Chest 2013 Oct 01;144(4)1340-1345, AMWJ Schols
Commentary By David Rakel, MD, FAAFP
Nutrition Treatment for COPD: Practical Suggestions
It is a relatively unexpected finding that nutrition can play a role in improving function and reducing the progression of COPD. Although this review discusses a rather complicated interplay between nutrients and lung function, the following take-home points can help us better manage this condition.
Although exercise is the best way to improve muscle oxidative metabolism, physical activity may be limited in people with COPD; however, metabolism can be improved through nutrition.
Muscle wasting equates to poor lung function. Patients should get their protein from healthy sources, such as fish, nuts, beans, and lean meat and maintain positive calorie intake to improve respiratory muscle strength.
Polyunsaturated fats (oils, seafood, and nuts) improve exercise endurance in COPD.
Polyphenols such as resveratrol (found in dark-colored grapes, berries, and peanuts) enhance mitochondrial energy production in muscles, thus improving function.
COPD patients must maintain vitamin D levels. Supplementation improves muscle strength in those with levels < 25 nmol/L.
Fiber ingested via vegetables and fruit is associated with a smaller decline in lung function.
The authors of this review summarize, “The current evidence strongly suggests that a prudent dietary pattern… may protect against COPD, especially in smokers and that dietary intervention in the management of COPD should target a healthy pattern.”
ABSTRACT
COPD is an important global health problem. In addition to pulmonary impairment, systemic inflammation, musculoskeletal abnormalities, and cardiovascular comorbidity influence disease burden and mortality risk. Body weight and body composition are important discriminants in classifying disease heterogeneity. The rationale for and efficacy of caloric supplementation in preventing and treating involuntary weight loss is currently well established. For maintenance of muscle and bone tissue, appropriately timed, high-quality protein intake and addressing vitamin D deficiency must be considered. Specific nutrients (eg, n-3 polyunsaturated fatty acids and polyphenolic compounds) may have the pharmacologic potential to boost decreased muscle mitochondrial metabolism and enhance impaired physical performance, particularly when the metabolic stimulus of physical activity alone is limited. At this stage, evidence is insufficient to support an intake of high doses of single nutritional supplements to modulate respiratory pathology, but some small studies have identified micronutrient modulation via the diet as a promising intervention.