Patients with chronic obstructive pulmonary disease (COPD) are at higher risk for malnutrition. The supply of adequate nutrition, maintaining ideal weight with improvement on respiratory muscle strength can prevent loss of weight and muscle that lead to exacerbation.

Target

Chronic Obstructive Pulmonary Disease (COPD) includes patients with emphysema and with chronic bronchitis.

Food Guidelines

1. Eat small amount through multiple meals to avoid post-meal flatulence and breathing difficulty.
2. The daily recommended calorie intake (Kcal) is the average weight in kilo x 30. Patients with lighter weight (BMI<21) should increase calorie and protein intake to improve malnutrition. Obese persons (BMI≧27) should consider food restriction to control weight, thereby reducing the burden on respiratory muscles.

• Calculation for body mass index (BMI): 【Weight (KG)  ÷  Height (Meter ²)】。

3. Protein intake is considerably important or patients to maintain muscle quality and patients should eat more high-quality protein food. For patients with complications of renal insufficiency, have the physician or nutritionist evaluate the proper protein intake.

(1) Food high in protein: animal protein and plant protein

• Source of animal protein: pork, chicken, fish, egg, beef, organs, and dairies.
• Source of plant protein: soy beans and processed products (tofu curd, tofu, soy intestines, vegan chicken). 

(2)Daily recommended protein intake:

• Over 65 years: The daily recommended protein intake is 1.0~1.2 gram per kilogram of weight. For example, a person weighing 50 KG should eat 50-60 grams of protein each day and a person weighing 60 KG should each 60-72 grams of protein each day.
• Elderly at risk of malnutrition: The daily recommended protein intake is 1.2-1.5 grams per kilogram of weigh.

4. Have enough water intake to prevent expectoration difficulty and constipation. For patients with heart disease, flatulence or ascites, have the doctor evaluate the limit of water intake. The daily recommended water intake is described below:

• Adults between 18-60 years: Per Kilogram of Weight x 35ml
• Adults over 60 years: Per Kilogram of Weight x 30ml

5. Avoid drinking strong tea, coffee, alcohols, and other stimulating beverages.
6. For inadequate calorie intake and malnutrition, follow the physician or nutritionist instructions to take oral supplement.
7. The daily recommended dietary fiber intake is 20-35 grams, along with adequate water intake to prevent constipation. However, excessive fiber intake could lead to flatulence and trigger breathing difficulty. Hence, eat with moderate amount. The following are tips to increase dietary fiber intake:

• If the patient does not suffer from problems with flatulence, choose unrefined whole grains such as brown rice, sweet yam, taro, and oat, to increase fiber intake.
• Choose vegetables and fruits high in fiber to receive enough intake of dietary fiber.
• Vegetables high in fiver (providing at least 2 gram of fiber per 100 gram of vegetable) include:  green pepper, Amaranthus tricolor, cauliflower, white Matsutake mushroom, oyster mushroom, king oyster mushroom, spinach, Bird-nest fern, sweet potato leaves, Taiwan Velvet Plant, mushroom, burdock, bitter gourd (green skin), fresh edible tree fungus, bamboo shoot, broccoli, straw mushroom, water bamboo, Marmoreal mushroom, enoki mushroom, baby corn, Hericium erinaceus, Blaze mushroom, young rape leaves, legumes, Chinese spinach, white king oyster mushroom, Okinawan spinach, carrot, soy sprout, water spinach,  and seaweed strips.
• Fruits high in fiber (providing at least 2 grams of fiber per each portion) include: passion fruit, guava, Citrus tankan, kiwi, dates, strawberry, Sunkist, prune, orange, plum(red skin and flesh), white nectarine, mulberry, peach, pomelo, figs, Chinese honey orange, carambole, red delicious apple, and red dragon fruit (white dragon fruit).
• For patient with weak teeth, finely chopped vegetable and long cooking time can increase vegetable intake.
• Try to each fruit as is and avoid juice. For patients with weak teeth, prepare fruit puree for the patient (Reserve the pomace and do not filter the puree).