Nutritional Issues in Pulmonary Rehabilitation

Dietary problems in patients with severe chronic obstructive pulmonary disease

“…Not only difficulties in chewing, but also economical reasons seem to contribute to this. The recommended level for protein intake in patients with COPD is 20 E% or 1.5 g protein kg −1 body weight and day (Fernandez et al. , 1993; Pingleton, 1996; Donahoe, 1997).…”

Optimal Patterns of Care in Patients with Chronic Obstructive Pulmonary Disease

“…Appropriate nutritional assessment, and intervention when warranted, should be incorporated into the comprehensive rehabilitation program. 17 Reports of weight loss in patients with COPD range from 27% to 71%. [18][19][20] Malnutrition has been associated with an exacerbation in symptoms, most likely related to a combination of factors rather than one isolated variable.…”

“…A body weight that is less than 90% of ideal body weight is the only measure of nutritional status that has been clearly linked with a poor outcome. 17 Despite the recorded weight losses, studies show that caloric intake in patients with COPD is not necessarily less than that recommended for healthy adults. 19,20,25 Several potential factors have been reported that may account for the weight loss without concomitant reductions in caloric intake.…”

“…26,27 One of these factors is that patients with COPD have increased metabolic rates. 17 Healthy volunteers who lost 25% of their body weight had a 40% decrease in metabolic rate. 28 However, malnourished COPD patients show an incomplete metabolic adaptation to weight loss and have resting energy requirements greater than predicted values.…”

“…28 However, malnourished COPD patients show an incomplete metabolic adaptation to weight loss and have resting energy requirements greater than predicted values. 17 Metabolic rates in cachectic patients with COPD have been shown to be significantly elevated compared with COPD patients of normal body weight. 29 Diet-induced thermogenesis that normally occurs during ingestion is abnormally elevated in malnourished COPD patients and contributes to this increased metabolic rate.…”