Nutrition and COPD
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Transcript Nutrition and COPD
Nutrition and COPD
What we will cover:
• Malnutrition and COPD
• Oral nutrition supplements
• Recommended dietary patterns for people with COPD
• Bone Health
• Obesity
• Micronutrient supplements
Katherine Stern
Dietitian 10/10/2014
Malnutrition
Malnutrition is more prevalent in people with COPD
25-40% of patients with COPD are malnourished
Observational studies suggest being underweight
(<BMI <18.5-20) is associated with increase disease
severity and poorer prognosis.
ESPEN Guidelines 2006
Impact of Malnutrition
Reduced ability to fight infections
Impaired wound healing, longer hospital stays and
recovery time
Muscle wasting- reduced ability to do usual activities
and lower exercise capacity
Impaired temperature regulation ‘feeling the cold’
Micronutrient deficiencies
BAPEN 2012
Identifying Malnutrition
Malnutrition can be described as:
5% unintentional weight loss in 3 months
10% unintentional weight loss in 6months
Underweight <BMI 18.5-20
Muscle and fat wasting
PEN (Practice-based Evidence in Nutrition )2010
Increased energy requirements
Varied total energy requirements due to differences
in resting energy expenditure and physical activity.
Estimated 5-10% increase in resting energy
expenditure in acute COPD exacerbations.
PEN (Practice-based Evidence in Nutrition )2010
Chewing and swallowing problems
Reduced intake due to chewing/swallowing problems
secondary to breathing problems
Small frequent meals
Soft, easily chewable foods
Convenience foods/ foods that require little
preparation
Meals on Wheels, other provides e.g. Eat
Oral Nutrition Supplements
The most recent systematic reviews and meta-analysis’s
have shown a benefit of nutritional supplements for people
with COPD.
Systematic Review in The American journal of clinical
nutrition 2012
Cochrane Systematic Review 2012
“ Moderate quality evidence that nutritional supplements
promote weight gain among patients with COPD, especially if
undernourished”
High fat, low carbohydrate
Supplements?
Pulmocare supplement- available on special authority
for people with COPD and hypercapnia CO2 >55mgHg
Theory: fat produces less CO2 per O2 molecule
consumed than carbohydrate decrease respiratory
quotient (RQ)
Conflicting evidence of a benefit on improved lung
function in individuals with COPD
ESPEN 2006/ PEN 2010
Recommended dietary patterns for
people with COPD
1-2 servings (palm size) of meat or
meat alternatives
A serving (about fist size) of
carbohydrates at each meal
(preferably wholegrain)
2-3 servings of milk and milk
alternatives
2 or more servings of fruit and 3 or
more servings of vegetables
Bone Health
Osteoporosis and bone fracture risk higher in people
with COPD.
Especially important if on steroids, low BMI, low fat free
mass, older adult >65+
Adequate calcium sources- 3 or more serving
Adequate Vitamin D- consider supplements
PEN (Practice-based Evidence in Nutrition )2010
Obesity and COPD
People with stable COPD and obesity may benefit from
weight reduction.
Extra weight may worsen exercise tolerance and increase
dyspnea.
Weight reduction may be more beneficial for those with
OSA and Asthma.
Encourage increased exercise alongside dietary changes to
prevent losses of muscle mass
PEN (Practice-based Evidence in Nutrition )2010
Micronutrient Supplements
Studies have not shown a benefit or lack of studies to
support supplementation for Vitamin C, E, beta-carotene,
selenium, magnesium, omega 3 and omega 6.
Vitamin D- consider supplementation for bone health
Comprehensive Multivitamins e.g. Centrum if poor intake
PEN (Practice-based Evidence in Nutrition )2010
Summary
Achieving adequate nutrition can be a challenge for
some people with COPD and malnutrition in common
in this patient group
Recent meta-analyses have shown a benefit of
nutritional supplements
Ensure adequate intake of calcium sources and
consider vitamin D supplementation
Consider weight reduction for those with obesity and
stable COPD.
References
Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for
stable chronic obstructive pulmonary disease (Review). The Cochrane Library
2012 Issue 12.
Collins PF, Strutton RJ, Elia M. Nutritional support in chronic obstructive
pulmonary disease: a systematic review and meta-analysis. Am J Clin Nutr 2012;
95:1385-95.
Anker SD, John M, Pedersen PU et al. ESPEN (European Society for Parenteral
and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Cardiology and
Pulmonology. Clin Nutr. 2006 April ;25(2):311-8.
BAPEN (British association for parenteral and enteral nutrition)
http://www.bapan.org.nz
PEN (Practise evidence based Nutrition) Nutrition and COPD pathway updated
2010.