Handbook of Clinical Nutrition and Aging

Abstract

By 2020, COPD will be the third leading cause of mortality worldwide. Many COPD patients are malnourished, resulting in clinical deterioration, decreased exercise capacity, and diminished survival. The weight loss and loss of lean mass associated with COPD reflect in part metabolic disturbances, including hypermetabolism, inflammation-induced catabolism, alterations in protein metabolism, hormonal alterations, and muscle alterations and dysfunction. Loss of body mass also results from low food intake caused by increased difficulty in carrying out daily food-related activities (e.g., shopping, cooking) due to fatigue, dietary problems (loss of appetite, early satiety, dyspnea associated with feeding, swallowing problems, gastroesophageal reflux), and psychological problems (solitude, depression, anxiety, attitude/beliefs). Hospital stay due to exacerbations and treatment with glucocorticosteroids can also contribute to reduced food consumption. Interventions should emphasize weight gain in patients with BMI < 25 and weight stability in those with higher BMI, positive nitrogen balance, and functional improvements in Muscle strength, handgrip strength, and walking ability. Strategies to help meet adequate intake include eating six to seven small meals (300-500 kcal/meal) throughout the day, using energy/protein-dense foods/supplements, using affordable yet enjoyable foods, and enlisting family community support at mealtime. Other strategies aim to minimize the energy cost of food activities. Meal preparation time should be kept to a minimum, one-dish recipes help reduce the energy spent cleaning up after the meal, frequently used foods and kitchenware should be close at hand, and cooking more than needed on good days to ensure having good food to eat on bad days.