Sustained but Attenuated Weight Gain following Pulmonary Rehabilitation in COPD: Evidence for a Gap in Post-Discharge Nutritional Care.

Abstract

Background: Malnutrition is common in patients with chronic obstructive pulmonary disease (COPD) and is associated with adverse clinical outcomes. Pulmonary rehabilitation (PR) improves nutritional status in the short term, but evidence on sustainability remains limited.

Objectives: To assess longitudinal changes in body weight following PR and to explore the role of oral nutritional supplementation (ONS) and post-discharge nutritional care.

Methods: A multicenter study was conducted combining retrospective analysis with prospective follow-up. Patients with COPD stages 2-4 undergoing inpatient PR were included. Patients with BMI ≥25 kg/m² and incomplete PR were excluded. Body weight was assessed on admission, discharge, and follow-up.

Secondary outcomes: 6-minute walk test (6MWT), nutritional care variables following discharge. Linear mixed models were used to analyze weight trajectories.

Results: 75 patients were included. Body weight increased during PR and remained higher at follow-up (57.7 kg on admission, 59.5 kg at discharge, and 60.6 kg at follow-up; p<0.001). Patients receiving ONS had lower baseline BMI, without a differential effect on weight trajectories. Nutritional counselling declined following discharge (21% at follow-up). In a logistic regression analysis, lower BMI at discharge was associated with a higher likelihood of post-discharge nutritional counselling (OR 0.72 per kg/m² increase, 95% CI 0.57-0.91, p=0.007).

Conclusions: PR was associated with an increase in body weight that persisted after discharge, although the magnitude of weight gain attenuated over time. The marked decline in post-discharge nutritional counselling highlights a potential gap in continuity of nutritional care. Future studies should evaluate whether structured long-term nutritional follow-up can improve nutritional outcomes after PR.