The Role of Nutrition in

Respiratory Disease

Divisi Ilmu Gizi Medik

Fakultas Kedokteran Unpad
2016
 Malnutrition and the Pulmonary System
Malnutrition impairs
• Respiratory muscle function
• Ventilatory drive
• Response to hypoxia
• Pulmonary defense mechanisms

Weight loss (inadequate energy intake)  poor prognosis in persons with pulmonary
diseases
Malnutrition  patient at high risk for developing respiratory infections
Patients with pulmonary disease (hospitalized and malnourished)  are likely to have
lengthy stay and are susceptible to increased morbidity and mortality

Eating can be hard for some people with lung disease. It is important to eat well even
during times of illness
 Problem
Feeling full • eat small, frequent meals and snacks
• make every bite count
quickly

• choose easy to prepare, easy to eat

Feeling tired - meals

fatigue • eat small meals more often

• reduce intake of gassy foods and

Feeling carbonated beverages
• drink liquids between meals
bloated - gas • limit use of straws and chewing gum

Firestone Institute for Respiratory Health- St. Joseph’s Hospital - McMaster University Health Sciences
 Shortness of • rest before eating
• avoid unnecessary movement or talking during a
meal
breath • try softer foods that require less chewing

• Drink 6-8 cups of noncaffeinated fluid each day

Constipation • Increase fibre slowly

• Keep as physical active as you can

• Eat 6-8 small meals and snacks daily

Poor Appetite • choose high calorie, high protein food
• Use Nutrition supplements

Dry mouth or • Drink adequate fluids

• Have moist foods
• Follow good mouth care-after using an inhaler as well
throat • Avoid very hot or very cold food and drink as these may
stimulate the cough reflex

Firestone Institute for Respiratory Health- St. Joseph’s Hospital - McMaster University Health Sciences
 Eating Well and Maintaining a Healthy Weight
It is important to maintain a healthy body weight in lung disease
 Body Mass Index or BMI

With lung disease, a healthy BMI > than 21 and < 25

Healthy BMI BMI BMI

• least likely • being • pick up

to have overweight infections
health increases easier
problems the work
related to of
weight breathing
 Problem with Chronic Lung Disease
• Gastroesophageal Reflux
– Many people with chronic lung disease also
have gastroesophageal reflux disease
(GERD)
Steroids and Diet
– Steroid pills (such as prednisone or
methylprednisolone) decrease swollen airways.
– They also interfere with calcium, potassium,
sodium, protein and vitamins C and D
 Steroid:

• increase the risk of osteoporosis (lossof bone density).

• very important to eat foods high in calcium, such as
dairy products  or be sure to take a calcium
supplement
• If need to control calories, low fat dairy products may
be used
• To prevent other side effects, limit the use of salt and
foods that are high in sodium and decrease the amount
of cholesterol and fats in your diet
• In many cases, taking a multi-vitamin may help ensure
adequate vitamin and mineral intake.
 Nutritional Implications of
Tuberculosis

• Nutritional Factors that Increase Risk of TB:

– Protein-energy malnutrition: affects the immune
system; debate whether it is a cause or
consequence of the disease
– Micronutrient deficiencies that affect immune
function (vitamin D, A, C, iron, zinc)
 Nutritional Consequences of TB
• Increased energy expenditure
• Loss of appetite and body weight
• Increase in protein catabolism leading to
muscle breakdown
• Malabsorption causing diarrhea, loss of fluids,
electrolytes
 Nutritional Needs in TB
• Energy: 35-40 kcals/kg of ideal body weight
• Protein: 1.2-1.5 grams/kg body weight, or 15%
of energy or 75-100 grams/day
• Multivitamin-mineral supplement at 100-
150% DRI
Chronic Obstructive Pulmonary
Disease (COPD)
 Affect on Nutrition
COPD: A catabolic “wasting” disease
• Low body weight, related muscle wasting and
malnutrition are common and present in up to one
third of people with COPD
• Malnutrition is associated with reduced muscle
strength and endurance and osteoporosis.
• The respiratory muscles are also affected which alters
ventilation of the lung tissue and contributes to the
worsening of respiratory conditions.
• For people with COPD, the presence of malnutrition is
an influential factor in functional performance and
quality of life.
Causes of altered nutritional status and low body
weight leading to malnutrition include:
– Increased energy needs
– Reduced consumption of food due to feeling full
quickly after eating, airflow obstruction, poor teeth
and gums, swallowing difficulties and fatigue
– Effects of ageing
– Altered oxygen supply
– Physical activity
– Frequent use of corticosteroid medication
Individualised nutrition therapy
– important
– should be started as early as possible in order to
improve nutritional state, immune function,
respiratory muscle function and exercise
tolerance.
 The Primary Goals of Nutrition care for
Patients with COPD

• Facilitate Nutritional Well Being

• Provide nutrition that promotes the maintenance of respiratory
muscle force, mass and function to optimise the performance of the
patient and meet the demands of undertaking daily activities
• Maintain an appropriate ratio of lean body mass to
adipose tissue
• Correct fluid imbalance and maintain adequate
hydration
– Keep secretions clear and thin and reduce the risk of
dehydration
• Manage drug-nutrient interaction
– Control the interaction between drugs and
nutrients that negatively influence the
consumption and absorption of nutrients
• Promote an improvement in quality of life
• Prevent osteoporosis
• To achieve these goals:
– Treatment and prevention may be achieved by increasing dietary
intake
– Altering dietary habits to include different foods and optimum timing
of meals or snacks in relation to symptoms and activity patterns, or
inclusion of an oral nutritional supplement.
• Health professionals should be aware of potential nutritional
problems such as weight loss and muscle wasting, preferably in the
early disease stages.
• For patients, taking note of any changes in weight, appetite and
food intake is important and should be discussed with their
doctor/specialist.
• It is important to ensure early diagnosis so that nutritional
intervention can be initiated to ensure minimal impact on
respiratory health.
• After FLUID status, ENERGY is a primary
consideration
• Maintaining energy balance Crucial for
combating this progressive disorder
• It is essential accurate evolution of both :
– Energy Intake
– Energy Expenditure
 MNT Assessment in COPD
• Fluid balance and requirements
• Energy needs
• Food intake (decreased intake common)
• Morning headache and confusion from
hypercapnia (excessive CO2 in the blood)
• Fat free mass
• Food drug interactions
• Fatigue
• Anorexia
• Difficulty chewing/swallowing because of dyspnea
• Impaired peristalsis secondary to lack of oxygen to
the GI tract
• Underweight patients have the highest
morbidity/mortality
 Nutrient Needs in Stable COPD
• Protein: 1.2-1.7 grams/kg (15-20% of calories) to
restore lung and muscle strength and promote
immune function
• Fat: 30-45% of calories
• Carbohydrate: 40-55% of calories
• Maintain appropriate RQ
• Address other underlying diseases (diabetes, heart
disease)
• Vitamins: intakes should at least meet the DRI
• Smokers may need more vitamin C (+16-32 mg)
depending on cigarette use
• Minerals: meet DRIs and monitor phosphorus and
magnesium in patients at risk for refeeding during
aggressive nutrition support
• GI motility: adequate exercise, fluids, dietary
fiber
• Abdominal bloating: limit foods associated
with gas formation
• Fatigue: resting before meals, eating nutrient-
dense foods, arrange assistance with shopping
and meal preparation
 MNT in COPD
• Oral supplements
• Nocturnal or supplemental tube feedings
• Specialized pulmonary products generally
not necessary
 Food Drug Interactions
• Aminoglycosides lower serum Mg++
—may need to replace
• Prednisone—monitor nitrogen, Ca++, serum
glucose, etc.
 Reasons for poor nutrition

• Dyspnea and coughing interfere

with adequate dietary intake
• Fatigue interferes with buying and
preparing foods
• Chronic mouth breathing alters the taste
of food
• Headaches, mental status changes
occur because of hypercapnia (excess
blood level of CO2)
 COPD: Carbohydrates

• CHO produce the most CO2 during

metabolism
• CHO should be 40% of intake
• Complex CHO best
 COPD:
Fats and Proteins
• Need at least 30%
of calories from
fat, whole dairy
encouraged
• Need 30% from
protein
 Micronutrients:
Fruits and Vegetables
• Antioxidants
• Vitamin C
• Calcium, Vitamin D
• Phosphorus
 Nutrition & Exercise Tips
• 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
 Help Eating Succeed
Suggest that patient
• Use oxygen at mealtimes
• Eat slowly
• Chew foods well
• Engage in social interaction at mealtime
• Coordinate swallowing with breathing
• Use upright posture to reduce risk of
aspiration
 Meet The Smokers
BEFORE

Wayne McLaren Maureen Hamilton

20 Years Later…

Wayne Maureen