The Effect Of Nutritional Status On Patients With Stable Chronic Obstructive Pulmonary Disease

Objective: The purpose of this study is to evaluate the effect of nutritional status on COPD patients through evaluation,intervention and regular follow-up,to explore the long-term management and monitoring of nutritional status of COPD patients based on mobile APP(COPD Manager),and to explore a new closed-loop management model for COPD patients.Methods: We recruited 36 COPD patients diagnosed in the outpatient and inpatient department of the Department of Respiratory and critical Medicine,General Hospital of Ningxia Medical University.All the patients met the diagnostic criteria of GOLD2019(Global Strategy For the Diagnosis,Management,and Prevention of Chronic Obstructive Pulmonary Disease in 2019).The included patients were given individualized nutrition intervention(diet guidance)and follow-up management for 3 months by using mobile phone APP.In the process of management,patients regularly completed the records of discomfort,medication record,CAT scale,PHQ-9 scale and GAD-7 scale.The researchers timely gave reasonable suggestions including COPD medication and nutritional diet according to the monitoring situation of the patients,and adjusted the diet plan of the patients on the basis of patients’ feedback.The research indicators,consisting of Nutritional assessment indicators(including body mass index,MNA (?)scale,total protein,albumin,hemoglobin),blood routine indicators(including neutrophil absolute value,lymphocyte absolute value,neutrophil to lymphocyte ratio),pulmonary function severity rating and psychosocial scale evaluation(including CAT scale,GAD-7 anxiety scale,PHQ-9 Depression scale)were collected before and after three-month management cycle,respectively.The COPD patients were divided into three groups based on the MNA (?)scale: good nutrition group,malnutrition risk group and malnutrition group.We compared the differences of nutritional indicators,pulmonary function,quality of life,anxiety and depression scores among different nutritional status groups,and analyzed the correlation between MNA (?)scale and CAT,GAD-7,PHQ--9 scale in COPD patients,and explored the effects of nutritional intervention on nutritional status,pulmonary function,CAT,anxiety scale,depression scale and nutritional indexes of patients with COPD under different GOLD grades.Results:1.Analysis of severity of disease,blood index and quality of life scale in different nutritional status subgroups of COPD:1.1 Among patients with stable COPD,13 were well-nourished,20 were at risk of malnutrition,3 were malnourished,and 63.89% of COPD patients had the risk of malnutrition or malnutrition.There was no significant difference in age,smoking index and pulmonary function among different subgroups of COPD(P > 0.05).1.2 Comparison of blood indexes in different nutritional status subgroups of COPD:There were significant differences in blood total protein and albumin levels between malnutrition risk group and malnutrition group compared with well-nourished group,but there was no significant difference in serum vitamin D,hemoglobin and NLR values(P >0.05).1.3 Comparison of quality of life scale among different nutritional status subgroups of COPD: There was no significant difference in the scores of CAT,GAD-7 and PHQ-9scale among different nutritional status subgroups of patients with stable COPD(P > 0.05).2.Correlation analysis between the MNA (?)scale and CAT,GAD-7,PHQ-9 scale:There was no correlation between MNA (?)scale and CAT,GAD-7,PHQ-9 scale,and there was no significant difference(P > 0.05).3.Analysis of related indexes before and after nutritional intervention in patients with stable COPD3.1 Comparison of nutrition-related evaluation indexes in patients with stable COPD before and after nutritional management: Before and after nutritional intervention,there were significant differences in body weight(63.2±6.2 vs 69.6±6.6),BMI(21.6±2.1 vs23.8±20.4)and serum total protein(61.9±8.2 vs 64.7±8.0)in patients with stable COPD.There was no significant difference in serum albumin,hemoglobin,vitamin D,hemoglobin and NLR(P > 0.05),and there was significant difference in MNA (?) scale score and CC(P <0.05)before and after nutritional management..3.2 Analysis of nutritional indexes of stable COPD patients with different GOLD grades before and after nutritional management: According to GOLD classification,COPD patients were divided into mild GOLD(13 moderate);GOLD(14 cases)and GOLD severe-extremely severe(9 cases).Before and after nutritional intervention,there were significant differences in nutritional index BMI,serum total protein and MNA(?) scale between GOLD moderate group and GOLD heavy-extremely severe group.There were significant differences in BMI and MNA (?)among different GOLD groups(P < 0.01).There was no significant difference in total protein,albumin,hemoglobin and NLR among different GOLD subgroups of COPD.3.3 Comparison of pulmonary function index,CAT,GAD-7 and PHQ--9 before and after nutritional management in stable COPD patients: There was significant difference in CAT and GAD-7 before and after nutritional intervention,but there was no significant difference in FEV1/FVC(0.62±0.17 vs 0.60±0.12)and PHQ-9.Conclusion:1.63.89% of COPD patients have the risk of malnutrition or malnutrition.2.There were significant differences in the levels of BMI,serum total protein and albumin among different nutritional status groups of COPD patients.3.There was no significant correlation between MNA (?)score and CAT,GAD-7 and PHQ-9 scale.4.It is feasible to adopt individualized nutrition management for stable COPD patients based on mobile phone APP.