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

Figures & data

Figure 1 Deductive conceptual model in patients with COPD.

Note: Adapted from Appetite, 2012;58(2), Vesnaver E, Keller HH, Payette H, Shatenstein B. Dietary resilience as described by older community-dwelling adults from the NuAge study “if there is a will-there is a way!” 730–738. Copyright 2012, with permission from Elsevier.⁷

Table 1 Characteristics of the study sample (n=12)

	N	Mean (± SDa) or median (IQRb)
Gender
Male	4
Female	8
Age, years		59.2 ± 8.3
BMI, kg/m^2		25.1 ± 6.3
Risk factors for impaired food intake
Living alone	7
Dry mouth	9
Chest tightness	12
Pain	6
Lack of appetite	4
Healthy dietc	2
Nutritional status
PG-SGAd stage A: well nourished	7
PG-SGA stage B: moderate or suspected malnutrition	4
PG-SGA stage C: severely malnourished	1
HADSe depression range (0–21 points)		3 (IQR: 1 to 5.5)
≥8 (possible or suspected depression)	1
HADS anxiety range (0–21 points)		3.5 (IQR: 1.3 to 5.8)
≥8 (possible or suspected anxiety disorder)	1
Comorbidities
Diabetes mellitus	1
Vascular diseasef	3
Cardiac arrhythmia	2
Arthrosis of the hip	1
Smoking status
Smoking	2
Quit smoking	10
Spirometry
FEV1 (L)		0.8 (IQR: 0.6 to 1.5)
FEV1 (% predicted)		29.5 (IQR: 22.0 to 57.3)
FEV1/FVC ratio (%)		34.5 (IQR: 26.0 to 48.3)
COPD
GOLDg 2 moderate	3
GOLD 3 severe	3
GOLD 4 very severe	6

Notes:

a Standard deviation.

b IQR.

c Defined as an intake of 80% of the age and gender specific recommendations in the Dutch Nutritional Guidelines 2011 (14), for at least 5 out of the 6 major food groups.

d Scored PG-SGA (PG-SGA©; FD Ottery 2005, 2006, 2015).

e HADS.

F Vascular disease: coronary artery disease, peripheral artery disease, transient ischemic attack.

g Disease classification according to the GOLD.

Abbreviations: IQR, interquartile range; BMI, body mass index; PG-SGA, Patient-Generated Subjective Global Assessment; HADS, Hospital Anxiety and Depression Scale; FEV₁, forced expiratory volume in the first second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 2 Food-related challenges and strategies reported by patients with COPD

Challenges	Strategies
Grocery shopping
Chest tightness (n=6) Lack of energy (n=3) Lack of physical strength (n=1) Being overweight (n=1) Nervousness (n=1) Windy weather (n=1) Hot weather (n=1) Misty weather (n=1) Cold weather (n=1) Limited financial resources (n=2)	Getting help from others Adjust to a slower pace Use of a car/E-bike Use of a trolley/cart Choose particular point in time to avoid crowded conditions
Cooking
Steam from cooking (n=5) Smell of food (n=1) Lack of energy (n=3)	Getting help from others Air-refreshing measures like opening all windows or use of a cooking hood Specific choice of food (with regard to time to cook or smell) Adjust to a slower pace Eating fast food now and then One-pan dish Prepare food for several days so the effort in the next days is limited Ready-made meals Hairdresser chair to easily move around the kitchen, while sitting
Eating
Loss of partner (n=2) Stress (n=3) Smell of cooked food (n=1) Dry mouth (n=1) Chest tightness (n=4) Fatigue (n=4) Lack of appetite (n=3) Early satiation (n=1) Eating too fast (n=1)	Creating a pleasant atmosphere at the dinner table with music and/or reading Search for companion to have dinner with Look ahead to the future Use of “meal boxes” Drinking with meal Breathing techniques Adjust the amount of activity before eating Smaller portions and spreading of meals Self-discipline by talking to one-self in a firm way Implementation of regularity Being encouraged by partner Alternatives like liquid foods or specific choice of food Being encouraged by children Taking extra time

VesnaverEKellerHHPayetteHShatensteinBDietary resilience as described by older community-dwelling adults from the NuAge study “if there is a will -there is a way!”Appetite201258273073822200412

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