ERS声明：COPD患者的营养评估和治疗(2014)

NutritionalassessmentandtherapyinCOPD:aEuropeanRespiratorySocietystatementAnnemieM.Schols1,IvoneM.Ferreira2,3,FritsM.Franssen4,HarryR.Gosker1,WimJanssens5,MaurizioMuscaritoli6,ChristophePison7,8,9,10,MaureenRutten-vanMo¨lken11,12,FrodeSlinde13,MichaelC.Steiner14,RuzenaTkacova15,16andSallyJ.Singh14Affiliations:1NUTRIMSchoolforNutrition,ToxicologyandMetabolism,DeptofRespiratoryMedicine,MaastrichtUniversityMedicalCentre+,Maastricht,TheNetherlands.2AsthmaandAirwaysCentre,TorontoWesternHospital,Toronto,Canada.3DeptofRespiratoryMedicine,McMasterUniversity,Hamilton,Canada.4ProgramDevelopmentCentre,CIRO+(CentreofExpertiseforChronicOrganFailure),Horn,TheNetherlands.5LaboratoryofRespiratoryMedicine,KatholiekeUniversiteit,Leuven,Belgium.6DeptofClinicalMedicine,SapienzaUniversityofRome,Rome,Italy.7CliniqueUniversitairedePneumologie,InstitutduThorax,CHUGrenoble,Grenoble,France.8InsermU1055,Grenoble,France.9Universite´JosephFourier,Grenoble,France.10EuropeanInstituteforSystemsBiologyandMedicine,Lyon,France.11ErasmusUniversityRotterdam,InstituteofHealthPolicyandManagement,RotterdamTheNetherlands.12ErasmusUniversityRotterdam,InstituteofMedicalTechnologyAssessment,Rotterdam,TheNetherlands.13DeptofInternalMedicineandClinicalNutrition,SahlgrenskaAcademyatUniversityofGothenburg,Gothenburg,Sweden.14CentreforExerciseandRehabilitationScience,LeicesterRespiratoryBiomedicalResearchUnit,UniversityHospitalsofLeicesterNHSTrust,GlenfieldHospital,Leicester,UK.15DeptofRespiratoryMedicine,FacultyofMedicine,P.J.SafarikUniversity,Kosice,Slovakia.16L.PasteurUniversityHospital,Kosice,Slovakia.Correspondence:AnnemieM.Schols,DeptofRespiratoryMedicine,MaastrichtUniversityMedicalCentre+,PObox5800,6202AZMaastricht,TheNetherlands.E-mail:[e-mail]tabolismhavebeenthetopicofextensivescientificresearchinchronicobstructivepulmonarydisease(COPD)butclinicalawarenessoftheimpactdietaryhabits,nutritionalstatusandnutritionalinterventionsmayhaveonCOPDincidence,progressionandoutcomeislimited.AmultidisciplinaryTaskForcewascreatedbytheEuropeanRespiratorySocietytodeliverasummaryoftheevidenceanddescriptionofcurrentpracticeinnutritionalassessmentandtherapyinCOPD,andtoprovidedirectionsforfutureresearch.TaskForcemembersconductedfocusedreviewsoftheliteratureonrelevanttopics,advisedbyamethodologist.Itiswellestablishedthatnutritionalstatus,andinparticularabnormalbodycomposition,isanimportantindependentdeterminantofCOPDoutcome.TheTaskForceidentifieddifferentmetabolicphenotypesofCOPDasabasisfornutritionalriskprofileassessmentthatisusefulinclinicaltrialdesignandpatientcounselling.Nutritionalinterventionisprobablyeffectiveinundernourishedpatientsandprobablymostwhencombinedwithanexerciseprogramme.Providingevidenceofcost-effectivenessofnutritionalinterventionisrequiredtosupportreimbursementandthusincreaseaccesstonutritionalintervention.Overall,theevidenceindicatesthatawell-balanceddietisbeneficialtoallCOPDpatients,notonlyforitspotentialpulmonarybenefits,butalsoforitsprovenbenefitsinmetabolicandcardiovascularrisk.@ERSpublicationsMetabolismandnutrition:shiftingparadigmsinCOPDmanagement:April152014|Acceptedafterrevision:June292014|Firstpublishedonline:Sept182014Conflictofinterest:Disclosurescanbefoundalongsidetheonlineversionofthisarticleaterj.ersjournals.comCopyrightERS2014TASKFORCEREPORTERSSTATEMENTEurRespirJ2014;44:1504–1520|DOI:10.1183/09031936.000709141504IntroductionNutritionhasbeenthetopicofextensivescientificresearchinchronicobstructivepulmonarydisease(COPD).Thisarticlewillexaminetheimpactthatdietaryhabits,nutritionalstatusandnutritionalinterventionsmayhaveontheincidence,progressionandoutcomeofCOPD.ThearticleaimstoraiseawarenessaboutdietandnutritioninCOPD,andtodeliveraresourcethatwillassistcliniciansandacademicsinprovidinghigh-qualitynutritionalassessmentandcaretoindividualswithCOPD.ThetopicsdiscussedrangefromunderstandingalteredmetabolismandrelatedtherapeutictargetsinCOPD,toimprovingdietaryhabits,outcomeandcost-effectivenessofnutritionalinterventionsincludingrecommendationsforfuturetranslational,epidemiologicalandclinicalresearch.TopicselectionwasbasedonscientificimportanceandclinicalrelevancetoensurethearticlewouldbeofinteresttomembersoftheEuropeanRespiratorySociety(ERS).MethodsAmultidisciplinaryTaskForcewascreatedbytheERS,consistingof12membersrepresentingabroadrangeofrespiratorycliniciansinvolvedindeliveryofcaretoindividualswithCOPD,basicscientists,nutritionalcaregiversspecialisedinpracticalchallengesofdietaryintervention,epidemiologists,andahealtheconomist.SeveralrepresentativeswerealsomembersoftheEuropeanSocietyforClinicalNutritionandMetabolism(ESPEN)inordertoguaranteeoptimalalignmentbetweenthisERSstatementandupdatedESPENguidelinesonnutritioninCOPD.ConflictsofinterestweredealtwithaccordingtoERSstandardprocedures.Thisdocumentwascreatedbycombiningafirmevidence-basedapproachandtheclinicalexpertiseoftheTaskForcemembers.However,aformal