Effects of Low and High Carbohydrate Feedings in Ambulatory Patients with Chronic Obstructive Pulmonary Disease and Chronic Hypercapnia

Abstract

In a randomized, double-blinded study, patients with chronic obstructive pulmonary disease and hypercapnia were fed low, moderate, and high carbohydrate diets to determine the effect on metabolic and ventilatory values. The low carbohydrate diet consisted of 28% carbohydrate calories and 55% fat calories and resulted in significantly lower production of CO2 (p less than 0.002), respiratory quotient (p less than 0.001), and arterial Pco2 (p less than 0.05). At the end of the 15-day study, both the forced vital capacity (p less than 0.05) and the forced expiratory volume in 1 second (p less than 0.05) had improved by 22% over baseline values. Total calories given surpassed daily caloric requirements. This approach, together with a low carbohydrate, high fat mixture, may be beneficial for such patients.

Chronic obstructive pulmonary disease and malnutrition: why are we not winning this battle?

“…The increase of ventilation requirement was larger following CHO intake than fat intake. These studies had results similar to other three which investigated the effects of shortterm supplementation (< two weeks) (40)(41)(42) . The VCO 2 increase can worsen the condition of patients in respiratory failure, but its effect on stable patients is small, of little clinical importance.…”

Aggravated hypoxia during breath-holds after prolonged exercise

“…Since the arterial level of CO 2 constitutes the primary respiratory drive, predominant lipid metabolism should theoretically reduce this respiratory drive. Indeed, this hypothesis is supported by a number of studies on healthy individuals and on patients with chronic obstructive pulmonary disease (COPD) (Jansson 1982;Angelillo et al 1985;Sue et al 1989), in which an increased ratio of lipid to carbohydrate metabolism was associated with a decrease in the respiratory minute ventilation, but no change in the arterial PCO 2 . Subsequently, lipid-rich diets have been employed clinically to reduce hypercapnia and dyspnoea in COPD patients (Kuo et al 1993;Cai et al 2003).…”

Benefits of Home Parenteral Nutrition Before Lung Transplantation: Report of a Case

“…Instructing patients with emphysema to increase their oral intake resulted in weight gain and an increased capacity to diffuse carbon monoxide (DLCO) as well as improved skeletal muscle strength. Angellilo et al 8 found that nutritional support rich in fat reduced the PaCO 2 in COPD patients with hypercapnia, while Efthimiou et al 9 reported that enteral nutrition rich in fat was useful for improving motor function and relieving dyspnea. However, the effect of dietary support on underweight candidates for lung transplantation is controversial.…”