الفهرس 
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Abstract
Malnutrition is frequent in COPD patients and is linked with a bad outcome. So as to improve their nutritional status, nutrition interventions are required . This study address whether the dietary counselling potentially enhance malnourished COPD patients’ food intake, nutritional status, functional results, and life quality. The goal of the study was to improve COPD patients’ quality of life through enhancement of their nutritional status, modification of their dietary intake and following suitable dietary habits according to the recent guidelines The research targets were to describe the current nutritional status; and food consumption of adult COPD patients admitted at the chest department in Tanta university hospitals. Also, to estimate the effect of dietary counseling and adherence to dietary guidelines on COPD patient’s dietary intake, nutritional status, and their life quality . Subjects and Methods: all stable COPD patients admitted to Tanta university chest hospital in six months (from May 2020 to November 2020) were the target group of the study. • Tanta city is the capital of El- Gharbia Governorate in middle Delta region of Egypt. It is 92 Km north Cairo. The total population served by the hospital is about 17 million . • Two hundred and twenty patients were involved at the research. The first 100 patients were the intervention group who instructed to follow dietary guidelines for COPD via dietary counseling sessions for 6 months . • They received dietary counseling once per week over six months, based on a set of written dietary guidelines specifically designed for COPD patients . • A pre designed questionnaire sheet was the tool of the study which contains data regarding, Socio demographic data, medical history, assessment of nutritional status through anthropometry which include height, weight, BMI, triceps skin fold measurement , mid upper-arm circumference , and mid arm muscle circumference ( MAMC ),waist circumference( WC), Nutritional screening by subjective global assessment , for functional assessment ,The COPD assessment test(CAT test) is utilized, for assessing dyspnea degrees the Medical Research Council (MRC) dyspnea scale was applied, Combined COPD testing for assessment to HRQL .Also, estimation of frequency of food intake was done by food frequency questionnaire. Each patients’ HB percent, albumin, and total protein levels were extracted from their medical records. The present study’s findings could be summarized : part1: Descriptive study: The research involved a total of 220 individual where the mean age 50± 12.3 years, 99.1% was male and 62.7% from urban residence ,47.3% were illiterate ,40.9% are manual workers, with average duration of employment 30 years.56.9% of them had enough income but not saving,93.2% were married with mean children number three children. As regards to respiratory impairment as measured by CAT score, mean CAT of 19.1±5.08 ,65.5% were moderate CAT SCORE 32.7% sever. As regards MRC dyspnea scale, regarding degree of dyspnea, mean dyspnea scale was 2.63±0.66 (moderate score), nearly half of them (50.1%) had moderate score on MRC dyspnea scale, (7.7%) were sever. Moreover, (97.3%) had bad HRQOL. As regards SGA,87% were malnourished (52%SGA B,35%SGA C), the results also revealed that 59.1% were (overweight, obese),37.7% had normal BMI, only 3.2% were underweight, mean BMI 26.6± 3.5 kg/m2, also mean of weight (78.8 kg), height (1.7 m), MUAC (32.7 cm), TSF (33.2cm), MAMC (31.6 cm), and WC (89.3 cm) which were slightly increased to some extent. As regards laboratory data, Mean HB (12.4 gm), Mean albumin (3.2 gm/dl), and mean total protein (6.6 gm/dl) respectively, which were within normal levels. By the socio-demographic information in relation to Subjective Global Assessment, where There was significant association between level of nutritional status measured by Subjective Global Assessment and following parameters (urban residence (p-value=0.001), enough family income (p-value=0.04), previous admission for two times, (p-value <0.001) number of exacerbations more than three times, (p-value=0.002) and dealing with animals (p-value=0.01). Concerning level of nutritional assessment as measured by Subjective Global Assessment, in relation to MRC Dyspnea Scale, CAT and HRQOL where there was significant association between level of nutritional status measured by Subjective Global Assessment, and following parameters (MRC Dyspnea Scale, CAT and HRQOL), (p-value <0.001). Regarding level of nutritional assessment as measured by Subjective Global Assessment and Quality of Dietary Intake where there was significant association between level of nutritional status and intake of different serving of those food items (CHO (p-value=0.01), fruits(p-value=0.002), vegetables(p-value=0.03) &fat&oil(p-value=0.03)). As regard level of nutritional assessment as measured by Subjective Global Assessment and anthropometric measurements. A significant association was found between level of nutritional status and anthropometric measurements, weight (p-value <0.001), BMI (p-value <0.001), MUAC (p-value =0.04), and WC (p-value =0.004). Regarding level of nutritional assessment as measured by Subjective Global Assessment and lab measurements where a significant association was found between mean HB level and level of nutritional status (p-value =0.03). part2: intervention study : The research included a total of hundred patients with a mean age 53.14±11.67years, majority 99% were male and nearly half of them (51%) from rural areas, 50% had secondary educational level, around one third (34%) were manual workers, with average duration of employment (31 years), nearly half of them (51%) of them had enough income, majority (96%) were married. The respiratory status as measured by CAT score among the intervention group, mean CAT score was 19.47± 5.75 (moderate score), highest percentage of them (48%) had moderate and sever respiratory impairment. Regarding degree of dyspnea, mean dyspnea scale was 2.70±.689 (moderate score), nearly half of studied patients (56%) had moderate score on MRC dyspnea scale,9% were sever. Moreover, majority of them (96%) of them had bad HRQOL. Nearly half of them (54%) were (overweight, obese), (6%) were underweight, more than one third (40%) of patients had normal BMI .Mean BMI 26.56±4.042 kg/m2, the means of weight (78.4Kg), height(1.7 m), Page | 154 SUMMARY MUAC(30.3 cm), TSF(31.5 cm), MAMC (31.6 cm) and WC, (89.3 cm) in which all was slightly elevated . More than three quarters, 77% were malnourished (52%SGA B, and 25% SGA C). Mean HB (13.2 gm), Mean albumin (3.3 gm/dl), and mean total protein (6.4 gm/dl) respectively, which were within normal levels. In terms of the influence of dietary counseling, 44 of the 100 individuals enhanced their nutritional status or SGA score, A significantly association was detected among group (p<0.001). where there was enhancement and shift in malnutrition from 77% (52%SGA B, 25%SGA C), to only 55% (43%SGA B, 12 %SGA C). Regarding MRC Dyspnea Scale, there is improvement and shift in SCORE from 31% mild degree to 39%, from 56% moderate score to 48%, from 9% sever to 7%. Also, increase in normal score from 4% up to 6% . Regarding CAT SCORE, there is improvement and shift in SCORE from 48% moderate score to 56%, from 42% sever to 30% only, also shift to mild condition from 4% to 10% There was also increase in mean difference of both CAT assessment test and MRC dyspnea scale from (19.47± 5.759and2.70±.689respectively) pre intervention to (12.98±5.635and1.99±.772) post intervention. There was significant relationship among group understudy. P-value <0.001 There was also improvement in HRQOL from 4% pre intervention to 30% post intervention. There was significant difference within the group pre, and post intervention, (P-value= 0.002). The present study showed that dietary counseling through customized nutritional education according to patient needs (underweight or overweight obese) , enhanced dietary adequacy of different food groups, alters eating lifestyles, stimulate weight loss for overweight, inhibit loss of weight, stimulate weight gain for underweight persons, thus enhanced nutritional status, outcome measures, and life quality in malnourished COPD adult patients. It showed also that dietary intake adequacy for different food groups (energy, protein, dairy, fruits, vegetables, and fat &oil) improved from respectively preintervention to post intervention and there was significant association within the group. There was significant difference between groups. Energy, (P-value =0.009), protein (P-value <0.001), dairy (P-value 0.026), fruits (P-value <0.001), vegetables (P-value 0.017), and fat &oil (P-value 0.3). As regards to anthropometry, where there was increase in those with normal BMI from 40% to 49%, decrease in underweight also from 6% to 2%, also improvement in mean of all parameters of anthropometric measurements BMI, from (26.5±4.04) to (26.3±3.2) kg/m2, weight from (78.4±12.4) to(78.2±10.02) kg, MUAC, from (32.7±4.6) to (32.5±3.89) cm, TSF, from (33.2±5.07) to (33.0±3.86) cm, MAMC, from (31.6±4.5) to(31.3±3.78) cm, WC from (89.3±10.4)) to, (89.0±10.1) cm respectively. There was significant difference between groups pre, and postintervention, p- value<0.001for all) except (height, and WC), p-value (0.132, and 0.393) respectively . Concerning lab data, showed that there was slight increase in mean values of lab data, but they are within normal level. A significant association was detected between values of albumin and total protein only without HB values(p=0.01).