Nutritional Status as a Risk Factor in COPD.

The third leading cause of death, chronic obstructive pulmonary disease COPD is gaining more and more attention in the literature and clinical practice. Precision medicine, already recognised as a right approach for COPD, requests a special attention to be allocated for nutritional status. Free fat mass index FFMI and visceral fat VFA area measurements should be added to body mass index (BMI) in order to have a complete perspective of the nutritional status and disease prognosis. Prospective medical nutrition therapy should consider caloric intake for achieving a BMI of 20-24 kg/m2, nutritionally dense, small and frequent meals, choosing the moment for the most important meal when the level of energy is the highest for the patient. A resting period before mealtime is adviced. Obesity paradox in COPD means a lower mortality associated with BMI between 25 and 32. This benefit is mainly related to higher muscular mass, as it has been described by some authors. The main objective in nutritional intervention will be to maintain muscular mass, adviced protein intake should be 1.2 g/kg body weight/day, higher vs general population. In the future, nutritional status evaluation should be included in pulmonary rehabilitation process, and a multidisciplinary team is expected to cooperate in order to achieve best pulmonary results.