COPDの栄養サポート：メタ分析

COPDの栄養サポートに関する系統的レビューとメタ分析の論文を紹介します。これは重要な論文です。

Peter F Collins, Rebecca J Stratton, and Marinos Elia. Nutritional support in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Am J Clin Nutr June 2012 First published April 18, 2012, doi: 10.3945/​ajcn.111.023499

2005年のコクランのレビューでは、栄養サポートは無効となっています。それ以降の改訂はありません。
http://www.ncbi.nlm.nih.gov/pubmed/15846608

今回は13のRCTのメタ分析です。うち11が経口での栄養剤摂取です。結果ですが、1日蛋白摂取量が14.8g、1日エネルギー摂取量が236kcal、有意に増加しました。体重は11研究で平均1.94kg増加、握力は4研究で平均5.3％改善（p=0.05ですが）しました。

以上より、COPDに対する主に経口栄養剤摂取の栄養サポートは、エネルギー摂取量、体重、握力を改善させるというのが今回の結論です。

抄録しか読めていないので詳細不明ですが、COPDの栄養サポートが有効というメタ分析の結果は素晴らしいことです。ただ、より厳格なメタ分析であるコクランレビューが改訂されて、こちらでも有効という結論が出るまでは、半喜び程度に抑えておいた方が良い気がします。

リハ栄養の立場では、機能訓練室での訓練直後の経口栄養剤摂取をより勧めることができるエビデンスだと思います。食事の時に経口栄養剤を摂取してももちろんよいですが、早期満腹感が多いことを考えると、少量頻回のほうがよいですし、訓練直後のほうがよいのではと考えます。

Abstract
Background: The efficacy of nutritional support in the management of malnutrition in chronic obstructive pulmonary disease (COPD) is controversial. Previous meta-analyses, based on only cross-sectional analysis at the end of intervention trials, found no evidence of improved outcomes.

Objective: The objective was to conduct a meta-analysis of randomized controlled trials (RCTs) to clarify the efficacy of nutritional support in improving intake, anthropometric measures, and grip strength in stable COPD.

Design: Literature databases were searched to identify RCTs comparing nutritional support with controls in stable COPD.

Results: Thirteen RCTs (n = 439) of nutritional support [dietary advice (1 RCT), oral nutritional supplements (ONS; 11 RCTs), and enteral tube feeding (1 RCT)] with a control comparison were identified. An analysis of the changes induced by nutritional support and those obtained only at the end of the intervention showed significantly greater increases in mean total protein and energy intakes with nutritional support of 14.8 g and 236 kcal daily. Meta-analyses also showed greater mean (±SE) improvements in favor of nutritional support for body weight (1.94 ± 0.26 kg, P < 0.001; 11 studies, n = 308) and grip strength (5.3%, P < 0.050; 4 studies, n = 156), which was not shown by ANOVA at the end of the intervention, largely because of bias associated with baseline imbalance between groups.

Conclusion: This systematic review and meta-analysis showed that nutritional support, mainly in the form of ONS, improves total intake, anthropometric measures, and grip strength in COPD. These results contrast with the results of previous analyses that were based on only cross-sectional measures at the end of intervention trials.