Optimal body weight

In chronic lung disease, both obesity and malnutrition or weight loss are associated with a poorer prognosis. People with AATD should therefore aim for an optimal BMI between 21 and 23 kg/m². The BMI, or Body Mass Index, is calculated by dividing body weight in kg by height in meters squared. For example, a weight of 64 kg at a height of 1.70 m results in a BMI of 22 kg/m².
The following will primarily focus on underweight and malnutrition.

Causes and consequences of malnutrition

The causes of malnutrition are varied. People with lung diseases have to expend more energy breathing, thus increasing their energy expenditure. Problems such as coughing, sore throat, difficulty swallowing, dental issues, or chewing difficulties impair food intake. Malnutrition is also caused by reduced appetite when one feels tired and exhausted or lacks the energy to eat. A monotonous diet, for example, consisting mainly of bread or rice, and insufficient protein intake, can also lead to malnutrition.
Malnutrition affects not only the body's fat stores but also, and perhaps more importantly, the muscles. When muscle mass is lost, the respiratory muscles and diaphragm are also affected. This restricts breathing and, consequently, lung function. Physical endurance is reduced as a result. Acute flare-ups become more frequent, and the disease progresses more rapidly.
For people with chronic lung disease, it is therefore important to prevent malnutrition and weight loss. This requires knowing one's body weight and checking it regularly.

Energy density of food

When eating, you should prefer foods with a high energy density. Energy density indicates how many calories are contained in 100g of a particular food. If the energy density is above 250 kcal per 100g, the food has a high energy density.
By understanding the energy density of your favorite foods, you can help manage your weight. For example, a poppy seed roll at breakfast has an energy density of 300 kcal per 100 g, while an apple pie with yeast dough has only 130 kcal per 100 g. Therefore, a single slice of baked good contains either 420 kcal or just 200 kcal. Other examples include sliced cheese, whipped cream, and sausages, which have a high energy density compared to cream cheese, sour cream, and ham, which have a low energy density. By paying attention to energy density, you can eat until you're full without worrying about calorie counts.
When experiencing a loss of appetite, it's best to choose foods with a high energy density and eat them first. You can also increase the calorie content of these meals, for example by adding cream, butter, oil, or maltodextrin.

Protein content of foods

The protein content of food is another important topic. Muscles consist largely of protein, so an adequate protein intake is essential for the respiratory muscles. Current recommendations suggest that healthy individuals should consume approximately 0.8 g of protein per kilogram of body weight daily, which equates to roughly 51 g for someone weighing 64 kg. People with lung diseases, however, should consume more than twice as much protein, namely 1.2–1.9 g of protein per kilogram of body weight.
It's important not to consume your entire protein intake in one meal, as the body can only process a limited amount of protein. A 100g serving of foods like tuna, salmon, or pork tenderloin provides approximately 30g of protein. Legumes such as peas and lentils are also good sources of protein, providing 14g per serving. Eggs, quark, cheese, and peanuts each provide 7-9g of protein per serving.

Tips about food

People with severe lung disease should exert themselves as little as possible when cooking and preparing food. It saves effort and time to prepare larger quantities at once and then freeze them in portions. Those who want to protect their airways while cooking should open the kitchen window or turn on the extractor fan.

Leave the grilling to others and stay away from the grill yourself. Hygiene in the kitchen is even more important than for other people. Accordingly, kitchen sponges should be replaced every 5-7 days, and bacteria and mold should be avoided in general. When cleaning, avoid harsh cleaning agents, as many irritate the lungs when the fumes are inhaled. For this reason, cleaning aids can be a great help. Ready-made meals and frozen foods also reduce the time required and can usually be quickly heated in the microwave before eating. Furthermore, you should always have a selection of different snacks at home, such as dried fruit, granola bars, or cheese cubes. These can be eaten without any effort.

People with lung conditions should eat 5-6 smaller, energy-rich meals rather than just 3 large ones. The advantages are that the meal itself doesn't take as long, and that stomach distension is reduced, leaving more room for lung expansion. It's important to eat as much as possible of foods that you enjoy and find pleasurable. Those experiencing coughs and phlegm should clear their lungs before eating and may want to use a bronchodilator inhaler. While eating, one can sit in a relaxed, upright position, which facilitates breathing. To do this, rest your forearms on the table with your plate between them and keep your legs straight, without crossing them.

Food and liver disease

When liver function is impaired, there are few specific dietary recommendations. In any case, alcohol must be avoided. Furthermore, one should not eat too much fruit or foods sweetened with fructose, as this sugar is metabolized by the liver. Adequate protein intake is also particularly important in this case.

Nutritional therapy and dietary advice

If a normal diet is insufficient to prevent weight loss, nutritional therapy follows a step-by-step approach. Qualified dietitians, including members of the Association of German Dietitians (VDD), assist with individualized treatment.
As a supplementary food, liquid nutritional supplements can be consumed. These contain carbohydrates, proteins, and fats, as well as all essential nutrients, vitamins, and trace elements in the correct amounts. They resemble yogurt drinks and are consumed in addition to regular food. To allow the body to adjust to these supplements, they should be sipped slowly and not consumed before meals. While most liquid nutritional supplements are sweet, there are now also preparations available in neutral or savory flavors. Liquid nutritional supplements are not counted towards daily fluid intake but are considered food. They can be prescribed. If liquid nutritional supplements are unsuccessful, nutrition can be administered via a nasogastric or ileal tube. Only very few patients require intravenous nutrition.

Summary: Prof. Gratiana Steinkamp

Note:

Nutrition is not a miracle cure! Nutrition can't do everything. But it can contribute to maintaining health and quality of life.
A varied diet, rich in different plant-based foods, is always superior to taking dietary supplements.

Nutritional therapy

Individualized nutritional therapy offers tailored recommendations and can help you maintain/improve your quality of life.

Qualified dietitians can be found, for example, through the Association of German Dietitians (VDD).

Published in Alpha1 Journal 1/2018.