COPD 患者的营养评估与治疗:欧洲呼吸学会立场声明

Nutritional assessment and therapy in COPD: a European Respiratory Society statement.

机构信息

NUTRIM School for Nutrition, Toxicology and Metabolism, Dept of Respiratory Medicine, Maastricht University Medical Centre+, Maastricht, The Netherlands

Asthma and Airways Centre, Toronto Western Hospital, Toronto, Canada Dept of Respiratory Medicine, McMaster University, Hamilton, Canada.

出版信息

Eur Respir J. 2014 Dec;44(6):1504-20. doi: 10.1183/09031936.00070914. Epub 2014 Sep 18.

Abstract

Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.

摘要

营养与代谢一直是慢性阻塞性肺疾病(COPD)的广泛研究课题,但临床对饮食习惯、营养状况和营养干预对 COPD 发病率、进展和结局的影响的认识有限。为此,欧洲呼吸学会成立了一个多学科工作组,以总结 COPD 营养评估和治疗方面的证据和现有实践,并为未来的研究提供方向。工作组的成员对相关主题的文献进行了重点审查,并由一名方法学家提供建议。营养状况,特别是异常的身体组成,是 COPD 结局的一个重要独立决定因素,这一点已得到充分证实。工作组确定了 COPD 的不同代谢表型,作为营养风险评估的基础,这在临床试验设计和患者咨询中很有用。营养干预可能对营养不足的患者有效,而与运动方案结合时可能效果最佳。需要提供营养干预的成本效益证据,以支持报销,从而增加获得营养干预的机会。总的来说,证据表明,均衡饮食对所有 COPD 患者都有益,不仅对其潜在的肺部有益,而且对其在代谢和心血管风险方面的已证实益处也有益。

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