Nutrition-focused program improves sarcopenia status and reduces physician visits and hospitalisations for patients with COPD and poor nutrition status

Rafique, F.S., Hardman, B., Hossain, M.J., Stevenson, R. and Kerr, K.W. (2025) Nutrition-focused program improves sarcopenia status and reduces physician visits and hospitalisations for patients with COPD and poor nutrition status. Clinical Nutrition ESPEN, 69, [1164]. (doi:10.1016/j.clnesp.2025.07.1050).

Abstract

Rationale: evaluate the impact on health outcomes of a nutrition-focused, pharmacist-led quality improvement program (QIP) in patients with chronic obstructive pulmonary disease (COPD) and poor nutrition status.

Methods: the QIP was conducted between 4/2023 and 6/ 2024 at 48 general practitioner (GP) practices in the UK. The QIP enrolled adult COPD patients with low BMI ≤18.5 kg/m2 or unexpected weight loss (5-10%), and at least one other risk factor: MUST score ≥1+, SARC-F ≥ 4, high dose inhaled corticosteroids, or 2+ exacerbations in 12 months. Enrolled patients consulted with a pharmacist and were provided pharmaceutical, non-pharmaceutical, and nutrition interventions per a protocol approved by the supervising GP. Nutrition interventions included food fortification advice or oral nutrition supplement (ONS) recommendations. Changes in nutritional status (MUST and SARC-F scores) and healthcare visits after 3-6 months were evaluated using T-tests or Wilcoxon signed-rank tests.

Results: Participating patients were mainly female (59.8%), with mean (±SD) age of 71.6 (±11.5) years, BMI of 19.8 (±4.09) kg/m2, MUST score of 2.279 (±0.93), and SARC-F score of 3.647 (±2.098). 44% of patients were prescribed ONS with 78.7% receiving a high-protein ONS and 69.3% receiving a high-protein ONS with HMB. Outcomes differences (Δ) were calculated as Non-ONS patient value - ONS patient value. Patients receiving ONS had lower MUST (Δ=0.618±1.011, p<0.001) and SARC-F (Δ=0.647±1.150, p<0.001) scores at follow-up. Patients receiving ONS also had decreased GP (Δ=1.063±1.256, p<0.001), hospital (Δ=0.4±0.89, p<0.001), accident & emergency (Δ=0.898±1.218, p<0.001), and nurse visits (Δ=0.705 ±1.297, p<0.001).

Conclusion: Healthcare providers should implement sarcopenia screening and nutrition treatment to reduce muscle loss and improve nutrition status of patients with COPD and malnutrition risk.

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Contributors

Author: M.J. Hossain

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