nutrition and copd all things considered. primary goals of medical nutrition therapy preserve lean...
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Nutrition and COPD
All Things Considered
Primary Goals of Medical Nutrition Therapy
Preserve lean body mass Prevent involuntary weight loss Maintain nutritional status Improve quality of life
Role of Nutrition
Improves energy Helps fight inflammation Improves immune function Helps retain muscle mass and
strength Helps retain bone mass Helps slow progression of the disease
Nutrition Concerns
Malnutrition Weight status Nutrient dense - Quality counts! Adequate fluids (helps thin mucus) Coping with COPD symptoms
Unplanned Weight Loss
An individual without lung disease uses about 100 calories per day expanding and contracting the muscles involved with breathing
Unplanned Weight Loss
An individual with COPD could use between 420 – 730 (or more) calories per day for the work of breathing
Unplanned weight loss affects as many as 40-70% of COPD patients
Malnutrition
Studies report that in individuals with COPD, the prevalence of lower BMI (under 20 kg/m2) may be as high as 30% and the risk of COPD-related death doubles with weight loss.
Body Composition
In individuals with stable COPD, studies report that even for the 70% of patients with BMI greater that 20 kg/m2, body composition differs from healthy controls.
Fat-free (muscle) mass index and bone mineral density are lower in individuals with COPD.
COPD Symptoms Contribute to Weight Loss
Shortness of breath Fatigue (too tired to cook) Loss of appetite Feeling bloated after eating Food tastes different
Shortness of Breath CO2 retention associated with food comes
from eating excess calories in general. Most individuals with COPD need smaller
nutrient-dense meals, more often Digestion requires energy. Energy requires
oxygen. Smaller meals use less oxygen. Learn to “graze” throughout day Strategic snacking – no room for “junk”
Shortness of Breath Often difficult to chew, swallow, and
breathe at the same time Try to rest for 30 minutes before meals Good body posture at table Easily prepared and easy to chew foods Eat 6 small meals per day If on continuous oxygen therapy, may
need to increase oxygen flow rate during meals (Check with doctor first)
Fatigue
Eat larger meals earlier in the day 6 small meals per day Prepare greater amounts of food
when feeling “up”. Freeze to eat later.
Prepare simple foods and recipes Enlist family, friends or community
agencies to help with meals
Feeling Bloated Factors: Swallowing air, not drinking
enough fluids, and not enough exercise Try not to rush meals Eat several small meals throughout day Drink fluids 1 hour before or after meals Avoid foods that cause gas and bloating Eat less fried, fatty foods Avoid constipation – gradually increase fiber
and fluid in diet and remember to move
If Individual is Underweight:
May be more likely to get an infection
May become weak and tired more often
May weaken the muscles that control breathing
Weight Gain or Maintenance
Small meals and snacks throughout day
Nutrient-dense, High calorie, High protein
Role of fat Overall nutritional quality of foods May use commercial nutrition
supplements (Not a meal replacement)
If Individual is Overweight: Heart and lungs must work harder Increased weight increases oxygen
needs Breathing may become more difficult,
especially if weight is around middle Weight may decrease ability to expand
chest well for breathing Increased risk of developing other
health problems
Weight Loss Wizard
We wish we had a magic wand!
Guidelines to Lose Weight
Lose weight gradually and sensibly Become more active Eat fewer calories Eat nutrient-dense, balanced diet Follow healthy nutrition guidelines – such
as the DASH diet or Choose My Plate Monitor or record food intake
DASH to Health
• Dietary Approaches to Stop Hypertension (DASH) eating plan is balanced, nutrient-dense, and fiber and mineral-rich.
• DASH is consistently ranked tops in independent comparisons of nutrition and diet plans.
Important Nutrition Guidelines for COPD
Protein Fluids Less Sodium Calcium Magnesium Phosphorus Potassium
Protein Most individuals with COPD have reduced
body muscle mass compared to normal Protein is key component of muscle and
antibodies to help fight infection Balanced diet is the real deal Include protein source at every meal (fish,
poultry, meat, eggs, dairy products, legumes, nuts, nut butters, soy products)
Tips to Increase Protein Snack on peanut butter, bean dips, nuts,
yogurt, boiled eggs, cheese or cottage cheese, instant breakfast, puddings
Add skim milk powder to milk, cereals, cream soups, casseroles, and sauces
Add cheese to sandwiches and vegetables Add chopped meats, cheese, or legumes
to soups and casseroles
Fluids Helps thin and clear lung secretions Helps prevent bloating and constipation Oxygen therapy is drying Choose caffeine-free, non-carbonated
beverages Goal: at least 8 cups liquids per day To reduce fullness at meals, drink more
between meals & sip throughout day
Reduce Sodium
Fluid retention makes breathing difficult
Choose more fresh, unprocessed foods
Use less packaged, prepared foods Read food labels for sodium values Use more herbs, spices and salt-free
seasonings to add flavor
Calcium
Helps with lung function, muscle contraction, and blood clotting
Helps make bones strong Important for healthy immune
system Helps transport nerve impulses Corticosteroids may increase
calcium loss
Calcium Food Sources
Dairy products are best source (milk, yogurt, cheese, ice cream)
Other foods sources: tofu, almonds, broccoli, leafy greens, legumes
Calcium-fortified foods Vitamin D is essential for calcium
absorption
Magnesium Normal muscle and nerve function Healthy immune system Bone health Energy metabolism Protein synthesis Heart rhythm Normal blood pressure Blood sugar and insulin regulation
Magnesium Food Sources Nuts Dark green vegetables Whole grains Legumes (beans, peas, lentils, peanuts) Soybeans and tofu Some seafood (Whole grains have about 80% more
magnesium than refined grains)
Potassium
Protective effect against hypertension (helps the body to excrete sodium)
Helps regulate water and mineral balance throughout the body
Required for muscle contractions Very important for the heart muscle Diuretics decrease potassium
Potassium Food Sources Banana, kiwi, apricot, nectarine Dried fruit (prunes, raisins, dates, figs) Milk and yogurt Potato (either white or sweet) Tomato (raw or cooked) Dried cooked beans (navy, black, lentil, limas,
pinto, black-eyed peas, etc.) Leafy greens (spinach, kale, Swiss chard) 100% bran cereals Fish: halibut, tuna, cod, snapper
What is the Role of Fat?
Insulation, circulation, hormone balance
Helps meet increased energy needs (Fat has twice the calories of protein or carbohydrates)
Transports fat-soluble vitamins Increases satiety
Unsaturated Fats are Healthy Fats
Olive oil, canola oil, and other vegetable oils
Nuts, seeds, nut butters Fatty fish – salmon, mackerel,
tuna, sardines Avocados Olives
Good Carbs and Fiber
Fiber only found in plant foods Nutrient dense Best sources: whole fruits and
vegetables, dried beans, whole grains, nuts & seeds
Eating for color = Nutrient density Whole grains – Try something
different
Choose Your Plate
5 - 6 small meals per day Balance between carbs, proteins,
and fats Simple and fresh Nutrient dense Variety of colors and textures Drink plenty of fluids
Fill Your Plate With Color!
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