Medical nutrition therapy in chronic obstructive pulmonary disease: A narrative review

Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous lung condition characterized by persistent airflow obstruction, associated with cardiovascular, metabolic and musculoskeletal comorbidities. In 2022, approximately 480 million people were affected by this disease, making it the third leading cause of mortality worldwide. Projections indicate that by 2050, this number could rise to 600 million. Nutrition status is a fundamental component in managing COPD patients, as it is a critical prognostic factor for morbidity and mortality. Patients with COPD may display different body composition phenotypes, ranging from cachexia to obesity to sarcopenia. Assessing body composition is essential to determine muscle mass, the latter crucial for respiratory function, and also to identify potential health risks and complications. Likewise, involuntary weight loss and decreased fat-free mass are associated with increased mortality. COPD should be viewed as a syndrome, or as a multimorbidity coexisting with other conditions, requiring comprehensive clinical and nutrition assessment for effective management. Nutrition intervention, including oral supplements, is crucial to preserve muscle mass and weight. Supplementation with protein, ω-3 fatty acids, and antioxidants, along with pulmonary rehabilitation, improves muscle strength and exercise tolerance. This narrative review examines nutrition phenotypes and highlights the importance of nutrition interventions in patients with COPD. A multimodal approach combining nutrition support, physical exercise, and pharmacological treatments is essential for managing COPD and its associated comorbidities.