Fuenzalida 1990.

Study characteristics
Methods	RCT. Parallel design with 2 treatment arms. Duration: 42 days total (21 days in hospital and 21 days at home). Location: single centre in the USA.
Participants	Inclusion criteria: adults with COPD with FEV1 30% ‐ 50% of predicted and more than 5% weight loss, mean (SD) % IBW at study entry 78.5% (9.6%). Exclusion criteria: not living in the area of the study, medical problems confounding thier nutritional or lung status, home oxygen therapy, cancer, use of oral corticosteroids, alcoholism, previous lobectomy, dementia, azotemia, CVD, liver disease, nonambulatory, chemotherapy use, interstitial lung disease, pneumonia in the past month, diabetes, malabsorption, use of ONS, and intestinal resection. Number randomised: 9 participants (intervention group, n = 4, control group, n = 5). Gender split: all males. Age: mean (SD) 62.4 (5.6) years. Nutritional status: per cent (SD) loss of usual weight in previous year 8.3 (1.54) %.
Interventions	Intervention: participants received dietary advice and ONS in the form of individually planned diet and 1080 kcal of a nutritional supplement. Control: participants received dietary advice alone in the form of individualised diet planned by dietitian to provide 100% of recommended daily intake.
Outcomes	Survival*, weight*, BMI*, TSF*, MAMC*, MUAC*, energy intake*, measures of pulmonary function (FEV1*), measures of immune function.
Publication details	Language: English. Funding: grant from the National Institute of Arthritis, Metabolism, Kidney and Digestive Diseases and grant from the National Institutes of Health. Publication status: peer‐reviewed journal.
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Described as randomised but method not stated.
Allocation concealment (selection bias)	Unclear risk	Method not stated.
Blinding (performance bias and detection bias) Clinical outcomes	Low risk	Not reported, but must have been an unblinded trial due to the nature of the intervention. However, this is unlike to have influenced clinical outcomes.
Blinding (performance bias and detection bias) Functional outcomes	High risk	Not reported, but must have been an unblinded trial due to the nature of the intervention. Functional outcomes could have been influenced by lack of blinding.
Blinding (performance bias and detection bias) Nutritional outcomes	Unclear risk	Not reported, but must have been an unblinded trial due to the nature of the intervention. Nutritional outcomes could have been influenced by lack of blinding.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not described and likely that researchers and participants were aware of group allocation as this was a nutritional intervention. It is possible that assessment of some outcomes was influenced by lack of blinding.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Judged to be unclear as low risk for clinical outcomes and high risk for functional and nutritional outcomes.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No losses occurred during the study.
Selective reporting (reporting bias)	Unclear risk	No study protocol identified, thus unable to judge whether all planned outcomes were reported. Outcomes reported not in a format suitable for direct entry into a meta‐analysis. Data in the paper on weight have been used to derive mean change (SD). Information on study quality obtained from authors.
Other bias	Low risk	Baseline variables given, groups similar at baseline.