Chronic at a malnourished or underweight stage. Weight loss

Chronic obstructivepulmonary disease (COPD) is characterized by limited airflow which is usuallyprogressive, partially reversible and correlated with an enhanced chronicinflammatory response in the airways and the lungs to harmful stimuli. Most ofthe patients that have severe chronic obstructive pulmonary disease are thin,lean and constantly at a malnourished or underweight stage. Weight loss inchronic obstructive pulmonary disease is a consequences of increased unbalancedenergy requirements due to dietary intake (Rawaland Yadav, 2015). The purposes of therapeutic nutrition managements in COPDpatients are to provide adequate energy in order to minimize the risk of weightloss, avoid excessive loss of fat-free mass, avoid malnutrition and alsoimprove the pulmonary status (Ilaria, 2009).             For chronic obstructive pulmonary disease patients, mostof them is in a negative energy balance and underweight conditions so COPDpatients may need to increase their energy intake. Patients of COPD will begiven or treated with energy and protein-enriched diet in several smallportions within a day. This kind of energy and protein-enriched diet is high infat content, around 30-45% of total energy as fats produce less metaboliccarbon dioxide and has lower respiratory quotients.

Because of the high fatproportion, the quality of the fats used for cooking should be considered byminimising the use of saturated fats (Scholset al., 2014). Omega-3 polyunsaturated fatty acids may be of benefit for COPD andalso malnourished patient because they have ananti-inflammatory effect (Rawal and Yadav, 2015). The recommended quantity ofcarbohydrates for patients with COPD ranges from 40-55% of the total energyexpenditure of the patient, as too high amount of carbohydrates intake may leadto lipogenesis, resulting in the production of excess carbon dioxide.Respiratory frequency might increase so that the lungs are able to removecarbon dioxide due to the increase of carbon dioxide can result in respiratoryinsufficient (Amanda Carla and Olivia,2006).

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The recommended protein intake for COPD patients is 15-20% of totalenergy. 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 respiratorymuscle force and to improve their immune system.

Fortified food products canalso be included in energy and protein diet in different meals (Schols et al., 2014).             As smoking is the main factor leads to chronicobstructive pulmonary disease, cigarette smoke contains free radicals and otheroxidants that can lead to subsequent inflammation, oxidative stress and mostimportantly reduced airflow to the lungs. Therefore COPD patients should take dietaryantioxidants in order to minimise free radical damage and also reduceinflammation occur (Ilaria, 2009). Vitamins like vitamin C, vitamin A andvitamin E have antioxidants effect. These kind of vitamins which containantioxidants properties can limit the destruction of the lung tissue andprotect them against the development of chronic obstructive pulmonary disease(Amanda Carla and Olivia, 2006).

Smokerswill have low level of serum vitamin C and antioxidants so smokers and patientswith COPD need higher amount of vitamins that have antioxidants properties. Forexamples, smokers and patients with COPD need around 16-32mg more of vitamin Cconsumption. Sufficient amount and intake of the fresh fruits and vegetableshave to be consumed as fruits and vegetables are found to be beneficial forCOPD patients as it contains antioxidants, vitamins and minerals (Schols etal., 2014). Increase amount of dietary intake has been consistently associatedto reduce COPD risk (Schols et al.,2014).

COPD patients always associated with vitamin D deficiency due to limitedintake of food and reduced outdoor activities which easily cause osteoporosisin COPD patients. Vitamin D can also protect the body against infections whichcan trigger COPD attacks. COPD patients are recommended to take at least 1200mgof calcium and 800-1000 IU of vitamin D to reduce bone loss (Ilaria, 2009) andosteoporosis. As for minerals, the minimum required for minerals have to meetdietary reference intake. Adequate amount of phosphorus is necessary for COPDpatients as phosphate deficiency may results in lower oxygen haemoglobin and thusdecreased oxygen availability to the cell tissues which may leads torespiratory insufficient (Amanda Carla andOlivia, 2006).

Sodium intake should also be limited as consuming too muchsodium may cause COPD patients’ body to retain water thus making breathing moredifficult (Ilaria, 2009).             Other dietary and nutritional management tips for chronicobstructive pulmonary disease patients are take or consume nutrients-rich mealsin several small portion to avoid becoming breathless during consumption offoods by consuming six small meals instead of only three big and normal meals. Eatthose nutrients-rich meals slowly and food should be chewed thoroughly in orderto prevent swallowing of air while eating. Try to choose foods that can beeasily chewed, avoid foods that can easily cause gas bloating as a full abdomenwill make cause discomfort and breathing uncomfortable. COPD patients shouldsit upright during consumption of food to ease for lung pressure.

Caffeineintake have to be limited as caffeine will deplete body’s fluid supply andcause restlessness. COPD patients should also breathing and swallowingcarefully, sit properly with good posture while eating to prevent aspirations. Wholegrains foods and complex carbohydrates like beans and peas are recommended toCOPD patients as these type of carbohydrates food able to minimise the carbondioxide produced by the foods (Ilaria, 2009).

Take plenty of drinks and fluid around8-12 cups can help to loosen and thin the mucus presence in lungs and airwaysof COPD patients.