Respiratory Healthcare Professionals Nutritional Guideline for COPD Patients

High BMI >25kg/m2

Weight stable
Food intake normal

Unintentional weight
or muscle loss
Food intake not
compromised

Unintentional weight
or muscle loss
Food intake
compromised

Normal BMI 20-25kg/m2

Low BMI <20kg/m2

Advise patient to eat a healthy and varied diet.

Give patient Eating Well for Your Lungs leaflet.

Advise patient to eat a healthy and varied diet monitor and review at next appointment.
Give patient COPD Improving Your Nutrition leaflet.
If following an activity programme, advise your
patient to increase their energy intake and consider
prescribing oral nutritional supplement: 600kcal daily
for 3 months.
Review at end of 3 months.

Advise patient to eat a healthy and varied diet and the

need to boost energy and protein intake, and make
changes to their diet if appetite is poor.
Give patient COPD Improving Your Nutrition leaflet.
Monitor and review if possible within 2 months or at
next appointment.

Advise patient to eat a healthy and varied diet and the

need to boost energy and protein intake, and make
changes to their diet if appetite is poor.
Give patient COPD Improving Your Nutrition leaflet.
Monitor and review if possible within 2 months or at
next appointment.

Advise patient to increase energy and protein intake,

and make changes to their diet if appetite is poor.
Give patient Nutrition Support in COPD leaflet.
Prescribe oral nutritional supplement: 600kcal
daily for 3 months, review monthly if possible. If no
improvement seek advice of the dietitian.
If following an activity programme, ensure your patient
understands the need to increase their energy intake.

Advise patient to increase energy and protein intake,

and make changes to manage with poor appetite.
Give patient Nutrition Support in COPD leaflet.
Prescribe oral nutritional supplement: 600kcal
daily for 3 months, review monthly if possible. If no
improvement seek advice of the dietitian.
If following an activity programme, ensure your patient
understands the need to increase their energy intake.

Advise patient to increase energy and protein intake,

and make changes to manage with poor appetite.
Give patient Nutrition Support in COPD leaflet.
Prescribe oral nutritional supplement: 600kcal
daily for 3 months, review monthly if possible. If no
improvement seek advice of the dietitian.
If following an activity programme, ensure your patient
understands the need to increase their energy intake.

Advise patient to increase energy and protein intake,

and make changes to manage with poor appetite.
Give patient Nutrition Support in COPD leaflet.
Prescribe oral nutritional supplement: 600kcal
daily for 3 months, review monthly if possible. If no
improvement seek advice of the dietitian.
If following an activity programme, ensure your patient
understands the need to increase their energy intake.

Advise patient to eat a healthy and varied diet.

Give patient Eating Well for Your Lungs leaflet.
If planning to reduce weight, discuss the need to cut
back on high-energy foods and aim for gradual weight
loss - do not consider unless BMI >30kg/m2.

Work with all patients to increase awareness of changes in weight, body shape and food intake, and when to seek help
If concerned about diet and co-morbidity, for example diabetes, seek advice from the Dietitian
Two standard bottles of oral nutritional supplements provide 600kcal
Malnutrition risk: Low
Medium
High
For a copy of the guideline plus accompanying patient leaflets contact
the Nutricia Resource Centre on 01225 751098 or for electronic copies
go to www.copdeducation.org.uk

Sponsored by an educational grant from Nutricia Ltd and supported by the Respiratory Dietitians Network

Calculate BMI
410 1/2 411

Use the following questions to help understand your patients

food intake and current nutritional status.
This information, together with their BMI, will help you
establish the position on the guideline to identify the
appropriate course of action for your patient.

1. How is your appetite?

3. Have you noticed any changes in your weight?

Are clothes and jewellery becoming looser, have friends/family

made comments?

4. Have you noticed any other changes to your body shape?

Any changes to arms and legs, muscle strength?

5. Do you have any concerns about your food intake and diet?
For a copy of the guideline plus accompanying patient leaflets contact
the Nutricia Resource Centre on 01225 751098 or for electronic copies
go to www.copdeducation.org.uk

Sponsored by an educational grant from Nutricia Ltd and supported by the Respiratory Dietitians Network

Weight (kg)

2. Are you managing to eat as well as you usually do?

100
99
98
97
96
95
94
93
92
91
90
89
88
87
86
85
84
83
82
81
80
79
78
77
76
75
74
73
72
71
70
69
68
67
66
65
64
63
62
61
60
59
58
57
56
55
54
53
52
51
50
49
48
47
46
45
44
43
42
41
40
39
38
37
36
35
34

50

501/2 511/2

52

53

54

Height (feet and inches)

541/2 551/2

56

57

571/2 581/2 591/2 510

511 5111/2 601/2

61

62

63

46
45
45
44
44
43
43
42
42
42
41
41
40
40
39
39
38
38
37
37
37
36
36
35
35
34
34
33
33
32
32
32
31
31
30
30
29
29
28
28
27
27
26
26
26
25
25
24
24
23
23
22
22
21
21
21
20
20
19
19
18
18
17
17
16
16
16

44
44
44
43
43
42
42
41
41
40
40
40
39
39
38
38
37
37
36
36
36
35
35
34
34
33
33
32
32
32
31
31
30
30
29
29
28
28
28
27
27
26
26
25
25
24
24
24
23
23
22
22
21
21
20
20
20
19
19
18
18
17
17
16
16
16
15

43
43
42
42
42
41
41
40
40
39
39
39
38
38
37
37
36
36
35
35
35
34
34
33
33
32
32
32
31
31
30
30
29
29
29
28
28
27
27
26
26
26
25
25
24
24
23
23
23
22
22
21
21
20
20
19
19
19
18
18
17
17
16
16
16
15
15

42
42
41
41
40
40
40
39
39
38
38
38
37
37
36
36
35
35
35
34
34
33
33
32
32
32
31
31
30
30
30
29
29
28
28
27
27
27
26
26
25
25
24
24
24
23
23
22
22
22
21
21
20
20
19
19
19
18
18
17
17
16
16
16
15
15
14

41
41
40
40
39
39
39
38
38
37
37
37
36
36
35
35
35
34
34
33
33
32
32
32
31
31
30
30
30
29
29
28
28
28
27
27
26
26
25
25
25
24
24
23
23
23
22
22
21
21
21
20
20
19
19
18
18
18
17
17
16
16
16
15
15
14
14

40
40
39
39
38
38
38
37
37
36
36
36
35
35
34
34
34
33
33
32
32
32
31
31
30
30
30
29
29
28
28
28
27
27
26
26
26
25
25
24
24
24
23
23
22
22
22
21
21
20
20
20
19
19
18
18
18
17
17
16
16
16
15
15
14
14
14

39
39
38
38
38
37
37
36
36
36
35
35
34
34
34
33
33
32
32
32
31
31
30
30
30
29
29
29
28
28
27
27
27
26
26
25
25
25
24
24
23
23
23
22
22
21
21
21
20
20
20
19
19
18
18
18
17
17
16
16
16
15
15
14
14
14
13

38
38
37
37
37
36
36
35
35
35
34
34
34
33
33
32
32
32
31
31
30
30
30
29
29
29
28
28
27
27
27
26
26
26
25
25
24
24
24
23
23
22
22
22
21
21
21
20
20
19
19
19
18
18
18
17
17
16
16
16
15
15
14
14
14
13
13

37
37
36
36
36
35
35
35
34
34
33
33
33
32
32
32
31
31
30
30
30
29
29
29
28
28
28
27
27
26
26
26
25
25
25
24
24
23
23
23
22
22
22
21
21
20
20
20
19
19
19
18
18
17
17
17
16
16
16
15
15
15
14
14
13
13
13

36
36
36
35
35
34
34
34
33
33
33
32
32
32
31
31
30
30
30
29
29
29
28
28
28
27
27
26
26
26
25
25
25
24
24
24
23
23
22
22
22
21
21
21
20
20
20
19
19
19
18
18
17
17
17
16
16
16
15
15
15
14
14
13
13
13
12

35
35
35
34
34
34
33
33
33
32
32
32
31
31
30
30
30
29
29
29
28
28
28
27
27
27
26
26
26
25
25
24
24
24
23
23
23
22
22
22
21
21
21
20
20
19
19
19
18
18
18
17
17
17
16
16
16
15
15
15
14
14
13
13
13
12
12

35
34
34
34
33
33
33
32
32
31
31
31
30
30
30
29
29
29
28
28
28
27
27
27
26
26
26
25
25
25
24
24
24
23
23
22
22
22
21
21
21
20
20
20
19
19
19
18
18
18
17
17
17
16
16
16
15
15
15
14
14
13
13
13
12
12
12

34
33
33
33
32
32
32
31
31
31
30
30
30
29
29
29
28
28
28
27
27
27
26
26
26
25
25
25
24
24
24
23
23
23
22
22
22
21
21
21
20
20
20
19
19
19
18
18
18
17
17
17
16
16
16
15
15
15
14
14
14
13
13
13
12
12
11

33
33
32
32
32
31
31
31
30
30
30
29
29
29
28
28
28
27
27
27
26
26
26
25
25
25
24
24
24
23
23
23
22
22
22
21
21
21
20
20
20
19
19
19
18
18
18
18
17
17
17
16
16
16
15
15
15
14
14
14
13
13
13
12
12
12
11

32
32
32
31
31
31
30
30
30
29
29
29
28
28
28
27
27
27
26
26
26
26
25
25
25
24
24
24
23
23
23
22
22
22
21
21
21
20
20
20
19
19
19
18
18
18
17
17
17
16
16
16
15
15
15
15
14
14
14
13
13
13
12
12
12
11
11

32
31
31
31
30
30
30
29
29
29
28
28
28
27
27
27
27
26
26
26
25
25
25
24
24
24
23
23
23
22
22
22
21
21
21
21
20
20
20
19
19
19
18
18
18
17
17
17
16
16
16
15
15
15
15
14
14
14
13
13
13
12
12
12
11
11
11

31
31
30
30
30
29
29
29
28
28
28
27
27
27
27
26
26
26
25
25
25
24
24
24
23
23
23
23
22
22
22
21
21
21
20
20
20
19
19
19
19
18
18
18
17
17
17
16
16
16
15
15
15
15
14
14
14
13
13
13
12
12
12
11
11
11
10

30
30
30
29
29
29
28
28
28
27
27
27
27
26
26
26
25
25
25
24
24
24
24
23
23
23
22
22
22
21
21
21
21
20
20
20
19
19
19
18
18
18
18
17
17
17
16
16
16
15
15
15
14
14
14
14
13
13
13
12
12
12
11
11
11
11
10

30
29
29
29
28
28
28
27
27
27
27
26
26
26
25
25
25
25
24
24
24
23
23
23
22
22
22
22
21
21
21
20
20
20
19
19
19
19
18
18
18
17
17
17
17
16
16
16
15
15
15
14
14
14
14
13
13
13
12
12
12
12
11
11
11
10
10

29
29
28
28
28
27
27
27
27
26
26
26
25
25
25
25
24
24
24
23
23
23
23
22
22
22
21
21
21
21
20
20
20
19
19
19
18
18
18
18
17
17
17
16
16
16
16
15
15
15
14
14
14
14
13
13
13
12
12
12
12
11
11
11
10
10
10

28
28
28
27
27
27
27
26
26
26
25
25
25
25
24
24
24
23
23
23
23
22
22
22
22
21
21
21
20
20
20
20
19
19
19
18
18
18
18
17
17
17
16
16
16
16
15
15
15
14
14
14
14
13
13
13
12
12
12
12
11
11
11
10
10
10
10

28
27
27
27
27
26
26
26
25
25
25
25
24
24
24
24
23
23
23
22
22
22
22
21
21
21
20
20
20
20
19
19
19
19
18
18
18
17
17
17
17
16
16
16
16
15
15
15
14
14
14
14
13
13
13
12
12
12
12
11
11
11
11
10
10
10
9

1.48

1.50

1.52

1.54

1.56

1.58

1.60

1.62

1.64

1.66

1.68

1.70

1.72

1.74

1.76

1.78

1.80

1.82

1.84

1.86

1.88

1.90

Height (m)

15 10
15 8
15 6
15 4
15 2
15 0
14 11
14 9
14 7
14 5
14 2
14 0
13 12
13 10
13 8
13 6
13 3
13 1
12 13
12 11
12 8
12 6
12 4
12 1
11 13
11 11
11 9
11 7
11 4
11 3
11 0
10 11
10 10
10 7
10 6
10 3
10 1
9 13
9 10
9 8
9 6
9 4
9 1
9 0
8 11
8 8
8 7
8 4
8 3
8 0
7 13
7 10
7 7
7 6
7 3
7 1
6 13
6 11
6 8
6 6
6 4
6 1
6 0
5 11
5 9
5 7
5 5

Weight (stones and pounds)

5 Key Questions