Effect of individual nutritional therapy during inpatient pulmonary rehabilitation in patients at risk for malnutrition and sarcopenia - a randomized controlled trial

Abstract

BackgroundMalnutrition and sarcopenia are common in inpatient rehabilitation, however individual nutritional therapy (iNT) is often underutilized. This study aimed to assess the effect of iNT on nutrition and muscular health.MethodPatients with chronic obstructive pulmonary disease (COPD) or post-pneumonia at risk for malnutrition and sarcopenia undergoing inpatient rehabilitation were enrolled. The control group received usual care including enriched food and educational group sessions on nutrition. The intervention group received additional counselling by a dietician twice a week. Both groups received individualized physiotherapy and self-management coaching, endurance exercise sessions on 5 days and strength training sessions on 2-3 days per week as part of the clinical routine. Primary outcomes were changes in energy and protein intake, assessed via menu consumption and macronutrient analysis. Secondary outcomes included handgrip strength, muscle mass by bioimpedance analysis, and physical performance measured by the timed-up-and-go test.ResultsTwenty-six patients per group (median age of 72 years, 60% men, 52% COPD) were included. Energy and protein intake increased significantly more in the intervention group with a 309 kcal and 16 g compared to -53 kcal and -1 g in the control group (p = 0.001 for group differences). Handgrip improved more in the intervention group by a median of 1 kg (p = 0.007), without group differences in muscle mass or physical performance.ConclusionINT effectively increased energy and protein intake in patients at risk of malnutrition and sarcopenia undergoing 3 weeks of pulmonary rehabilitation, with a positive impact on prognostic handgrip strength.Trial registrationThe study was registered by the US National Institutes of Health (ClinicalTrials.gov). # NCT05096013.

Keywords: individual nutritional therapy; malnutrition; muscle function; muscle strength; pulmonary rehabilitation; sarcopenia.

Figure 1.

Flow chart.

Figure 2.

Energy intake, protein intake and handgrip strength by group and timepoint.

Figure 3.

Energy and protein intake of each study participant at the end or rehabilitation in percentage of the individual requirement.