Chronic at a malnourished or underweight stage. Weight loss

Chronic obstructive
pulmonary disease (COPD) is characterized by limited airflow which is usually
progressive, partially reversible and correlated with an enhanced chronic
inflammatory response in the airways and the lungs to harmful stimuli. Most of
the patients that have severe chronic obstructive pulmonary disease are thin,
lean and constantly at a malnourished or underweight stage. Weight loss in
chronic obstructive pulmonary disease is a consequences of increased unbalanced
energy requirements due to dietary intake (Rawal
and Yadav, 2015). The purposes of therapeutic nutrition managements in COPD
patients are to provide adequate energy in order to minimize the risk of weight
loss, avoid excessive loss of fat-free mass, avoid malnutrition and also
improve the pulmonary status (Ilaria, 2009).

            For chronic obstructive pulmonary disease patients, most
of them is in a negative energy balance and underweight conditions so COPD
patients may need to increase their energy intake. Patients of COPD will be
given or treated with energy and protein-enriched diet in several small
portions within a day. This kind of energy and protein-enriched diet is high in
fat content, around 30-45% of total energy as fats produce less metabolic
carbon dioxide and has lower respiratory quotients. Because of the high fat
proportion, the quality of the fats used for cooking should be considered by
minimising the use of saturated fats (Schols
et al., 2014). Omega-3 polyunsaturated fatty acids may be of benefit for COPD and
also malnourished patient because they have an
anti-inflammatory effect (Rawal and Yadav, 2015). The recommended quantity of
carbohydrates for patients with COPD ranges from 40-55% of the total energy
expenditure of the patient, as too high amount of carbohydrates intake may lead
to lipogenesis, resulting in the production of excess carbon dioxide.
Respiratory frequency might increase so that the lungs are able to remove
carbon dioxide due to the increase of carbon dioxide can result in respiratory
insufficient (Amanda Carla and Olivia,
2006). The recommended protein intake for COPD patients is 15-20% of total
energy. The protein intake should be around 1.2-1.7 grams/kg of body weight/day.
High protein diet is recommended for COPD patient in order restore their respiratory
muscle force and to improve their immune system. Fortified food products can
also be included in energy and protein diet in different meals (Schols et al., 2014).

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            As smoking is the main factor leads to chronic
obstructive pulmonary disease, cigarette smoke contains free radicals and other
oxidants that can lead to subsequent inflammation, oxidative stress and most
importantly reduced airflow to the lungs. Therefore COPD patients should take dietary
antioxidants in order to minimise free radical damage and also reduce
inflammation occur (Ilaria, 2009). Vitamins like vitamin C, vitamin A and
vitamin E have antioxidants effect. These kind of vitamins which contain
antioxidants properties can limit the destruction of the lung tissue and
protect them against the development of chronic obstructive pulmonary disease
(Amanda Carla and Olivia, 2006). Smokers
will have low level of serum vitamin C and antioxidants so smokers and patients
with COPD need higher amount of vitamins that have antioxidants properties. For
examples, smokers and patients with COPD need around 16-32mg more of vitamin C
consumption. Sufficient amount and intake of the fresh fruits and vegetables
have to be consumed as fruits and vegetables are found to be beneficial for
COPD patients as it contains antioxidants, vitamins and minerals (Schols et
al., 2014). Increase amount of dietary intake has been consistently associated
to reduce COPD risk (Schols et al.,
2014). COPD patients always associated with vitamin D deficiency due to limited
intake of food and reduced outdoor activities which easily cause osteoporosis
in COPD patients. Vitamin D can also protect the body against infections which
can trigger COPD attacks. COPD patients are recommended to take at least 1200mg
of calcium and 800-1000 IU of vitamin D to reduce bone loss (Ilaria, 2009) and
osteoporosis. As for minerals, the minimum required for minerals have to meet
dietary reference intake. Adequate amount of phosphorus is necessary for COPD
patients as phosphate deficiency may results in lower oxygen haemoglobin and thus
decreased oxygen availability to the cell tissues which may leads to
respiratory insufficient (Amanda Carla and
Olivia, 2006). Sodium intake should also be limited as consuming too much
sodium may cause COPD patients’ body to retain water thus making breathing more
difficult (Ilaria, 2009).

            Other dietary and nutritional management tips for chronic
obstructive pulmonary disease patients are take or consume nutrients-rich meals
in several small portion to avoid becoming breathless during consumption of
foods by consuming six small meals instead of only three big and normal meals. Eat
those nutrients-rich meals slowly and food should be chewed thoroughly in order
to prevent swallowing of air while eating. Try to choose foods that can be
easily chewed, avoid foods that can easily cause gas bloating as a full abdomen
will make cause discomfort and breathing uncomfortable. COPD patients should
sit upright during consumption of food to ease for lung pressure. Caffeine
intake have to be limited as caffeine will deplete body’s fluid supply and
cause restlessness. COPD patients should also breathing and swallowing
carefully, sit properly with good posture while eating to prevent aspirations. Whole
grains foods and complex carbohydrates like beans and peas are recommended to
COPD patients as these type of carbohydrates food able to minimise the carbon
dioxide produced by the foods (Ilaria, 2009). Take plenty of drinks and fluid around
8-12 cups can help to loosen and thin the mucus presence in lungs and airways
of COPD patients.


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