Zeng Jia, Cheng Jing, Zhu Liangdong, Tang Sufang
The First Affiliated Hospital of Guangzhou Medical University, No. 151 Yanjiang West Road, Guangzhou City, Guangdong, Yuexiu District, China.
The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China.
BMC Pulm Med. 2025 May 8;25(1):220. doi: 10.1186/s12890-025-03667-0.
To evaluate the effectiveness of various nutritional supplements as interventions for patients with Chronic Obstructive Pulmonary Disease (COPD) using network meta-analysis.
We searched PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials on nutritional supplements for COPD patients, with the search updated to March 24, 2025. The risk of bias for each included study was assessed using appropriate tools, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data synthesis was performed using R software, employing network meta-analysis methods to compare the relative efficacy of different nutritional interventions.
Thirty-seven studies involving 1975 COPD patients and 21 different nutritional supplements were analyzed. Butyrate [MD = 2.7, 95% CrI (1.0, 4.4)], Nanocurcumin [MD = 13, 95% CrI (5.4, 21)], and probiotics [MD = 7.1, 95% CrI (5.2, 9.1)] significantly improved Forced Expiratory Volume in One Second (FEV1). Nanocurcumin also slowed the decline in the ratio of Forced Expiratory Volume in One Second to Forced Vital Capacity (FEV1/FVC) [MD = 12, 95% CrI (5.5, 18)]. For exercise endurance, coenzyme Q10 combined with creatine [MD = 63, 95% CrI (36, 90)], Melatonin (MLT) [MD = 46, 95% CrI (1.3, 92)], Nitrate [MD = 30, 95% CrI (19, 41)], and whey proteins [MD = 11, 95% CrI (9.2, 13)] significantly improved 6-minute walk distance (6MWD). Regarding dyspnea reduction, MLT [MD = -0.90, 95% CrI (-1.6, -0.21)] and Yam-Epimedium [MD = -1.3, 95% CrI (-1.9, -0.67)] significantly lowered modified Medical Research Council (mMRC) scores. In terms of quality of life, MLT [MD = -8, 95% CrI (-12, -4.2)], Vitamin D (VD) [MD = -2.5, 95% CrI (-3.1, -1.9)], and whey proteins [MD = -0.70, 95% CrI (-0.99, -0.41)] reduced COPD Assessment Test (CAT) scores. Additionally, AKL1 [MD = -9.2, 95% CrI (-18, -0.41)], creatine [MD = -9.6, 95% CrI (-17, -2.8)], and Yam-Epimedium [MD = -24, 95% CrI (-34, -13)] lowered St. George's Respiratory Questionnaire (SGRQ) scores. The Surface Under the Cumulative Ranking Curve (SUCRA) analysis showed Nanocurcumin ranked highest for improving FEV1/FVC, coenzyme Q10 combined with creatine for 6MWD, Yam-Epimedium for reducing dyspnea and SGRQ, and MLT for lowering CAT scores.
This analysis indicates that various nutritional supplements, including Nanocurcumin, butyrate, probiotics, coenzyme Q10 combined with creatine, MLT, nitrate, whey proteins, VD, AKL1, creatine, and Yam-Epimedium, can potentially benefit COPD patients, demonstrating differing levels of effectiveness. Specifically, Nanocurcumin may be the best choice for improving lung function; coenzyme Q10 combined with creatine may be the most effective for enhancing exercise endurance; Additionally, Yam-Epimedium is the most likely supplement to reduce the symptoms of dyspnea in COPD patients. Yam-Epimedium and MLT may be the most effective for improving quality of life and overall health status.
采用网状Meta分析评估各种营养补充剂作为慢性阻塞性肺疾病（COPD）患者干预措施的有效性。
我们检索了PubMed、Embase、Cochrane图书馆和Web of Science数据库，查找关于COPD患者营养补充剂的随机对照试验，检索更新至2025年3月24日。使用适当工具评估每项纳入研究的偏倚风险，并根据推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。使用R软件进行数据合成，采用网状Meta分析方法比较不同营养干预措施的相对疗效。
分析了37项研究，涉及1975例COPD患者和21种不同的营养补充剂。丁酸盐[MD = 2.7，95% CrI（1.0，4.4）]、纳米姜黄素[MD = 13，95% CrI（5.4，21）]和益生菌[MD = 7.1，95% CrI（5.2，9.1）]显著改善了一秒用力呼气量（FEV1）。纳米姜黄素还减缓了一秒用力呼气量与用力肺活量之比（FEV1/FVC）的下降[MD = 12，95% CrI（5.5，18）]。对于运动耐力，辅酶Q10联合肌酸[MD = 63，95% CrI（36，90）]、褪黑素（MLT）[MD = 46，95% CrI（1.3，92）]、硝酸盐[MD = 30，95% CrI（19，41）]和乳清蛋白[MD = 11，95% CrI（9.2，13）]显著改善了6分钟步行距离（6MWD）。关于减轻呼吸困难，MLT[MD = -0.90，95% CrI（-1.6，-0.21）]和山药-淫羊藿[MD = -1.3，95% CrI（-1.9，-0.67）]显著降低了改良医学研究委员会（mMRC）评分。在生活质量方面，MLT[MD = -8，95% CrI（-12，-4.2）]、维生素D（VD）[MD = -2.5，95% CrI（-3.1，-1.9）]和乳清蛋白[MD = -（此处原文有误，应为-）0.70，95% CrI（-0.99，-0.41）]降低了慢性阻塞性肺疾病评估测试（CAT）评分。此外，AKL1[MD = -9.2，95% CrI（-18，-0.41）]、肌酸[MD = -9.6，95% CrI（-（此处原文有误，应为-）17，-2.8）]和山药-淫羊藿[MD = -24，95% CrI（-34，-13）]降低了圣乔治呼吸问卷（SGRQ）评分。累积排序曲线下面积（SUCRA）分析显示，纳米姜黄素在改善FEV1/FVC方面排名最高，辅酶Q10联合肌酸在改善6MWD方面排名最高，山药-淫羊藿在减轻呼吸困难和SGRQ方面排名最高，MLT在降低CAT评分方面排名最高。
该分析表明，包括纳米姜黄素、丁酸盐、益生菌、辅酶Q10联合肌酸、MLT、硝酸盐、乳清蛋白、VD、AKL1、肌酸和山药-淫羊藿在内的各种营养补充剂可能使COPD患者受益，显示出不同程度的有效性。具体而言，纳米姜黄素可能是改善肺功能的最佳选择；辅酶Q10联合肌酸可能是增强运动耐力最有效的；此外，山药-淫羊藿是最有可能减轻COPD患者呼吸困难症状的补充剂。山药-淫羊藿和MLT可能是改善生活质量和整体健康状况最有效的。
