Nutrition in pulmonary rehabilitation

Nutrition and metabolism have been the topic of extensive scientific research in COPD, but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have in the COPD rehabilitation trajectory is limited. It is well established that nutritional status, and in particular low fat-free mass, is an important independent determinant of physical functioning and mortality in COPD. Relative to muscle loss, the effects of obesity on physical performance in patients eligible for rehabilitation seem limited, but abdominal obesity adversely affects cardiometabolic risk profile even in normal-weight patients with COPD. A multidisciplinary taskforce installed by the ERS in 2011 (Schols et al. European Respiratory Journal, 44(6):1504-1520, 2014) identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design, patient counselling and nutritional therapy. Based on a systematic review of the literature, protein energy supplementation likely is effective in undernourished COPD patients and probably most when combined with an exercise programme. There is some evidence that specific nutrients may enhance efficacy of pulmonary rehabilitation, but further research is needed in this area. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential benefits for the respiratory system but also for its proven benefits on metabolic and cardiovascular risk.