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Nutritional management in COPD and the role of targeted nutrition . COPD and Nutritional Status. Malnutrition in COPD can present in a number of ways Obesity Under nutrition / nutritional depletion Low weight categorised by low BMI (kg / m 2 ) Acute weight loss Muscle wasting
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Categorised in ERS/ATS COPD Guidelines:
BMI < 21kg/m2 &/or
wt loss 5% in 3 mths,10% in 6 mths &/or
FFMI < 16 kg/m2 (males) < 15 kg/m2 (females)
How is it identified?
-- Around 21 % found to have nutritional depletion 1
-- Around 25 % patients will develop cachexia 2
-- Between 25-40% with advanced COPD are malnourished 3
1Engelen et al. Eur Resp J 1994; 7:1793-1797 2Wagner PD Eur Resp J 2008; 31:492-591
3Anker et al. Clin Nutr 2006; 25: 311-318
References: 1Anker et al. Clin Nutr 2006; 25: 311-318 2Schols et al. AJCN 2005; 82:53-59
1GOLD guidelines updated Nov 2008
2ATS/ERS Standards for the diagnosis and management of patients with COPD. 2004
1NICE Guideline CG12 Chronic Obstructive Pulmonary Disease 2004, Unchanged Update 2010
2ANker et al. 2004 Clinical Nutrition 25:311-318
*All based on consistent findings in randomized controlled trials in patients with chronic obstructive pulmonary disease (i.e., “Evidence A”) according to the GOLD 2008 Guidelines.
1 ZuWallack R and Hedges H. The American Journal of Medicine. 2008:121;S25–S32
Take Respifor in combination with physical training to improve physical capacity
Respifor is a specialist high energy (1.5kcal/ml), high protein Oral Nutritional Supplement enriched with vitamins and minerals designed for patients with COPD
Flavours: Strawberry, Vanilla and Chocolate
Recommended dose: 3 x 125ml per day in combination with
activity plan for 3 months
Pison et al. www.ers.org 2009; Cano et al. Clinical Nutrition Suppls. 2008: 3(1);16
Van Wetering et al. JAMDA 2010; 11(3):179-187
First study showing a prolonged positive response to nutritional support as part of an integrated lifestyle programme
Steiner et al. Thorax 2003:58;745-51
Steiner et al
Broekhuizen et al. 2005
n=19 (Respifor) n=19 (Standard supplements)