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?
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
INTERVENTIONS
17. Help 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
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 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
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 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
̶ Salt and any seasoning with the word “salt” in it
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
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.
