Assessment of nutritional status and meal‐related situations among patients with chronic obstructive pulmonary disease in Primary health care – obese patients; a challenge for the future

Aims and objectives. To describe nutritional status, meal related situations, food habits and food preferences of patients with chronic obstructive pulmonary disease (COPD) in a Primary health care (PHC) setting. Background. To date, guidelines have mainly focused on underweight patients with COPD, as a low body mass index (BMI) is a risk factor for mortality. However, in recent years there has been an increase in the number of overweight patients with COPD, and therefore nutritional management must be developed to cover problems related to both under and overweight. Design. Descriptive. Methods. One hundred and three patients from PHC centres representing COPD stages 2 and 3 were included. The Mini Nutritional Assessment (MNA) was used to collect nutritional status data while semi‐structured interviews provided information on food and meal related situations. Results. Mean age was 69 (±5) years and 45% were women. Among all patients mean BMI was 27 and 14% had a BMI ≤ 21 kg/m2. More women (31%) than men (26%) had a BMI ≥ 30 kg/m2. According to the MNA screening score, 86% of the patients were assessed as normal or not at risk of malnutrition. The total MNA assessment score revealed that 10 patients were at risk of malnutrition or malnourishment. Problems with meal related situations were mostly associated with eating, and only a small number reported difficulties with shopping or preparing food. Conclusions. In PHC, more patients with COPD were obese than malnourished and their self‐reported nutritional status was not always accurate. Relevance to clinical practice. It is challenging to identify the patient’s nutritional status, individualize nutritional care and educate obese patients with COPD at PHC centres. It is necessary to develop screening instruments to assess the risk of both obesity and malnutrition.