Article Text

Download PDFPDF

Oral nutrition supplements and between-meal snacks for nutrition therapy in patients with COPD identified as at nutritional risk: a randomised feasibility trial
  1. Arora Ros Ingadottir1,2,
  2. Anne Marie Beck3,4,
  3. Christine Baldwin5,
  4. Christine Elizabeth Weekes5,
  5. Olof Gudny Geirsdottir1,6,
  6. Alfons Ramel1,
  7. Thorarinn Gislason7,8 and
  8. Ingibjorg Gunnarsdottir1,2
  1. 1 Unit for Nutrition Research, Landspitali University Hospital and Faculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland
  2. 2 Department of Clinical Nutrition, Landspitali University Hospital, Reykjavik, Iceland
  3. 3 Faculty of Health, Copenhagen University College, Copenhagen, Denmark
  4. 4 Research Unit for Nutrition, Herlev and Gentofte Hospital, Copenhagen, Denmark
  5. 5 Department of Nutritional Sciences, King's College London, London, UK
  6. 6 The Icelandic Gerontological Research Institute, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
  7. 7 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
  8. 8 Department of Sleep, Landspitali University Hospital, Reykjavik, Iceland
  1. Correspondence to Dr Arora Ros Ingadottir; aroraros{at}


Introduction Intervention studies have mainly used oral nutritional supplements (ONS) for the management of patients with chronic obstructive pulmonary disease (COPD) identified as at nutritional risk. In this 12-month randomised feasibility trial, we assessed the (1) feasibility of the recruitment, retention and provision of two interventions: ONS and between-meal snacks (snacks) and (2) the potential impact of the provision of snacks and ONS on body weight and quality of life in patients with COPD.

Methods Hospitalised patients with COPD, at nutritional risk, were randomised to ONS (n=19) or snacks (n=15) providing 600 kcal and 22 g protein a day in addition to regular daily diet. The intervention started in hospital and was continued for 12 months after discharge from the hospital.

Results Study recruitment rate was n=34 (45%) and retention rate at 12 months was similar for both groups: n=13 (68%) in the ONS group and n=10 (67%) in the Snacks group. Both groups gained weight from baseline to 12 months (2.3±4.6 kg (p=0.060) in the ONS group and 4.4±6.4 kg (p=0.030) in the Snacks group). The St George’s Respiratory Questionnaire total score improved from baseline to 12 months in both groups (score 3.9±11.0 (p=0.176) in the ONS group and score 8.9±14.1 (p=0.041) in the Snacks group).

Discussion In patients with COPD who are at nutritional risk snacks are at least as feasible and effective as ONS, however, adequately powered trials that take account of the difficulties in recruiting this patient group are required to confirm this effect.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors Concept and design of study: ARI, IG, AMB, CB, AR, TG and OGG. Data collection and data management: ARI. Analysing and interpretation of data: ARI, IG, AMB, CB, CEW, AR, TG and OGG. Writing the manuscript: ARI. All authors participated in editing and final revisions of the manuscript. All authors have read and approved the final manuscript.

  • Funding This paper presents independent research that was supported by the Icelandic Research Fund of the Icelandic Centre for Research (141216-051), the Eimskip University Fund and the Landspitali University Hospital Research Fund. Oral nutritional supplements were partly funded by Nutricia (Icepharma) and between meals by MS Iceland Dairies (Mjólkursamsalan).

  • Disclaimer The views expressed in this study are those of the authors and not necessarily those of the funding source.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the National Bioethics Committee (VSN14-066-S1), Chief Medical Officer Landspitali (LSH 68-14) and Data Protection Authority (2014/908).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.