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      Dietary resilience in patients with severe COPD at the start of a pulmonary rehabilitation program

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          COPD may impact food-related activities, such as grocery shopping, cooking, and eating. Decreased food intake may result in an unhealthy diet, and in malnutrition, which is highly prevalent in patients with COPD. Malnutrition is known to negatively impact clinical outcome and quality of life.


          In this qualitative study, we aimed to explore strategies used to overcome food-related challenges, ie, dietary resilience, and whether these led to a healthy diet. Furthermore, we aimed to identify the key themes of motivation for dietary resilience in patients with severe COPD.


          In October 2015 to April 2016, 12 patients with severe COPD starting a pulmonary rehabilitation program were interviewed. Qualitative description and thematic analysis were performed.


          All participants mentioned the use of strategies to overcome challenges. Key themes of motivation for dietary resilience were identified as “wanting to be as healthy as possible”, “staying independent”, and “promoting a sense of continuity and duty”. Two out of 12 participants met the criteria for a healthy diet.


          Our study showed a variety of motivational factors and strategies reported by patients with severe COPD to overcome food-related challenges. However, the majority (n=10) of the participants did not meet the criteria for a healthy diet. The identified key themes can be used to develop education to support patients with severe COPD to improve their diet.

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          Most cited references 16

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          How should we define health?

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            Nutritional assessment and therapy in COPD: a European Respiratory Society statement.

            Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of cost-effectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk.
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              Malnutrition and quality of life in older people: a systematic review and meta-analysis.

               S Rasheed,  Andy Woods (2013)
              Although the effects of malnutrition on morbidity and mortality of older people is well established, there has been little work done to investigate the relationship between malnutrition and quality of life (QoL) in this population. In order to facilitate further research and to aggregate existing evidence into a clear overview, a systematic review was conducted. The objective was to identify the literature on the topic, review the findings systematically, and assess the association between nutritional status and QoL. MEDLINE, EMBASE, CINAHL and Web of Science were searched for relevant studies published up to April 2011. References within identified studies also searched. The primary author extracted all data using a purpose-built form, and evaluated the quality of the studies using a published checklist. A second reviewer checked a random sample of articles independently. Evidence in the current review comes from both cohort studies and intervention trials. Results from the former suggested that individuals with malnutrition are more likely to experience poor QoL (OR: 2.85; 95% CI: 2.20-3.70, p<0.001). Consistent with this, interventions designed to improve nutritional status can also lead to significant improvements in QoL, both physical (standard mean difference 0.23, CI: 0.08-0.38, p=0.002) and mental aspects (standard mean difference 0.24, CI: 0.11-0.36, p<0.001). However, the results should be interpreted with caution in view of the poor quality of the included studies and the heterogeneity of methods employed in the assessment of both nutritional status and QoL. Future studies should carefully characterise their participants and use standardised parameters for nutritional and QoL assessments in order to achieve better evaluation and comparability of study results. Copyright © 2012 Elsevier B.V. All rights reserved.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                23 April 2018
                : 13
                : 1317-1324
                [1 ]Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Groningen, the Netherlands
                [2 ]University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases and Tuberculosis, Center for Rehabilitation, Groningen, the Netherlands
                [3 ]University of Groningen, University Medical Center Groningen, Department of Maxillofacial Surgery, Groningen, the Netherlands
                [4 ]Hanze University of Applied Sciences, Department of Applied Psychology, Groningen, the Netherlands
                [5 ]University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
                [6 ]University of Groningen, University Medical Center Groningen, Health Psychology Research, Groningen, the Netherlands
                [7 ]University of Waterloo, Schlegel Research Institute for Aging, Waterloo, ON, Canada
                [8 ]University of Waterloo, Department of Kinesiology, Waterloo, ON, Canada
                Author notes
                Correspondence: Lies ter Beek, Hanze University of Applied Sciences, Research Group Healthy Ageing, Allied Health Care and Nursing, Petrus Driessenstraat 3, 9714 CA Groningen, the Netherlands, Tel +31 50 595 2771, Email l.ter.beek@
                © 2018 ter Beek et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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