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

• Published in: Thorax Vol. 66; no. 11; pp. 953 - 960
• Main Authors: Pison, Christophe M, Cano, Noël J, Chérion, Cécile, Caron, Fabrice, Court-Fortune, Isabelle, Antonini, Marie-Thérèse, Gonzalez-Bermejo, Jésus, Meziane, Lahouari, Molano, Luis Carlos, Janssens, Jean-Paul, Costes, Frédéric, Wuyam, Bernard, Similowski, Thomas, Melloni, Boris, Hayot, Maurice, Augustin, Julie, Tardif, Catherine, Lejeune, Hervé, Roth, Hubert, Pichard, Claude
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Thoracic Society 01.11.2011; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Biochemistry, Molecular Biology; Biological and medical sciences; Body Composition; Cardiology. Vascular system; Chronic Disease; Chronic obstructive pulmonary disease; Clinical outcomes; Combined Modality Therapy; COPD pharmacology; Dietary Supplements; Exercise Therapy; Exercise Tolerance; Exercise Tolerance - physiology; Female; Health Education; Health Education - methods; Home Care Services, Hospital-Based; Humans; Life Sciences; long-term oxygen therapy; Male; Malnutrition; Malnutrition - etiology; Malnutrition - physiopathology; Malnutrition - rehabilitation; Medical sciences; Metabolic diseases; Middle Aged; nutrition; Nutritional Status; Other nutritional diseases (malnutrition, nutritional and vitamin deficiencies...); Pneumology; Quality of Life; rehabilitation; Respiratory Insufficiency; Respiratory Insufficiency - complications; Respiratory Insufficiency - physiopathology; Respiratory Insufficiency - rehabilitation; Respiratory system : syndromes and miscellaneous diseases; Testosterone; Testosterone - therapeutic use; Treatment Outcome; Human; Prognosis; Respiratory disease; Nutrition disorder; Patient; Chronic; Respiratory failure; Rehabilitation(human); Anesthesia; Circulatory system; Rehabilitation; Cardiology; Malnutrition; TERM OXYGEN-THERAPY; SUPPLEMENTATION; OBSTRUCTIVE PULMONARY-DISEASE; TESTOSTERONE; PROGNOSIS; EMPHYSEMA; BODY-MASS INDEX; FAT MASS; EXERCISE; COPD
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thx.2010.154922

BackgroundIn chronic respiratory failure (CRF), body composition strongly predicts survival.MethodsA 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.ResultsMean (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).ConclusionsMultimodal 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 numberNCT00230984.