COPD & Nutrition
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Transcript of COPD & Nutrition
COPD & NUTRITION
By
Dr. Riham Hazem RaafatLecturer of Chest Diseases
Ainshams University
• Case 1: Stable COPD Grade B patient, BMI 20, no wt loss,
coming for rehab. program, what will be his nutritional program?
• Case 2: COPD patient with acute infective exacerbation, BMI 17,
increased purulence and amount of sputum and needs admission in
hospital, what will change in his nutritional support program?
• Case 3: COPD patient with RF II and mechanically ventilated in
ICU and hypotensive, how will u manage his nutrition?
Gandy. Manual of Dietetic Practice. Wiley-Blackwell, 2014.
Pharmacological
•Dry mouth
•Oral thrush
•Taste changes
Physical
•Dyspnoea
•Fatigue
•Dysphagia
Psychological
•Depression
•Anxiety
•Loneliness
Social
•Social isolation
•Unemployment
•Housebound
Consequences of malnutrition in COPD
Case 1 Case 2 Case 3
Screening/Assessment
SGA -HB or IC Anthropometric
Laboratory
SGA- HB or ICAnthropometric
Laboratory
MUST Ireton-jonesHB x1.3-1.5
REE + Fluids
20-25 Kcal/dayOral diet
8cup/d30ml//kg
25-30 Kcal/dONS bid
Small, Frequent
1st resuscitate EN in 24-48hrs
25-30 Kcal/d
Macro-nutrients
CHO: 40-50 %Fat: 15-25 %
Protein: 0.8-1.5 g/kg (25 %)
Less CHO, High Fat,
High Protein to 2g/kg
DecreasedIncreased
Up to 2.5g/kgRQ decrease
Micro-nutrients
Vitamins, Minerals, Trace
Elements
AntioxidantsOmega 3, MCT
(Pulmocare)
AntioxidantsPo4, Vit. D, CaGlutamine, O3
/ Malnutrition Universal Screening Tool
Body composition abnormalities:
↑ ACTIVITY RELATED ENERGY EXPENDITURE
HYPERMETABOLIC STATE
DECREASED INTAKE
IMPAIRMENT OF ENERGY BALANCE
IMBALANCE IN PROTEIN SYNTHESIS AND BREAKDOWN
LOSS OF FAT
LOSS OF WEIGHT: BMI <2110% WEIGHT LOSS IN 6 MONTHS5% WEIGHT LOSS IN 1 MONTH
LOSS OF FFMANTHROPOMETRYBIOIMPEDANCE ANALYSISDEXALab. Investigations
CALORIC SUPPLEMENTS
PROTEIN SUPPLEMENT
STRENGTH
EXERCISE
ANABOLIC
STEROIDS
GROWTH
HORMONE
INTERVENTIONS
Help Eating SucceedHelp Eating Succeed
Prepare meals early
Rest and medicate before eating
Oral care before meal
Stimulate the appetite
Liquefy foods to reduce chewing
Eat small, frequent meals
Adequate water intake daily
CarbohydratesCarbohydrates
• CHO produce the
most CO2 during
metabolism
• CHO should be
40% of intake
• Complex CHO best
When Limited Carbohydrate Intake needed
• Follow a high-protein diet with moderate carbohydrates
• Reduce carbohydrates consumed• Start by limiting these foods:
SodaSweet teaCandyCake and dessertsStarchesFruits
Milk
Fats and ProteinsFats and Proteins
• Need at least 30%
of calories from
fat, whole dairy
encouraged
• Need 30% from protein
when in malnutrition
How to Meet Protein Needs
1 egg 6 g protein
1 ounce (oz) nuts 2-4 g protein
6 oz yogurt 6 g protein
½ cup (C) cottage cheese 14 g protein
3 oz canned tuna 25 g protein
6 oz steak 42 g protein
4 oz hamburger 28 g protein
3 oz chicken breast 26 g proteinOz = 28.35g
Increase Dietary Fats
• Increase calories to compensate for reduced
carbohydrates by increasing dietary fats
• Increase your intake of omega-3 fatty acids: Salmon
Haddock
Mackerel
Tuna
Flaxseed
Omega-3 fatty acid eggs
Limit Salt Intake
• Follow a low-sodium or no-added-salt diet
• Reduce sodium (or salt) consumed by limiting these
foods:Canned foods
Snack foods, such as chips, pretzels, crackers, and
popcorn
Packaged starchy foods, such as stuffing and rice mixes
Cured/luncheon meats and cheeses
Condiments, such as ketchup, barbecue sauce, and soy
sauce
Salt and any seasoning with the word “salt” in it
Micronutrients:Micronutrients:Fruits and VegetablesFruits and Vegetables
• Antioxidants
• Vitamin C
(smokers need double dose)
• Calcium, Vitamin D
• Phosphorus
Reduce Gas-Forming Foods
• Gas-forming foods can cause bloating and displacement of the diaphragm
• If this occurs, avoid the following:BroccoliCabbageOnionsLeeksAsparagusCarbonated beveragesDried beans and peas
Anabolic steroids
• Anabolic steroids
• Nandrolone decanoate - 50 mg for male; 25 mg
for females; 2 Weekly 4 doses
• Anabolic therapy alone increases muscle mass
but not exercise capacity
INTERVENTION WEIGHT GAIN
FFM GAIN EXERCISE CAPACITY
CALORIC SUPP. + - -
CALORIC SUPPLEMENTATION +EXERCISE TRAINING
++ + +
STRENGTH EXERCISE - + -
ANABOLIC STEROIDS ++ ++ -
ANABOLIC STEROIDS + EXERCISE
++ +++ ?