Individualized nutritional care including adherence support improves health-related quality of life in individuals with severe chronic obstructive pulmonary disease: a randomized controlled trial

BACKGROUND: Undernutrition and reduced health-related quality of life (HRQoL) are common in severe chronic obstructive pulmonary disease (COPD) and may exacerbate functional decline. This study evaluated whether individualized nutritional care with adherence support improves HRQoL in individuals with severe COPD at risk of undernutrition. Secondary outcomes included physical function, anthropometry, body composition, and dietary intake. METHODS: In this 3-month, single-center, open-label randomized controlled trial, 87 adults with severe COPD were randomized 1:1 to individualized nutritional care or standard care. The intervention comprised tailored dietary plans, adherence support (phone calls, reminders), optional oral nutritional supplements and weight diary. The primary outcome was HRQoL (EQ-5D-5 L). Secondary outcomes were disease-specific HRQoL (CAT), chair stand test, grip strength, anthropometry, body composition, and protein and energy intake. Analyses followed an intention-to-treat approach using linear mixed-effects models. RESULTS: Of 674 individuals screened, 91 were enrolled; of whom 87 completed the baseline visit; 44 received the intervention and 43 standard care, with 78 (90%) completing follow-up. At 3 months, the intervention improved HRQoL versus standard care (mean difference in EQ-5D-5 L utility index 0.053; 95% CI 0.003–0.103), driven by better mobility, self-care, and usual activities. Functional gains were supported by more chair stands (mean difference 0.80; 95% CI 0.05–1.55). Protein (+ 16 g/day) and energy intake (+ 326 kcal/day) increased, while no significant differences were observed in disease-specific HRQoL, anthropometry, or body composition. Benefits were greater in undernourished, frail, solitary-living participants, and men. CONCLUSION: Individualized nutritional care with adherence support improved HRQoL, particularly physical functioning, in individuals with severe COPD at risk of undernutrition, supporting its consideration in clinical practice. TRIAL REGISTRATION: The study was registered on ClinicalTrials (NCT04873856) in April 2021.