MEDICAL NUTRITION

THERAPY FOR
PULMONARY DISEASES
Nurul Hazirah Jaafar (PhD)
Dept of Nutrition Sciences
Kulliyyah of Allied Health Sciences
International Islamic University Malaysia
hazirahjaafar@iium.edu.my
 Course outline
General
Asthma
Bronchopulmonary dysplasia
Chronic obstructive pulmonary disease
Cystic fibrosis
Further reading:
1. Krause’s Food & The Nutrition Tuberculosis
Care Process, 14th Ed (pg. 851) Respiratory failure
2. Nutrition and Diagnosis related
Care, 8th Ed (pg. 303)
General
The Pulmonary System
1
• Pulmonary system grows and matures during gestation
and childhood; aging diminish lung integrity
2 • Respiratory structures – nose, pharynx, larynx, trachea,
bronchi, bronchioles, alveolar ducts, alveoli
• Supporting structures - skeleton, muscles (intercostal, a
3 bdominal, diaphragm)

4
General
The Pulmonary System
• Major function: respiration (gas exchange; O2 in,
CO2 out)
• Other functions:
a) To enable body obtaining oxygen for cellular m
etabolic demands
b) To filter, warm and humidify inspired air
c) Synthesize surfactant
d) Regulate acid base balance
e) Synthesize arachidonic acid
f) Convert angiotensin I to angiotensin II
General
Instruments for Pulmonary Function

Auscultation Pulse oximetry Percussion Spirometry

 General
Measurements of Pulmonary Function
01
Measurement Indications
Forced Viral Capacity (FVC) Total volume of air expired after a full inspiration

Forced Expiratory Volume In The volume of exhaled in the first second a deep inhalation
one Second (FEV1)

03
FEV1/FVC ratio
04
The ratio between the amount of air you were able to blow out
in the first second versus the total amount of air you could blow
out
Measurements of Pulmonary Function (cont’d)

Measurement Indications
Partial Pressure of Dissolved Carbon dioxide is able to move out of the blood into the a
Carbon Dioxide (PaCO2) irspaces of the lung, and then out with the exhaled air

Partial Pressure Of Dissolved Measure how well oxygen is able to move from the air int
Oxygen (PaO2) o the lungs

Oxygen Saturation (O2Sat)
The measure of the amount of oxygen carried by the red
blood cells and can be calculated using the partial press
ure of dissolved oxygen (PaO2)
-Inpatients with pulmonary disease, fewer red blood cell
s carry the usual load of oxygen, and oxygen saturatio
n is decreased
Measurements of Pulmonary Function (cont’d)
Measurement Indications

pH Measure of hydrogen ion concentration (H) in blood

• pH of less than 7 is acidic, and a pH greater than 7 is alkaline.
• CO2 dissolves more readily in the blood than oxygen and forms
bicarbonate and smaller amounts of carbonic acid.
• Normal amounts, the ratio of carbonic acid to bicarbonate helps to
keep the body pH normal.
• Acidosis : respiratory activity is increased and the lungs quickly
compensate to excrete excess CO2
• Alkalosis: respiratory activity decreases and CO2 is retained,
producing a compensatory respiratory acidosis.
 General
Indications of blood gases

Blood Gas Normal Values

Partial Pressure of Oxygen (PaO2) 75-100 mmHg
Partial Pressure of Dissolved Carbon Dioxide (PaCO2) 35-45 mmHg
pH 7.35-7.45
Oxygen saturation (O2Sat) 94%-100%
Bicarbonate (HCO3) 22-26 mEq/liter
Indications of blood gases
Parameter Normal values
Arterial Blood Gas Venous Blood Gas
pH 7.35-7.45 7.33-7.43
pCO2 (mmHg) 35-45 38-51
pO2 (mmHg) 71-104 30-71
O2 sat (%) 95-100 60-85
HCO3 (mmol/L) 22-29 22-29
Indications of blood gases

pH result Bicarbonate PCO2 Condition Common causes

result result
Less than 7.4 Low Low Metabolic Kidney failure, shock,
acidosis diabetic ketoacidosis

Greater than High High Metabolic Chronic vomiting, low

7.4 alkalosis blood potassium

Less than 7.4 High High Respiratory Lung diseases such as

acidosis pneumonia
Greater than Low Low Respiratory Hyperventilation, pain,
7.4 alkalosis anxiety
General Lung
structures,
elasticity &
function

Impacts of malnutrition Strength &

endurance
on pulmonary system
Malnutrition

Lung
Control of
immune
breathing
defense

Respiratory
muscle
mass
Impacts of malnutrition on pulmonary system

❑ Protein and Fe deficiency → low Hb → decrease oxygen carrying capacity of blood

❑ Low Ca, Mg, P, K → compromise muscle function at cellular level
❑ Hypoproteinemia → decrease colloid osmotic pressure → allows body fluid to move into interstitial space
→ pulmonary oedema
❑ Decrease surfactant (synthesized from protein and PL) → collapse of alveoli → increase work of breathing
❑ Supporting connective tissue of the lungs composed of collagen(vitamin C)
❑ Normal airway mucus –water, glycoproteins, electrolytes
❑ Weight loss (inadequate E intake) →poor prognosis of pulmonary disease
❑ Malnutrition <---> impaired immunity <---> respiratory infections →lengthy hospitalization →increase mo
rbidity and mortality
 General Impacts of pulmonary disease on
nutrition status
Increased Energy Expenditure

Increased work of breathing Additional limitations

Chronic infections Difficulty preparing food due to fatigue
Medical treatments: bronchodilators, antibiotics, steroi Lack of financial resources
ds, diuretics, chest physical therapy
Impaired feeding skills (for infants & children)
Reduced intake
Altered metabolism
Fluid restriction
Food-drug interaction
Shortness of breath

Decrease oxygen saturation when eating

Anorexia

Gastrointestinal distress and vomiting

General Pulmonary conditions with nutritional
implications
Category Examples
Neonate Bronchopulmonary dysplasia

Obstruction Cystic fibrosis

Chronic obstructive pulmonary disease (COPD)
-Emphysema
-Chronic bronchitis
Asthma, aspiration (foreign body, food, fluid)
Tumour Lung cancer
Infection Pneumonia, Tuberculosis (TB)
Respiratory failure Acute respiratory failure, lung transplantation
Neuromuscular Muscular dystrophy
Neuromuscular Muscular dystrophy
Skeletal Paralysis, osteoporosis, scoliosis
Cardiovascular Pulmonary oedema Severe obesity
Endocrine Prader-Willi syndrome
 Asthma
▪ Bronchial hyperresponsiveness and airway inflam
mation → airflow obstruction
▪ Factors: Genetic, immunologic, environmental fact
ors
▪ Inadequate management leads to status asthmati
cus, life threatening.
▪ Hypothesis of nutritional contributions of asthma:
maternal diet in pregnancy, diet during infancy & c
hildhood
▪ Common sign: persistent mouth breathing → oral
structure malformation, ‘open bite’
Asthma
Pathophysiology of Asthma
 Asthma
Medical Nutrition Therapy
Assessment, monitoring & evaluation

• Anthropometry – weight, height, BMI, growth

• Clinical – blood pressure, spirometry test, respiratory distress (i.e. indented chest for chronic
asthma), food allergies
• Symptoms – audible wheezing, dehydration, hard & dry cough

Possible objectives
• Address environmental triggers & prevent allergenic food
• Promote optimal growth and encourage healthy, balanced diet
 Asthma
Medical Nutrition Therapy
Intervention / management
• Address possible dietary triggers – food allergens (i.e. protein-based food, pollen products) & food additives
(eg: potassium metasulfide & sodium sulfide)
• Optimize nutritional status, correct energy & nutrient deficiencies / excess in diet. Sufficient vitamins C, B6,
D and E, selenium and magnesium are important. Increase omega-3 fatty acids if tolerated (i.e. Omega 3 &
6 - ↓broncho-constrictive leukotriens)
• Encourage a health maintenance program including physical activity. Monitor growth in children – higher th
an desirable BMI during childhood is associated with asthma. Combination of diet therapy & weight loss hel
ps improve asthma episodes, lung function & QOL
• Caffeine relaxes muscles and opens the airways; 2 to 3 cups of coffee daily may be useful in adults.
• Watch for food-drug interaction – corticosteroids usage leads to GERD (i.e. need to cut down spicy & acidic
food)
Bronchopulmonary dysplasia (BD)
▪ Chronic lung condition in infancy
▪ In premature infants (respiratory distress sy
ndrome)
▪ Prolonged intensive medical care –mechani
cal ventilation, supplemental oxygen, medic
ation, tube feeding
▪ Growth (often slowly) –inadequate E intake,
GI reflux, emotional deprivation, chronic hyp
oxia, low oxygen saturation during feeding
Bronchopulmonary dysplasia (BD)
Medical Nutrition Therapy
Assessment, monitoring & evaluation

History Nutrition-biochemical measures Feeding history

Birthweight
Gestational age
Previous growth pattern
Nutrition history
Medical status
Respiratory status
Oxygen saturation
Use of medications
Urine output, stool pattern, emesis
Ventilator dependency
Anthropometrics – weight, length,
growth centiles, head circumference.
Serum electrolytes, hemoglobin,
c-reactive protein
Volume of intake
Frequency of feedings
Formula & solid food consumption
Swallowing difficulty
GERD
Environmental concerns
Parent-child interaction, mealtime behaviour
Home facilities – access to safe & adequate
food supply
Economic resources
Bronchopulmonary dysplasia (BD)
Medical Nutrition Therapy
Possible objectives

• To supply adequate nutrient intakes

• Promote linear growth

• Maintain fluid balance

• Develop age-appropriate feeding skills

Bronchopulmonary dysplasia (BD)
Medical Nutrition Therapy
Intervention / management Energy & Nutrients

• REE increase 25-50% than normal, require 50% more energy for pts with growth failure
• Acute phase, in controlled temp environment, PN, remain inactive, not or slowly growing
E = 50-85 kcal/kg/day
• Infants growing rapidly, fed orally, using additional energy for temp regulation, activity, breathing works
E =120-130 kcal/kg/day
• Protein within advised range, minimum 7% for growth
• Additional of fat & CHO to formula only after 24 kcal/oz to ensure adequate protein
• Fat provides EFAs and help meeting E demands, especially with fluid & CO2 limitation (CHO restriction)
• Fluid & Na restriction to maintain balance, with diuretics
• Adequate supply of vitamin A, C, E – role in cell membrane integrity, antioxidants
Bronchopulmonary dysplasia (BD)
Medical Nutrition Therapy
Intervention / management Dietary modification
Challenges to meet energy demands – anorexia, fatigue, poor coordination of breathing and swallowing,
weakness of suck
To meet energy requirement:
a) Calorically-dense formulas (>24 kcal/oz) **monitor fluid adequacy and urinary output closely
b) Small & frequent feedings
c) Use soft nipple
d) Nasogastric or gastrostomy tube feedings
e) To treat GERD/vomiting – thickened feedings (add infant cereals), prone positioning, antacids
f) Pleasant and calm mealtime environment, oral stimulation during tube feeding, consistent and appropriate
feeding techniques, progressive texture and flavour changes
 Chronic obstructive pulmonary disease (COPD)

➢ Characterized by slowly progressive airways obstruction

➢ Two categories:
1) Type 1
• Emphysema (thin, cachectic, older, mild hypoxemia,
normal hemotocrit values, cor pulmonale develop lat
e)
2) Type 2
• Chronic bronchitis (normal or overweight, prominent
hypoxemia, increase hemotocrit values, cor pulmon
ale develop early)
➢ Risk factors: tobacco smoking, occupational exposure,
exposure to biomass fuel smoke & environmental tobac
co smoke
 Chronic obstructive pulmonary disease (COPD)
➢ COPD symptoms often don't appear until si
gnificant lung damage has occurred, and th
ey usually worsen over time, particularly if s
moking exposure continues.
➢ For chronic bronchitis, the main symptom is
a daily cough and mucus (sputum) productio
n at least three months a year for two conse
cutive years.
➢ People with COPD are also likely to experie
nce episodes called exacerbations, during w
hich their symptoms become worse than us
ual day-to-day variation and persist for at le
ast several days.
Other signs and symptoms of COPD may include:
Shortness of breath, especially during physical activities
Wheezing
Chest tightness
Having to clear your throat first thing in the morning, due to exces
s mucus in your lungs
A chronic cough that may produce mucus (sputum) that may be cl
ear, white, yellow or greenish
Blueness of the lips or fingernail beds (cyanosis)
Frequent respiratory infections
Lack of energy
Unintended weight loss (in later stages)
Swelling in ankles, feet or legs
 Chronic obstructive pulmonary disease (COPD)
Medical Nutrition Therapy
Assessment, monitoring & evaluation

• Anthropometric – weight, height, BMI, skinfolds (i.e. MUST screening tools) - low weight-for-height, redu
ced triceps fat fold measurements, wt loss will worsen the prognosis
• Handgrip measurement
• Oedema - pts with cor pulmonale will experience fluid retention, wt maintenance or gain may mask actua
l wasting of LBM. Morning headache and confusion from hypercapnia may interfere food prep or intake
• Current food intake, appetite - decreased food intake, increase E expenditure
• Nutritional depletion will leads to pulmonary complications, airflow obstruction, gas diffusing capacity, CO
2 retention, respiratory & limbs muscle strength, altered muscle function
• Abnormal parameters –Alb, serum transferrin, creatinine-height index, TIBC, serum Zn, immune function
 Chronic obstructive pulmonary disease (COPD)

Medical Nutrition Therapy

Possible objectives
• To provide adequate nutrition so that pt is more resistant to stresses (infections)
• To provide nutrient mix that benefits pt’s pulmonary function by reducing production of CO2 and
maintaining respiratory muscle function
• To facilitate nutritional well-being
• To maintain appropriate LBM-adipose tissue ratio
• Correct fluid imbalance
• Manage drug-nutrient interactions
 Chronic obstructive pulmonary disease (COPD)
Medical Nutrition Therapy
Intervention / management
❑ Increase calorie requirements (35-45kcal/kg/day)
❑ Protein 1.0-1.5 g/kg/day to maintain or restore lung
or muscle strength, promote immune function
❑ 15-20% protein, 30-45% fat, 40-55% CHO to prom
ote good RQ from substrate utilization
❑ Plan for repletion; not overfeeding
❑ Discontinue smoking
❑ Vitamin C supplement, Ca & Mg at RDA level
❑ To reduce gastric distention, bloating and the
oxygen needed for chewing & digestion:
• Small nutrient-densed meals
• Take fluid between meals
• Restrict fluids to volume-sensitive pts (cor pul
monale), 2-3 L fluids/day for N pts (for hydrati
on, prevent constipation, thinning mucus)
• Resting before meals
• Enteral nutrition supplements (sip-feed or tube
feeding), incorporate structured exercise
 Chronic obstructive pulmonary disease (COPD)
Medical Nutrition Therapy
Intervention / management
❑ Tips to add calories;
• Have snacks ready to eat, such as nuts, dried fruits, crackers and cheese, granola, and popsicles
• Mix butter into hot foods such as soups and vegetables, mashed potatoes, cooked cereals, and rice.
• Fry the entrée (e.g., chicken, meat, fish) and sauté vegetables in butter or oil.
❑ Tips to increase protein consumption;
• Add nuts to breads and muffins; use peanut butter on celery and crackers
• Add protein powder to casseroles, soups, sauces, gravies, milk shakes, and eggnogs.
• Add chopped, hard-cooked eggs to salads or vegetables. Add an extra egg to French toast or meal.
❑ Oral supplementation should be incorporated with structured exercise in stable COPD patients to increase
muscle mass, weight gain & inhibit systemic inflammation
Cystic fibrosis (CF)
❖ Autosomal recessive
❖ CF gene at chromosome 7q the long arm –encodes the
CF transmembrane regulator (control Cl-channel, Cl-/Na
transport across epithelial cell membranes)
❖ Median age ~37 yrs
❖ Almost all exocrine glands are affected by thick mucous
–ducts are obstructed
❖ Respiratory tract, sweat glands, intestine, pancreas, liver
, reproductive tract
❖ Acute/chronic bronchitis, pneumonia, infections (Strephil
ococcus aureus, Pseudomas aeruginosa), cor pulmonale
.
Cystic fibrosis (CF)

❖ Diagnostic test (neonatal screening)

a) Sweat test –by pilocarpine iontophoresis
b) High Na and Cl (>60 mEq/L) indicative of CF
c) Criteria for diagnosis –sweat test +ve, chronic lung
disease, FTT, malabsorption, family history of CF
❖ 85-90% with pancreatic insufficiency –thick mucous red
uce enzymes release → maldigestion, malabsorption
❖ GI complications –bulky, foul-smelling stools, cramping,
intestinal obstruction, rectal prolapse
❖ Impaired glucose tolerance, CF-related DM
Cystic fibrosis (CF)

a) Genotyping

b) Oral or IV antibiotics

c) Aerosol antibiotics

d) Inhaled medication

e) Chest and physical therapy

 Cystic fibrosis (CF)
Medical Nutrition Therapy
Assessment, monitoring & evaluation
• Anthropometric – height/length, weight, growth on centile chart
➢ High risk for malnutrition (i.e. difficulty in meeting increased nutrient needs, growth retardation, difficulty mai
ntaining normal growth)
➢ Recommend regular assessment of anthropometric reflecting nutritional status, i.e., weight- and length-for-
age percentiles for infants and children ≤ 2 years, weight-, length- and BMI- for-age percentiles for older chi
ldren (>2years), and BMI for adults.
• Use of enzyme therapy - to review the adequacy of therapy, evaluate fecal elastase, fecal fat, or nitrogen bal
ance studies
➢ Pancreatic enzyme replacement therapy to correct maldigestion and malabsorption
➢ Depends on the degree of pancreatic insufficiency, amount of food eaten, CHO, protein and fat, types of e
nzyme used
Cystic fibrosis (CF)

Medical Nutrition Therapy

Possible objectives
• Achieve desirable body weight
• Provide optimal amount of protein for growth, development, resistance to infection, replete LBM
• Decrease and replace losses (maldigestion, malabsorption, steatorrhea, vomiting)
• Achieve adequate enzyme replacement therapy
• Prevent progressive complications (glucose tolerance, intestinal obstruction, cirrhosis, pancreatic
and cardiac disease)
• Improve tolerance for therapies and medications
Cystic fibrosis (CF)

Medical Nutrition Therapy

Intervention / management Energy & macronutrients
Requirements should
➢ Consider age, gender, BMR, physical activity, respiratory infection, lung disease, malabsorption
➢ Increase energy intake –high calorie, moderate fat diet + sufficient pancreatic enzyme supplementation
• Calorie –150% RDA, 150 kcal/kg –children, 200kcal/kg-infants
• Protein –1.5g/kg for adults, 2g/kg teenagers, 3g/kg-children, 4 g/kg-infants
• Fat –35-40% as tolerated (verify with signs of fat malabsorption + enzyme supplementation); source of EFA
and fat-soluble vits
• Energy-dense and improve palatability
• Pts at risk of EFA deficiency are encouraged to include EFA sources in diet (canola, flaxseed, corn oil, fish)
• CHO-adjust accordingly (presence of glucose/lactose intolerance, pancreatic endocrine involvement)
Cystic fibrosis (CF)

Medical Nutrition Therapy

Intervention / management Micronutrients

• Water soluble vits are adequately absorbed in PE supplement

• Fat-soluble vits remain inadequately absorbed
• ↓ serum vit. A (impaired mobilization and transport to the liver)
• ↓ vit D metabolites
• ↓ vit E –haemolytic anaemia, neurologic abnormality
• ↓ vit K (antibiotics, liver disease, malabsorption)
• ↑ Na requirement –loss in sweat (lethargy, vomiting, dehydration) – extra salt 1/8 –¼ tsp/day for infants
• Supplementation of Fe, Zn, Mg based on body status
Cystic fibrosis (CF)

Medical Nutrition Therapy

Intervention / management Feeding strategies
• Encourage breast feeding-immunologic and psychosocial benefits
• Pancreatic enzyme microspheres added to small amount of baby’s foods or directly in the mouth
• High-calorie formulas;
➢ Expressed breast milk + enzyme supplement Or protein hydrolysate and MCT (to fortified expressed
breast milk)
➢ Normal infant formulas (20-27 kcal/oz) + enzyme supplement Or protein hydrolysate and MCT
• Children & adults –enjoyable mealtime, larger portion, high-nutrient density, small frequent meal times
• Nutrition support (enterally) –but cautious on the medical status (nasal polyps, degree of oxygenation, a
spiration)
• TPN-best short term support esp. in GI surgery
Cystic fibrosis (CF)

Medical Nutrition Therapy

Intervention / management Feeding strategies

Table 1: Feeding undernourished people with CF: a consensus guideline

Nutritional status & intervention Decision point for intensified nutritional support

Infant ≤ 2 years Children 2-18 years Adults ≥ years

Normal nutritional status: Weight, length ≥ 50th centile BMIp ≥ 50th centile BMI: 18.5 – 22 (♀), 18.5 – 23 (♂) or
Preventive nutritional counselling No weight loss

Impaired nutritional status: Weight, length 10th – 50th centile BMIp 10th – 50th centile or BMI ≤ 18.5 or
Diet modification + oral supplements Weight loss in previous 2-4 mo or Weight loss of 5% in previous 2 mo
No weight gain in previous 2 mo

Persistent undernutrition: Persistent weight, length ≤ 10th centile Persistent BMIp ≤ 10th centile or Persistent BMI ≤ 18.5 or
Enteral tube feeding Weight loss of 2 centile points since last Continuing weight loss > 5% BW
visit

BMIp: Body Mass Index percentile

Tuberculosis (TB)

o A bacterial disease (My cobacterium tuberculosis,

M. bovis, M. africanum) – spread from inhalation
of organisms dissolve as droplets from the sputu
m of infected person
o Diagnosed among economically disadvantage po
pulation (refugees, immigrants, homeless, armed
forces)
o High risk of TB-healthcare workers, nursing home
s, cancer, CKD, HIV
o Signs and symptoms-undernutrition, LOW, night s
weats, fatigue, dyspnoea, haemoptysis
Tuberculosis (TB)

Medical Nutrition Therapy

Possible objectives
• Maintain or prevent losses in weight. Reduce fever. The basal metabolic rate is 20% to 30% above
normal to counteract fever of 102°F or higher.
• Normalize serum calcium and vitamin D 3 levels and correct either hypo- or hypercalcemia.
• Stimulate appetite (i.e. which is generally poor)
• Prevent dehydration.
Tuberculosis (TB)

Medical Nutrition Therapy

Intervention / management

• By the underlying disease or social condition

• Increased energy (i.e. may be useful to calculate needs as 35 to 45 kcal/kg if weight loss has been
significant) and fluid intake (35 mL/kg, unless otherwise contraindicated)
• High-calorie, high-protein supplements. Protein intake of 15% of energy needs or 1.2 to 1.5g/kg ide
al body weight, app. 75 – 100 g per day, is recommended
• Nutrient-drug interactions: to take antibiotics 1-2 hrs postprandial
• At risk of B6, vit D, Ca and P metabolism → increase intake from food and supplements. 50% - 150
% of the RDA is helpful because TB pts have increase requirements that is impossible to meet with
diet alone.
Tuberculosis (TB)

Medical Nutrition Therapy

Intervention / management Feeding strategies

• Add protein powders or nonfat dry milk to beverages, casseroles, soups, and desserts to increase protein
and calcium intake, unless contraindicated for other medical reasons. (same as tips to add calorie & protein in COPD)
• Encourage preparation of small, appetizing meals. Plan rest periods before and after meals.
• Educate patient on foodborne illness risk;
a) Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or the same
knife for preparing raw meat and cooked or ready-to-eat foods.
b) Do not handle either raw or cooked foods without washing hands in between.
c) All foods from poultry should be cooked thoroughly, including eggs. Egg yolks should not be runny or liqu
id.
Respiratory failure

• When the pulmonary system failed to perform its functions

• Causes: trauma, surgery, medical
• MODS (multi-organ dysfunction syndrome) & ARDS (adult res
piratory distress syndrome) – common complications of critical
illness
• Pts require oxygen via nasal cannula or mechanical ventilator (
various duration and levels of oxygen)
• Factors for failure to wean from oxygen support:
a) Respiratory muscle weakness
b) CO2 retention
Respiratory failure

Medical Nutrition Therapy

Assessment, monitoring & evaluation

• Nutritional needs depend on underlying disease process, prior nutritional status, age
• Presence of hypercatabolism and hypermetabolism
• Body composition fluctuations
• Incorrect interpretation of lab results due to fluid imbalance, medications, ventilation support
• Other factors to assess: immunocompetence, chronic mouth breathing, aerophagia, dyspnoea,
exercise tolerance, depression
Respiratory failure

Medical Nutrition Therapy

Possible objectives
• To meet basic nutritional requirements,
• Preserve LBM
• Restore respiratory muscle mass and strength
• Maintain fluid balance
• Improve resistance to infection
• Facilitate weaning from oxygen support
Respiratory failure

Medical Nutrition Therapy

Intervention / management Energy & nutrients

• Energy needs are elevated to spare body’s protein and fat

• High protein to reverse negative nitrogen balance (1.5-2.0 g/kg/day)
• Normal adequate CHO and fat (equally divided from NPC)
• Vitamins & minerals at RDA level for anabolism, wound healing, immunity, antioxidants
• Small portions and favourite foods enhance oral intake
• Provide adequate O2 for proper digestion and absorption (inadequate O2 –anorexia, bloating, early satiety,
malaise, constipation/diarrhoea)
• Intubated pts: tube feeding, preferably GI tube, continuous method, chest elevation, frequent evaluation of
gastric residuals
 Thank you

Additional reading:
1) ESPEN expert statement and practical guidance for nutritional management of individuals with SARS-CoV-2 infection
2) ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children and adults with cystic fibrosis