COPD & Nutrition
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How is COPD and Nutrition Overlapped and Affecting Each Other How to Solve the Problem as a Part of Pulmonary Rehabilitation The Presentation is Discussing these items in the form of Problem Solving
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COPD & Nutrition
- 1. COPD & NUTRITION By Dr. Riham Hazem Raafat Lecturer of Chest Diseases Ainshams University
- 2. • 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?
- 3. 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
- 5. Consequences of malnutrition in COPD
- 6. Case 1 Case 2 Case 3 Screening/ Assessment SGA -HB or IC Anthropometric Laboratory SGA- HB or IC Anthropometric Laboratory MUST Ireton-jones HB x1.3-1.5 REE + Fluids 20-25 Kcal/day Oral diet 8cup/d30ml//kg 25-30 Kcal/d ONS 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 Decreased Increased Up to 2.5g/kg RQ decrease Micro- nutrients Vitamins, Minerals, Trace Elements Antioxidants Omega 3, MCT (Pulmocare) Antioxidants Po4, Vit. D, Ca Glutamine, O3
- 16. 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 <21 10% WEIGHT LOSS IN 6 MONTHS 5% WEIGHT LOSS IN 1 MONTH LOSS OF FFM ANTHROPOMETRY BIOIMPEDANCE ANALYSIS DEXA Lab. Investigations CALORIC SUPPLEMENTS PROTEIN SUPPLEMENT STRENGTH EXERCISE ANABOLIC STEROIDS GROW TH HORM ONE INTERVENTIONS
- 17. 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
- 19. CarbohydratesCarbohydrates • CHO produce the most CO2 during metabolism • CHO should be 40% of intake • Complex CHO best
- 20. When Limited Carbohydrate Intake needed • Follow a high-protein diet with moderate carbohydrates • Reduce carbohydrates consumed • Start by limiting these foods: Soda Sweet tea Candy Cake and desserts Starches Fruits Milk
- 21. Fats and ProteinsFats and Proteins • Need at least 30% of calories from fat, whole dairy encouraged • Need 30% from protein when in malnutrition
- 22. How to Meet Protein Needs 1egg 6g protein 1ounce (oz) nuts 2-4g protein 6oz yogurt 6g protein ½cup (C) cottage cheese 14g protein 3oz canned tuna 25g protein 6oz steak 42g protein 4oz hamburger 28g protein 3oz chicken breast 26g protein Oz = 28.35g
- 23. 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
- 24. 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
- 25. Micronutrients:Micronutrients: Fruits and VegetablesFruits and Vegetables • Antioxidants • Vitamin C (smokers need double dose) • Calcium, Vitamin D • Phosphorus
- 26. Reduce Gas-Forming Foods • Gas-forming foods can cause bloating and displacement of the diaphragm • If this occurs, avoid the following: Broccoli Cabbage Onions Leeks Asparagus Carbonated beverages Dried beans and peas
- 27. 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
- 28. INTERVENTION WEIGHT GAIN FFM GAIN EXERCISE CAPACITY CALORIC SUPP. + - - CALORIC SUPPLEMENTATION+ EXERCISE TRAINING ++ + + STRENGTH EXERCISE - + - ANABOLIC STEROIDS ++ ++ - ANABOLIC STEROIDS+ EXERCISE ++ +++ ?
Editor's Notes
- Prepare meals early or at peak levels Rest 30 minutes and use bronchodilator medications before eating Oral care before meal to moisten/clean Select foods to stimulate the appetite Liquefy foods to reduce chewing Eat 5-6 small, frequent meals & snacks 2-3 liters of water daily, but not at meals
- A high-protein diet with moderate carbohydrates is recommended to reduce carbon dioxide in the body. Increased carbohydrates in the diet can increase respirations, which can make eating more difficult (Dorner). Try to reduce concentrated sweets, such as sodas, sweet tea, candy, cake, and desserts, and limit other carbohydrates, such as starches, fruits, and milk.
- Here is a list of foods to meet your protein needs (mypyramid.gov).
- Increasing dietary fats can make up for the reduced carbohydrates in your diet (Dorner). Increase omega-3 fatty acids, which are found in salmon, haddock, mackerel, tuna, flaxseed, and omega-3 fatty acid eggs.
- Salt can cause fluid retention in your body, which can make it difficult to breathe (Escott-Stump). Reduce salt in your diet by limiting the following foods: Canned foods (unless you purchase low-sodium varieties) Snack foods, such as chips, pretzels, crackers, and popcorn Packaged starchy foods, such as stuffing and rice mixes Cured meats, luncheon meats, and cheese, such as: Ham Turkey Bologna Roast beef Corned beef Sausage Canned meats Velveeta® Condiments, including ketchup, barbecue sauce, and soy sauce Salt and any seasoning with the word “salt” in it Try not to add salt to foods, because ¼ teaspoon has 600 milligrams (mg) of salt. Our daily intake of salt is 2300 mg/day (American Dietetic Association).
- Antioxidents minimize free radical damage and reduce inflammation Vitamin C can increase pulmonary function and slow progression of COPD Glucocorticoids that reduce airway inflammation has side effect of reducing bone mass, increase fx risk. Can slow progression of COPD
- Foods that are gas forming can cause abdominal bloating and discomfort. This can lead to displacement of the diaphragm, which will cause increased difficulty breathing (Dorner). If this is noticed, avoid the following foods: Broccoli Cabbage Onions Leeks Asparagus Carbonated beverages Dried beans and peas Remember, everyone is different, so other foods also may cause gas, depending on the individual.