the feasibility and effectiveness of energy- and protein-rich nutritional supplements during hospitalization for an acute exacerbation in nutritionally depleted COPD patients. METHODS: In a randomized double-blind, placebo-controlled two-center trial, 56 COPD patients were randomized and 47 patients completed the study. Nutritional intervention consisted of 3 x 125 ml (2.38 MJ/day) and the placebo group received similar amounts of a non-caloric fluid. Medical therapy and dietetic consultation were standardized and dietary intake was measured daily. Body composition, respiratory and skeletal muscle strength, lung function and symptoms were measured on admission and on days 4 and 8 of hospitalization. RESULTS: Forty-seven percent of the patients had experienced recent involuntary weight loss prior to admission. The degree of weight loss was inversely related to resting arterial oxygen tension (r = 0.31; P < 0.05). Nutritional intervention resulted in a significant increase in energy (16% vs. placebo) and protein intake (38% vs. placebo). Mean duration of hospitalization was 9 +/- 2 days. Relative to usual care, no additional improvements in lung function or muscle strength were seen after nutritional intervention. CONCLUSIONS: Oral nutritional supplementation during hospitalization for an acute exacerbation is feasible in nutritionally depleted COPD patients and does not interfere with normal dietary intake.     

Minimal effect on energy intake by additional evening meal for frail elderly service flat residents — A pilot study

Background: Nutritional problems are common in frail elderly individuals receiving municipal care.Objective: To evaluate if an additional evening meal could improve total daily food intake, nutritional status, and health-related quality of life (HRQOL) in frail elderly service flat (SF) residents.Design: Out of 122 residents in two SF complexes, 60 subjects agreed to participate, of which 49 subjects (median 84 (79–90) years, (25th–75th percentile)) completed the study. For six months 23 residents in one SF complex were served 530 kcal in addition to their regular meals, i.e. intervention group (I-group). Twenty-six residents in the other SF building were controls (C-group). Nutritional status, energy and nutrient intake, length of night time fast, cognitive function and HRQOL was assessed before and after the intervention.Results: At the start, the Mini Nutritional Assessment classified 27% as malnourished and 63% as at risk for malnutrition, with no difference between the groups. After six months the median body weight was unchanged in the I-group, +0.6 (−1.7 - +1.6) kg (p=0.72) and the C-group −0.6 (−2.0 - +0.5) kg (p=0.15). Weight change ranged from −13% to +15%. The evening meal improved the protein and carbohydrate intake (p< 0.01) but the energy intake increased by only 180 kcal/day (p=0.15). The night time fast decreased in the I-group from 15.0 (13.0–16.0) to 13.0 (12.0–14.0) hours (p< 0.05). There was no significant difference in cognitive function or HRQOL between the groups.Conclusion: Nine out of ten frail elderly SF residents had nutritional problems. Serving an additional evening meal increased the protein and carbohydrate intake, but the meal had no significant effect on energy intake, body weight or HRQOL. The variation in outcome within each study group was large.     

Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: A randomized controlled trial

ObjectiveWeight loss is common in patients with malignant tumors and it can adversely affect quality of life and survival. The aim of the present study was to investigate the effects of a nutritional intervention in cancer patients in an outpatient setting.MethodsCancer outpatients (N = 58) who were classified as undernourished or at high risk for undernutrition by the Nutritional Risk Screening 2002 tool were randomized into two groups. One group (n = 30) received standardized individual nutritional therapy, including counseling by a dietitian, food fortification, and oral nutritional supplements if required. The second group (n = 28) received standard care. The nutritional intervention lasted 3 mo. Dietary intake (3-d dietary record), nutritional status (body weight), physical functioning (performance status, hand-grip strength) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0) were assessed at baseline and after 6 wk and 3 mo. An additional follow-up assessment was carried out 3 mo post-intervention.ResultsNutritional intervention led to a significantly higher average energy and protein intake in the nutritional therapy group (+379 kcal; 95% confidence interval [CI], 117–642; P = 0.007, respectively; +10.4 g; 95% CI, 2.3–18.5; P = 0.016). However, the increased dietary intake was not associated with improvements in nutritional status, physical functioning, or quality of life.ConclusionsIndividual nutritional counseling significantly and positively influenced energy and protein intake, but did not improve nutritional or physical outcome or quality of life. These results indicate that nutritional therapy alone is of limited efficacy in cancer patients whose nutritional status has already deteriorated.     

Effect of nutritional education and dietary counselling on body weight in HIV-seropositive South Africans not receiving antiretroviral therapy

Background Unintentional weight loss of > 10% contributes to morbidity and mortality in HIV-infected patients. In poorer developing countries, cost-effective options to promote weight gain are extremely limited.
Methods We conducted a pilot study of the effect of nutritional education and dietary counselling on body weight in 90 HIV/AIDS patients. Education entailed principles of healthy eating, socioeconomics of nutrition, food safety, and symptom-related dietary guidelines. Other clinical parameters examined for potential impact on body weight included age, sex, CD4+ lymphocyte count, presence of complicating infections, concomitant medications, vitamin use, and nutritional supplementation. No patients received antiretroviral therapy.
Results At study end (mean follow-up, 4.2 months) body weight compared to baseline was greater in study subjects than in controls ( P  < 0.01); stable or increasing weight was seen in 73% of study patients. Weight gain (≥ 1 kg) occurred in 53% of counselled patients (mean = 3.5 kg; range 1–11 kg) vs. 21% of matched controls (mean = 2.0 kg; range 1–3 kg) ( P  < 0.03). Nutritional counselling was found to offset the adverse effects of gastrointestinal tract or systemic infection (especially in patients with CD4+ counts < 200 cells mm^–3).
Conclusion In low-resource areas, culturally and economically relevant nutritional education and dietary counselling are simple yet effective means of stabilizing or increasing body weight in HIV-infected patients.     

ESPEN Guidelines on Enteral Nutrition: Wasting in HIV and other chronic infectious diseases

Undernutrition (wasting) is still frequent in patients infected with the human immunodeficiency virus (HIV), despite recent decreases in the prevalence of undernutrition in western countries (as opposed to developing countries) due to the use of highly active antiretroviral treatment. Undernutrition has been shown to have a negative prognostic effect independently of immunodeficiency and viral load. These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) in HIV-infected patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. Nutritional therapy is indicated when significant weight loss (>5% in 3 months) or a significant loss of body cell mass (>5% in 3 months) has occurred, and should be considered when the body mass index (BMI) is <18.5 kg/m(2). If normal food intake including nutritional counselling and optimal use of ONS cannot achieve an adequate nutrient intake, TF with standard formulae is indicated. Due to conflicting results from studies investigating the impact of immune-modulating formulae, these are not generally recommended. The results obtained in HIV patients may be extrapolated to other chronic infectious diseases, in the absence of available data.     

The influence of nutritional intervention on resting energy expenditure in obese adolescents aged 15-18 years

The aim of this research was to assess the influence of dietary intervention on weight loss and resting energy expenditure (REE) in 20 obese and overweight adolescents (BMI = 29 +/- 3,8 kg/m2) aged 15-18 years. Nutritional habits and nutritional status were estimated before and after the introduction of low-calorie diet. Measurements of REE were carried out by indirect calorimetry in a respiratory chamber Nutritional intervention had a significant influence in decreasing body weight (from 85 +/- 14.3 kg to 82.5 +/- 12.8 kg), BMI and fat mass. Muscle mass was found to be significantly elevated (p < 0.050). REE did not decline significantly due to nutritional intervention (p > 0.05; p = 0.84).     

Effects of nutritional support long time after total gastrectomy

BACKGROUND & AIMS: Long-term effects of total gastrectomy on nutritional status are not well known, neither is the role of nutritional support. Dietary counselling is usually individualized, but generally not well defined. We aimed to evaluate effects of individualized oral nutritional support long time after total gastrectomy. METHODS: Dietary advice was given, aiming for an energy and protein rich diet, using ordinary food and liquid supplements tailored to individual needs and preferences. Counselling was repeated monthly. Body weight and a 4-day food record were obtained at baseline, and thereafter-at month 1, 3, 6 and 12. Body composition, resting and total energy expenditure were measured at baseline and at 12 months. RESULTS: Thirteen of 15 included patients completed the study. Though a trend of weight gain was seen after 1 month, there was no significant weight change at 12 months as weight development was quite heterogeneous. Six patients who remained healthy during the study (all with BMI<25) gained weight (p<0.05), while five patients with intercurrent co-morbidity and two with initial BMI>25 lost weight or remained stable. CONCLUSIONS: Nutritional intervention long time after total gastrectomy did not change body weight, body composition or energy metabolism. Intercurrent co-morbidity appeared to have a major impact on outcome, as the nutritional support was more effective in patients who remained healthy and had a BMI<25.     

Enteral feeding in burn hypermetabolism: nutritional and metabolic effects of different levels of calorie and protein intake

Enteral nutrition was provided by continuous pump-controlled gastrostomy tube feeding for 14 days in 97 guinea pigs bearing a 30% full thickness burn. Seven defined combinations of caloric and protein intake were studied. With a caloric intake of 175 kcal/kg/day, equaling the measured energy expenditure, the animals receiving 10% of calories as protein had a significantly greater postburn weight loss (p less than 0.05) and muscle mass depletion (p less than 0.05), and a significantly lower muscle nitrogen concentration (p less than 0.05), serum albumin level (p less than 0.01) and liver nitrogen content (p less than 0.01). With the same caloric intake but with more than 20% of calories as protein, the weight loss and the muscle wasting were reduced, but not abolished, and the serum albumin level and liver nitrogen content were normalized. Also with the diets containing 200 kcal/kg/day the muscle tissue depletion could not be abolished. However, with this caloric intake, the animals given 20% of calories as protein had a lower weight loss and a higher serum albumin level (p less than 0.01), but also a greater fat infiltration of the liver (p less than 0.01). At both levels of caloric intake, the nitrogen balance correlated significantly with the level of nitrogen intake but did not correlate with the changes of body weight. The incidence of diarrhea was lowest in animals fed 20% protein calories at a caloric intake of 175 kcal/kg/day. All things considered, the best metabolic and nutritional results were obtained with diets containing 20 to 30% of calories as protein and providing a caloric intake that paralleled the measured energy expenditure.     

A multi-center trial of the effects of oral nutritional supplementation in critically ill older inpatients. GAGE Group. Groupe Aquitain Geriatrique d'Evaluation

The purpose of this study was to assess the effect of nutritional supplementation on dietary intake and on pressure ulcer development in critically ill older patients. The multi-center trial involved 19 wards stratified according to specialty and recruitment for critically ill older patients; 9 wards were randomly selected for nutritional intervention (nutritional intervention group), consisting of the daily distribution of two oral supplements, with each supplement containg 200 kcal, for 15 d. Pressure ulcer incidence was prospectively recorded for grades I (erythema), II (superficial broken skin), and III (subcutaneous lesion) for 15 d. Nutritional intake was monitored by using estimates in units of quarters validated by comparison with weight measurement. There were 672 subjects older than 65 y, and 295 were in the nutritional intervention group versus 377 in the control group. The patients were similar for age, sex ratio, and C-reactive protein. In comparison with the control group, the nutritional intervention group included more patients with stroke, heart failure, and dyspnea and fewer with antecedent falls, delirium, lower limb fractures, and digestive disease. The nutritional intervention group had a lower risk of pressure ulcers according to the Norton score but was less dependent (Kuntzman score) and had a lower serum albumin level. During the trial, energy and protein intakes were higher in the nutritional intervention group (day 2: 1081 +/- 595 kcal versus 957 +/- 530 kcal, P = 0.006; 45.9 +/- 27.8 g protein versus 38.3 +/- 23.8 g protein in the control group, P < 0.001). At 15 d, the cumulative incidence of pressure ulcers was 40.6% in the nutritional intervention group versus 47.2% in the control group. The proportion of grade I cases relative to the total number of cases was 90%. Multivariate analysis, taking into account all diagnoses, potential risk factors, and the intra-ward correlation, indicated that the independent risk factors of developing a pressure ulcer during this period were: serum albumin level at baseline, for 1 g/L decrease: 1.05 (95% confidence interval: 1.02 to 1.07, P < 0.001); Kuntzmann score at baseline, for 1-point increase: 1.22 (0.32 to 4.58, P = 0.003); lower limb fracture: 2.68 (1.75 to 4.11, P < 0.001); Norton score < 10 versus > 14: 1.28 (1.01 to 1.62, P = 0.04); and belonging to the control group: 1.57 (1.03 to 2.38, P = 0.04). In conclusion, it was possible to increase the dietary intake of critically ill elderly subjects by systematic use of oral supplements. This intervention was associated with a decreased risk of pressure ulcer incidence.     

Energy and macronutirents intake by overweight and obese children aged 7-12

Energy and macronutrient such as protein, fat and carbonhydrate as well as anthropometric measurments were caried out in overweight and obesity children aged 7-12 (n=25) during two visits of the loss weight program for children (before and 6 weeks after dietary intervention) at the Faculty of Human Nutrition and Consumer Sciences, Warsaw Agricultural University. The study showed no significant (p > 0.05) body weight reduction expressed as body mass index (BMI), but nutrition counselling resulted in a decline in obesity prevalence in examined subject. Before nutritional counselling energy and macronutrient mean intakes from the diets of examined: children aged 7-9 y, boys 10-12 y and girls 10-12 y, were found to be: of energy (kcal): 1770, 1680, 1711 and protein: 107%, 85%, 84%; fat: 107%, 84%, 111% and carbohydrates: 81%, 57%, 67% RDA, respectively. After 6 weeks of the aplication of--low energy diet the consumption of energy and fat decreased among most of children (p < 0.05). The intakes of energy and fat need to be monitored in this group of population, since their overeating can predispose to diet-related diseases, such as cardiovascular in adulthood.     

Dietary problems in patients with severe chronic obstructive pulmonary disease

Background and aims Low body weight and low fat-free mass-index (FFMI) are common in patients with severe chronic obstructive pulmonary disease (COPD). Several factors seem to contribute. The aims of the present observational study were to investigate dietary problems in patients with severe COPD and to compare dietary problems to nutritional status, energy intake and smoking habits. Methods Nutritional status was assessed in 73 stable outpatients using body mass index and FFMI by single-frequency bioelectrical impedance. Lung function, smoking habits, energy intake and dietary problems were also assessed. Results The most frequently reported dietary problems were ‘anorexia’, ‘dyspeptic symptoms other than diarrhoea’, ‘slimming’, ‘fear of gaining weight’, ‘dyspnoea’, ‘diarrhoea’, ’depression, anxiety, solitude’. Smoking habits and gender had impact on the kind of dietary problems reported. Reporting two dietary problems correlated to low FFMI, whereas reporting one or more dietary problems correlated to decreased energy intake. Conclusion Dietary problems are common in the group studied and related to smoking habits and gender. Dietary problems affect energy intake and FFMI negatively. It is important to recognize dietary problems and to offer intervention of the dietary problems as a part of the dietary intervention.     

Nutritional assessment and follow-up of residents with and without dementia in nursing homes in the Limousin region of France: A health network initiative

Introduction

Limousin in France has the second oldest regional population in Europe, with people over 65-years-old who have Alzheimer??s disease accounting for more than 9%. In France as a whole, a large number of residents in nursing homes (NH) have dementia, leading to many nutritional problems. LINUT is a health network that assesses the nutritional status of elderly NH residents and provides support where necessary. Aims of the present study were to use this network to evaluate the nutritional status of NH residents with and without dementia and to review changes after 4 months of intervention.

Methods

A cross-sectional survey was conducted by a doctor and a dietician at baseline (T0) and 4 months (T4) among residents at the 26 NH in Limousin that agreed to take part. The evaluation criteria included presence of dementia, depression and autonomy, weight, height, body mass index, Mini Nutritional Assessement (MNA?), and a 3-day survey of food intake.

Results

The 346 residents assessed at T0 were aged 87.9±6.9 years, 83.4% were women, 66.8% had dementia, 53.3% were malnourished and 27.4% obese. Autonomy was not affected by obesity. Residents with dementia had a lower Activities of Daily Living score and a lower weight than non-demented individuals (2.2±1.2 vs. 2.7±1.7 p=0.03 and 60.1±16.3 vs. 64.7±20.0 kg p=0.03, respectively), were more often malnourished (56.1% vs. 46.4% p=0.004) and less often obese (22.0% vs. 39.1% p=0.004) but consumed more protein (62.6±17.8 vs. 58.2±16.9 g/d p=0.04, 1.1±0.4 vs. 1.0±0.4 g/kg/d p=0.005). Energy intake was at the lower limit of French recommendations (26.4±8.8 vs. >25.0 kcal/kg/d). Assessment of all residents at T4 showed improved MNA? (+0.4 points/month p=0.02), protein intake (+3.3 g/d p=0.0007), and energy intake (+41.4 kcal/d p=0.01 and 0.1 kcal/kg/d p=0.03). Variations in prevalences of malnutrition and obesity were not statistically significant. MNA? increased in the dementia group (+0.29±0.8 points/month p=0.003). All other changes were comparable, and nutritional status did not differ more between the two groups at T4 than at T0.

Conclusion

The prevalence of dementia was high in the population studied. Malnutrition was the main problem, particularly if residents had dementia. Protein intake was satisfactory, but energy intake often insufficient. The nutritional status of dementia patients improved after 4 months of follow-up, suggesting that effective action to support such services would be worthwhile.     

Diet intervention methods to reduce fat intake: nutrient and food group composition of self-selected low-fat diets

A multicentered pilot study was conducted to test an intervention protocol designed to reduce fat intake to 15% of energy intake. Eligible subjects were postmenopausal women with stage II breast cancer whose baseline fat intake was more than 30% of energy intake. The low-fat diet intervention protocol consisted of bi-weekly individual counseling sessions with emphasis on substitution of lower-fat foods for high-fat foods and maintenance of nutritional adequacy. Nutrient intakes were calculated from 4-day food records collected at baseline and after 3 months of diet intervention. Mean daily fat intake for the 17 patients on the low-fat diet dropped significantly from 38.4 +/- 4.3% of energy intake at baseline to 22.8 +/- 7.8% at 3 months (p less than .001). A 25% reduction in mean energy intake, from 1,840 +/- 419 kcal at baseline to 1,365 +/- 291 kcal at 3 months, was accompanied by significant increases in protein and carbohydrate as percent of energy intake. A mean weight loss of 2.8 kg and a 7.7% reduction in serum cholesterol were observed; both changes were significant at the p less than .01 level. Absolute intakes of zinc and magnesium were significantly reduced. However, mean intake on the low-fat diet for 14 vitamins and minerals, including zinc and magnesium, exceeded two-thirds of the 1989 Recommended Dietary Allowances (RDAs). When expressed as nutrient density (i.e., amount of nutrient per 1,000 kcal), increases were observed for all micronutrients. These results support the hypothesis that a nutritionally adequate low-fat diet can be successfully implemented in a highly motivated, free-living population.     

Nutrient intake and nitrogen metabolism in cancer patients during oncological chemotherapy

Aggressive oncological chemotherapy often impairs the nutritional status of tumor patients. To evaluate the pathogenetic mechanisms, food intake in 13 cancer patients was investigated in correlation with nitrogen losses, N balances, muscle wasting, and weight course, during cytostatic therapy. Median daily N and energy intakes were reduced only in patients with weight loss [0.55 g protein, 16.5 kcal/kg ideal body wt (IBW)]. Patients with constant weight had the same intake as control subjects (1.27 g protein, 37.2 kcal IBW). N balances and creatinine height index (CHI) correlated with daily nutrient intake. Fecal N excretions did not correlate with urinary losses; there was no excess of fecal N loss because of cytostatic treatment. The impairment of cancer patients' nutritional status seems to depend primarily on the decrease of spontaneous oral intake as a consequence of the side effects of tumor therapy. Changes in CHI, compared before and after chemotherapy, indicated muscle wasting of weight-losing patients.     

Changes in food intake and nutritional status in patients treated with radiation therapy for cancer of the larynx and pharynx

Nutritional status and food intake were recorded for 28 patients with cancer of the larynx and 13 patients with cancer of the pharynx. All patients were without distant metastases and received radiotherapy with a curative intent. No patients were nutritionally depleted when treatment began. Treatment did not induce changes in nutritional status or food intake in patients with cancer of the larynx. The mean energy intake was 135% of the basal metabolic rate (BMR), and the protein intake was 1 g/kg/day. Inversely, patients with cancer of the pharynx suffered a mean loss of body weight of 5 kg (p less than .01), which was almost equally divided between fat tissue (-2.2 kg) and fat-free cell mass (-2.6 kg). There were only minor or no changes in serum albumin and serum transferrin. Mean energy intake was 121% of BMR, and the mean protein intake was 0.9 g/kg/day. Neither nutritional support during admission nor dietetic instructions managed to preserve the nutritional status in patients with cancer of the pharynx. Therefore, these patients need a more intensified nutritional therapy, such as tube feeding.     

Interdisciplinary approach improves nutritional status of children with heart diseases

OBJECTIVES: We evaluated the role of an interdisciplinary team in improving the nutrient intake and nutritional status of children with heart diseases. METHODS: Thirty-five children 10.0 +/- 7.5 mo old were studied over a 6-mo period with regard to anthropometric measurements and dietary intake. RESULTS: On admission, malnutrition prevalence was 57% and vitamin and mineral intakes were below estimated average requirement levels (dietary reference intakes) in the majority of patients. Stunting and wasting were more frequent among patients with pulmonary hypertension and/or uncompensated congestive heart failure. Follow-up analyses showed increased Z scores of weight for height (-1.17 +/- 1.03 versus -0.32 +/- 1.08, P < 0.01) and height for age (-1.09 +/- 0.96 versus -0.51 +/- 1.36, P < 0.01). In patients with pulmonary hypertension or uncompensated congestive heart failure, the height-for-age index remained unchanged. Energy intake did not differ (112.0 +/- 20.4 and 119.0 +/- 18.0 kcal.kg(-1).d(-1)) and significant increases were seen in intakes of micronutrients and minerals over the study period. CONCLUSION: Intervention by an interdisciplinary team improved the nutrient intake and nutritional status of patients overall but was insufficient to improve growth in the subgroup with pulmonary hypertension or uncompensated congestive heart failure. Nutritional support should be made routine in the treatment of children with heart disease.     

The efficacy of dietetic intervention in patients with chronic obstructive pulmonary disease

Background: Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status. Methods: Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann–Whitney U non parametric tests, paired t‐tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee. Results: Changes reported were not statistically significant (P > 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge. Discussion: An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none‐the‐less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice. Conclusion: The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation. References Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793. Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330–336.     

Self-Directed Weight Loss Strategies: Energy Expenditure Due to Physical Activity Is Not Increased to Achieve Intended Weight Loss

Reduced physical activity and almost unlimited availability of food are major contributors to the development of obesity. With the decline of strenuous work, energy expenditure due to spontaneous physical activity has attracted increasing attention. Our aim was to assess changes in energy expenditure, physical activity patterns and nutritional habits in obese subjects aiming at self-directed weight loss. Methods: Energy expenditure and physical activity patterns were measured with a portable armband device. Nutritional habits were assessed with a food frequency questionnaire. Results: Data on weight development, energy expenditure, physical activity patterns and nutritional habits were obtained for 105 patients over a six-month period from an initial cohort of 160 outpatients aiming at weight loss. Mean weight loss was −1.5 ± 7.0 kg (p = 0.028). Patients with weight maintenance (n = 75), with substantial weight loss (>5% body weight, n = 20) and with substantial weight gain (>5% body weight, n = 10) did not differ in regard to changes of body weight adjusted energy expenditure components (total energy expenditure: −0.2 kcal/kg/day; non-exercise activity thermogenesis: −0.3 kcal/kg/day; exercise-related activity thermogenesis (EAT): −0.2 kcal/kg/day) or patterns of physical activity (duration of EAT: −2 min/day; steps/day: −156; metabolic equivalent unchanged) measured objectively with a portable armband device. Self-reported consumption frequency of unfavorable food decreased significantly (p = 0.019) over the six-month period. Conclusions: An increase in energy expenditure or changes of physical activity patterns (objectively assessed with a portable armband device) are not employed by obese subjects to achieve self-directed weight loss. However, modified nutritional habits could be detected with the use of a food frequency questionnaire.