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.