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are\treduced\tin\tthe\tpresence\tof\tinfection.\tWeight\tloss\tleads\tto\tan\tincreased\tload\ton\tthe\trespiratory\nmuscles,\tcontributing\tto\tthe\tonset\tof\tacute\trespiratory\tfailure\t(\nHill\tet\tal,\t2013\n).\nMany\tfactors\taffect\tnutritional\tstatus\tduring\tthe\tprogression\n\tof\tCOPD.\tAlthough\tbody\tweight\tand
|
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of\tCOPD.\tAlthough\tbody\tweight\tand\nBMI\tshould\tbe\tfollowed\tbecause\tthey\tare\teasily\tobtained\tmarkers\tof\tnutritional\tstatus\tin\tpatients,\nthey\tcan\tunderestimate\tthe\textent\tof\tnutritional\timpairment\t(\nHill\tet\tal,\t2013\n).\nCurrent\tevidence\tsuggests\tthat\ta\thealthy\tdiet\tpattern\thelps\tin\tprotecting\tsmokers\tagainst
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] |
malnutrition.\tA\tcombination\tof\tnutritional\tcounseling\tand\tnicotine\treplacement\tseems\tto\toptimize\nsuccess\t(\nHill\tet\tal,\t2013\n).\nStudies\thave\tshown\tan\tinverse\trelationship\tbetween\tdietary\tiron\tand\tcalcium\tintake\tand\tCOPD\nrisk.\tIron\tdeficiency\tanemia\tis\tseen\tin\t10%\tto\t30%\tof\tpatients\twith\tCOPD\t(\nSilverberg\tet\tal,\t2014\n).\tIt
|
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] |
Silverberg\tet\tal,\t2014\n).\tIt\nhas\tbeen\tseen\tthat\tcorrecting\tthe\tanemia\tand\tiron\tdeficiency\tby\teither\tblood\ttransfusions\tor\nintravenous\tiron\ttherapy\timproves\tdyspnea\t(shortness\tof\tbreath)\tin\tCOPD\tpatients\t(\nSilverberg\tet\tal,\n2014\n).\tCOPD\tpatients\tare\talso\tat\thigher\trisk\tof\tdeveloping\tosteoporosis\tresulting\tfrom\tsteroid\tusage,
|
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smoking,\tand\tvitamin\tD\tdepletion.\tMaintaining\tadequate\tlevels\tof\t25(OH)D\tis\timportant\tfor\tCOPD\npatients\t(\nLee\tet\tal,\t2013\n;\tsee\t\nAppendix\t38\n).\nThe\tprimary\tgoals\tof\tnutrition\tcare\tfor\tpatients\twith\tCOPD\tare\tto\tfacilitate\tnutritional\twell-being,\nmaintain\tan\tappropriate\tratio\tof\tLBM\tto\tadipose\ttissue,\tcorrect\n\tfluid\timbalance,\tmanage\tdrug-
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] |
nutrient\tinteractions\t(see\t\nAppendix\t13\n),\tand\tprevent\tosteoporosis.\nNutritional\tdepletion\tmay\tbe\tevidenced\tclinically\tby\tlow\tbody\tweight\tfor\theight\tand\tdecreased\tgrip\nstrength.\tCalculation\tof\tBMI\tmay\tbe\tinsufficient\tto\tdetect\tchanges\tin\tfat\tand\tmuscle\tmass.\tInstead,
|
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] |
determination\tof\tbody\tcomposition\thelps\tto\tdifferentiate\tlean\tmuscle\tmass\tfrom\tadipose\ttissue\tand\noverhydration\n\tfrom\tdehydration.\tIn\tpatients\twith\t\ncor\tpulmonale\n\t(increased\tblood\tpressure\tthat\nleads\tto\tenlargement\tand\tfailure\tof\tthe\tright\tventricle\tof\tthe\theart)\tand\tthe\tresultant\tfluid\tretention,
|
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] |
weight\tmaintenance,\tor\tgain\tfrom\tfluid\tmay\tcamouflage\tactual\twasting\tof\tLBM.\tThus\tfor\tpatients\nretaining\tfluids,\tcareful\tinterpretation\tof\tanthropometric\tmeasurements,\tbiochemical\tindicators,\tand\nfunctional\tmeasures\n\tof\tnutrition\tstatus\tare\tnecessary\t(see\t\nChapter\t5\n\tand\t\nAppendices\t11\n\tand\t\n12\n).
|
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0.04700950160622597,
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0.0068808807991445065,
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0.05525761470198631,
0.050839416682720184,
0.07031923532485962,
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] |
Chapter\t5\n\tand\t\nAppendices\t11\n\tand\t\n12\n).\nA\tcombination\tof\tprotein\trich\tsupplements\tand\tanabolic\tsteroids\tcan\tincrease\tmuscle\tmass\tand\nreverse\tany\tnegative\teffects\tof\tweight\tloss.\tExercise\ttolerance\thas\tbeen\tshown\tto\timprove\twith\ta\ndietary\tsupplement\tthat\tcontains\tomega-3\tPUFA,\twhich\thas\tantiinflammatory\teffects\t(\nBerman,\t2011\n)\n(see\t\nChapter\t7\n).
|
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] |
Berman,\t2011\n)\n(see\t\nChapter\t7\n).\nAdipokines\tis\n\ta\tgeneric\tterm\tfor\tthe\tbioactive\tproteins\tthat\tare\tsecreted\tby\tadipocytes.\tThey\ninclude\tadiponectin,\tleptin,\tIL-6,\tand\tTNF-α.\tThey\tplay\ta\tvital\trole\tin\tinfluencing\tthe\tnutritional\nstatus\tand\tregulating\tthe\tappetite.\t\nLeptin\n\t(satiety\thormone)\tis\tsecreted\tpromptly\tin\tresponse\tto\tfood
|
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] |
Leptin\n\t(satiety\thormone)\tis\tsecreted\tpromptly\tin\tresponse\tto\tfood\nintake\tand\tplays\ta\trole\tin\tsuppressing\tappetite\tand\tenhancing\tenergy\texpenditure.\tIt\thas\tbeen\nsuggested\tthat\tmeasuring\n\tlevels\tof\tleptin\tin\tthe\tsputum\tcan\tbe\tuseful\tin\tdetermining\tthe\tseverity\tof\nlung\tdisease\tbecause\tit\thas\tbeen\tshown\tto\tincrease\tduring\tacute\texacerbations\t(
|
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] |
Itoh\tet\tal,\t2013\n).\nAdiponectin\n\t(a\tprotein\tinvolved\tin\tfatty\tacid\tbreakdown\tand\tglucose\tregulation),\tlike\tleptin,\tis\nsecreted\tfrom\tadipocytes,\tbut\thas\tan\topposite\teffect.\tAdiponectin\tenhances\tappetite\tand\thas\tan\nantiinflammatory,\tantidiabetic,\n\tand\tantiatherosclerotic\teffect\tand\tis\tconsidered\tbeneficial.\t\nResistin\n,
|
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] |
Resistin\n,\nanother\tadipokine,\tinduces\tinflammation\tand\tinsulin\tresistance.\tIn\taddition\tto\tbeing\tan\tappetite\nstimulant,\t\nghrelin\n\talso\tstimulates\tgrowth\thormone\tsecretion,\twith\tantagonistic\teffects\tto\tleptin.\nTable\t33.2\n\tsummarizes\tthe\tfunctions\tand\tchange\tin\tthe\tblood\tlevels\tof\tthese\tadipokines\tin\tCOPD\npatients,\tand\thow\tthey\tcan\tinfluence
|
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0.015956809744238853,
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0.11973374336957932,
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0.057869717478752136,
0.038175467401742935,
0.08535270392894745,
-0.020513027906417847
] |
patients,\tand\thow\tthey\tcan\tinfluence\n\tmanagement\tand\trecovery\t(\nItoh\tet\tal,\t2013\n).\nTABLE\t33.2\nBlood\tLevels\tof\tHormones\tand\tAdipokines\tin\tPatients\twith\tChronic\tObstructive\tPulmonary\tDisease\t(COPD)\nHormone\nFunction\nChanges\tin\tBlood\tLevels\twith\tCOPD\nLeptin\n•\t\nSuppresses\tappetite\n•\t\nPromotes\tinflammation\n•\t\nRegulates\thematopoiesis,
|
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0.09370649605989456,
0.07892639189958572,
0.016308411955833435
] |
•\t\nPromotes\tinflammation\n•\t\nRegulates\thematopoiesis,\nangiogenesis,\tand\twound\thealing\nDecreased\tin\tpatients\twith\ta\tlow\tBMI\ncompared\twith\tpatients\twith\n\ta\tnormal\tand\nhigh\tBMI\nGhrelin\nStimulates\tappetite\tand\trelease\tof\ngrowth\thormone\nIncreased\tin\tunderweight\tpatients\ncompared\twith\tnormal\tweight\tpatients\nAdiponectin\n•\t\nStimulates\tfatty\tacid\toxidation
|
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] |
Adiponectin\n•\t\nStimulates\tfatty\tacid\toxidation\n•\t\nIncreases\tinsulin\tsensitivity\tand\ninhibits\tinflammatory\tprocess\nIncreased\tduring\tacute\texacerbation\nDecreased\tlevels\tin\tcurrent\tsmokers\nResistin\nPromotes\tinflammation\tand\tinsulin\nresistance\n\tby\tthe\tproduction\tof\tIL-6\nand\tTNF-α\nInversely\tcorrelated\twith\tpredicted\tFEV\n1\n\t%\nTNF-α
|
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] |
and\tTNF-α\nInversely\tcorrelated\twith\tpredicted\tFEV\n1\n\t%\nTNF-α\nAntagonizes\tinsulin\tsignaling\tand\npromotes\tinflammation\nIncreased\tcompared\twith\thealthy\nindividuals\nIL-6\n•\t\nLoss\tof\tappetite\n•\t\nPromotes\tinflammation\nIncreased\tcompared\twith\thealthy\nindividuals\nBMI\n,\tBody\tmass\tindex;\t\nFEV1\n,\tforced\texpiratory\tvolume;\t\nIL-6\n,\tinterleukin-6;\t\nTNF-
|
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] |
FEV1\n,\tforced\texpiratory\tvolume;\t\nIL-6\n,\tinterleukin-6;\t\nTNF-\nα,\ttumor\tnecrosis\tfactor\n\talpha.\nAdapted\tfrom\tItoh\tM,\tet\tal:\tUndernutrition\tin\tpatients\twith\tCOPD\tand\tits\ttreatment,\t\nNutrients\n\t5:1316,\t2013.\nMacronutrients\nIn\tstable\tCOPD,\trequirements\tfor\twater,\tprotein,\tfat,\tand\tcarbohydrate\tare\tdetermined\tby\tthe
|
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] |
underlying\tlung\tdisease,\toxygen\ttherapy,\tmedications,\tweight\tstatus,\tand\tany\tacute\tfluid\tfluctuations.\nAttention\tto\tthe\tmetabolic\tside\teffects\tof\tmalnutrition\tand\tthe\n\trole\tof\tindividual\tamino\tacids\tis\nnecessary.\tDetermination\tof\ta\tspecific\tpatient’s\tmacronutrient\tneeds\tis\tmade\ton\tan\tindividual\tbasis,\nwith\tclose\tmonitoring\tof\toutcomes.\nEnergy
|
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] |
with\tclose\tmonitoring\tof\toutcomes.\nEnergy\nMeeting\tenergy\tneeds\tcan\tbe\tdifficult.\tFor\tpatients\tparticipating\tin\tpulmonary\trehabilitation\nprograms,\tenergy\trequirements\tdepend\ton\tthe\tintensity\tand\tfrequency\tof\texercise\ttherapy\tand\tcan\nbe\tincreased\tor\tdecreased.\n\tIt\tis\tcrucial\tto\tremember\tthat\tenergy\tbalance\tand\tnitrogen\tbalance\tare
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] |
intertwined.\tConsequently,\tmaintaining\toptimal\tenergy\tbalance\tis\tessential\tto\tpreserving\tvisceral\nand\tsomatic\tproteins.\tPreferably,\tindirect\tcalorimetry\tshould\tbe\tused\tto\tdetermine\tenergy\tneeds\tand\nto\tprescribe\tand\tmonitor\tthe\tprovision\tof\tsufficient,\tbut\tnot\texcessive\tcalories.\tWhen\tenergy\nequations\tare\tused\tfor\tprediction\tof
|
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] |
equations\tare\tused\tfor\tprediction\tof\n\tneeds,\tincreases\tfor\tphysiologic\tstress\tmust\tbe\tincluded.\tCaloric\nneeds\tmay\tvary\tsignificantly\tfrom\tone\tperson\tto\tthe\tnext\tand\teven\tin\tthe\tsame\tindividual\tover\ttime\n(see\t\nChapter\t2\n).\nFat\nOmega-3\tand\tomega-6\tare\tPUFAs\tthat\tare\tessential\tfatty\tacids.\tThe\tsimplest\tforms\tof\tthese\tfatty
|
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] |
acids\tare\tthe\tomega-6\tlinoleic\tacid\t(LA)\tand\talpha-linolenic\tacid\t(ALA).\tThe\tbody\tis\tunable\tto
|
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] |
synthesize\tthem,\n\tand\tthey\tmust\tbe\tconsumed\tin\tthe\thuman\tdiet.\tThese\tfatty\tacids\tare\tdesaturated\tto\nform\tlong-chain\tomega-3\tPUFAs\tor\tomega-6\tPUFAs.\tDocosahexaenoic\tacid\t(DHA),\teicosapentaenoic\nacid\t(EPA),\tand\tALA\tare\tthe\tmajor\tomega-3\tPUFAs,\tand\tthe\tmajor\tlong-chain\tomega-6\tfatty\tacids\tare\nLA\tand\tarachidonic\tacid\t(AA).\tSee\t\nAppendix\t26
|
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LA\tand\tarachidonic\tacid\t(AA).\tSee\t\nAppendix\t26\n\tfor\tthe\tsources\tof\tthese\tfatty\tacids\tin\tthe\tdiet.\tIn\ntheory,\tintake\tof\tlong-chain\n\tomega-3\tPUFAs,\twhich\treduces\tinflammation,\tshould\timprove\tthe\nefficacy\tof\tCOPD\ttreatments.\tPUFA\tsupplementation\tis\tbeneficial\tin\tCOPD,\tbut\tvarious\tfactors\tsuch
|
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] |
as\tsupplement\tadherence,\tcomorbidities,\tand\tduration\tof\tthe\tsupplementation\tplay\tvital\troles\t(\nFulton\net\tal,\t2013\n).\nDietary\tsupplementation\tof\tDHA\tand\tAA\thas\tbeen\tshown\tto\tdelay\tand\treduce\trisk\tof\tupper\nrespiratory\tinfections\tand\tasthma,\n\twith\tlowering\tthe\tincidence\tof\tbronchiolitis\tduring\tthe\tfirst\tyear\nof\tlife\t(\nShek\tet\tal,\t2012
|
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of\tlife\t(\nShek\tet\tal,\t2012\n).\tData\tfrom\tvarious\tstudies\thave\tshown\tthe\tpositive\timpact\tof\tlong-chain\nPUFAs\tin\tinitiating\tand\tproviding\tresolution\tof\tinflammation\tin\trespiratory\tdiseases\t(\nShek\tet\tal,\n2012\n).\tIt\thas\tbeen\tshown\tthat\taspirin\thelps\tto\ttrigger\tresolvin,\ta\tmolecule\tnaturally\tmade\tby\tthe\nbody\tfrom\tomega-3\tfatty\tacids.\t\nResolvin
|
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] |
body\tfrom\tomega-3\tfatty\tacids.\t\nResolvin\n\tresolves\tor\tturns\toff\tthe\tinflammation\tin\tunderlying\ndestructive\tconditions\tsuch\tas\tinflammatory\tlung\tdiseases\t(\nDalli\tet\tal,\t2013\n).\tAt\tthis\ttime,\tthere\tare\nongoing\tlarge\tstudies\tevaluating\tthe\teffectiveness\tof\tomega-3\tPUFAs\tin\tthe\ttreatment\tof\tCOPD.\nProtein
|
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] |
Protein\nSufficient\tprotein\tof\t1.2\tto\t1.5\tg/kg\tof\tdry\tbody\tweight\tis\tnecessary\tto\tmaintain\tor\trestore\tlung\tand\nmuscle\tstrength,\tas\twell\tas\tto\tpromote\n\timmune\tfunction.\tOther\tconcurrent\tdisease\tprocesses\tsuch\tas\ncardiovascular\tor\trenal\tdisease,\tcancer,\tor\tdiabetes\taffect\tthe\ttotal\tamounts,\tratios,\tand\tkinds\tof
|
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] |
protein,\tfat,\tand\tcarbohydrate\tprescribed.\nVitamins\tand\tminerals\nAs\twith\tmacronutrients,\tvitamin\tand\tmineral\trequirements\tfor\tindividuals\twith\tstable\tCOPD\tdepend\non\tthe\tunderlying\tpathologic\tconditions\tof\tthe\tlung,\tother\tconcurrent\n\tdiseases,\tmedical\ttreatments,
|
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] |
diseases,\tmedical\ttreatments,\nweight\tstatus,\tand\tbone\tmineral\tdensity.\tFor\tpeople\tcontinuing\tto\tsmoke\ttobacco,\tadditional\tvitamin\nC\tis\tnecessary\t(see\t\nAppendix\t35\n).\tOne\tstudy\tindicated\tthat\tvitamin\tC’s\trole\tas\tan\tantioxidant\nimproved\tplasma\tglutathione\tlevels\t(\nPirabbasi\tet\tal,\t2016\n).
|
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improved\tplasma\tglutathione\tlevels\t(\nPirabbasi\tet\tal,\t2016\n).\nThe\trole\tof\tminerals\tsuch\tas\tmagnesium\tand\tcalcium\tin\tmuscle\tcontraction\tand\trelaxation\tmay\tbe\nimportant\tfor\tpeople\n\twith\tCOPD.\tIntakes\tat\tleast\tequivalent\tto\tthe\tdietary\treference\tintake\t(DRI)
|
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0.07163336127996445,
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0.13232462108135223,
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0.0800548791885376,
0.016731372103095055,
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0.07721390575170517,
0.04613948240876198,
0.055542949587106705,
-0.006948957219719887
] |
should\tbe\tprovided.\tDepending\ton\tbone\tmineral\tdensity\ttest\tresults,\tcoupled\twith\tfood\tintake\thistory\nand\tglucocorticoid\tmedications\tuse,\tadditional\tvitamins\tD\tand\tK\talso\tmay\tbe\tnecessary\t(see\t\nChapter\n23\n).\nPatients\twith\tcor\tpulmonale\tand\tsubsequent\tfluid\tretention\trequire\tsodium\tand\tfluid\trestriction.\nDepending\ton\tthe
|
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] |
Depending\ton\tthe\n\tdiuretics\tprescribed,\tincreased\tpotassium\tsupplementation\tmay\tbe\trequired\n(\nAppendix\t13\n).\tAnd\tother\twater-soluble\tvitamins,\tparticularly\tthiamin,\tmay\tneed\tto\tbe\tsupplemented.\nPatients\tare\trecommended\tto\tdrink\tadequate\tfluids\tand\tstay\thydrated\tto\thelp\tsputum\tconsistency
|
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] |
and\teasier\texpectoration.\tThe\tParenteral\tand\tEnteral\tNutrition\tGroup\t(PENG)\trecommends\ta\tfluid\nintake\tof\t35\tmL/kg\tbody\tweight\n\tdaily\tfor\tadults\t18\tto\t60\tyears\tand\t30\tmL\tof\tfluid/kg\tbody\tdaily\tfor\nadults\tover\t60\tyears\t(\nPENG,\t2011\n).\nCOPD\tpatients\treport\tdifficulties\twith\teating\tbecause\tof\tlow\tappetite,\tincreased\tbreathlessness
|
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] |
when\teating,\tdifficulty\tshopping\tand\tpreparing\tmeals,\tdry\tmouth,\tearly\tsatiety\tand\tbloating,\tanxiety\nand\tdepression,\tand\tfatigue.\tIn\taddition\tto\tthe\tabove,\tinefficient\tand\toverworking\trespiratory\nmuscles\tlead\tto\tincreased\tnutritional\trequirements\t(\nEvans,\t2012\n).\nPatients\tin\tthe\tadvanced\tstage\tof\tCOPD
|
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] |
Evans,\t2012\n).\nPatients\tin\tthe\tadvanced\tstage\tof\tCOPD\nPatients\twith\tadvanced\tCOPD\tare\tundernourished\tand\tin\ta\tstate\tof\t\npulmonary\tcachexia\n,\twhich\tis\ndefined\tas\ta\tBMI\tof\tless\tthan\t17\tin\tmen\tand\tless\tthan\t14\tin\twomen\t(\nAllen\tet\tal,\t2017\n).\tThe\tcause\tof\ncachexia\tin\tadvanced\tCOPD\tis\tpoorly\tunderstood.\tThe\trole\tfor\tmyostatin\thas\tbeen\tsuggested.
|
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Myostatin\n\tis\ta\tmember\tof\tthe\ttransforming\tgrowth\tfactor-beta\tsuperfamily\tthat\tfunctions\tas\ta\nnegative\tregulator\tof\tmuscle\tgrowth.\tThis\thas\tbeen\tsuggested\tby\tthe\tsignificantly\thigh\tlevels\tof\nmyostatin\tin\tpatients\twith\tstable\tCOPD\tcompared\twith\thealthy\tindividuals\t(\nBenedik\tet\tal,\t2011\n).
|
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] |
Benedik\tet\tal,\t2011\n).\nThese\tcachectic\tpatients\thave\tanorexia\tas\ta\ttypical\tsymptom.\tPulmonary\tcachexia\tis\tan\nindependent\trisk\tfactor\tand\tis\tcommon\n\tin\tthe\tadvanced\tstage\tof\tCOPD.\tPharmacotherapy\tand\nnonpharmacotherapeutic\ttreatments\tsuch\tas\trespiratory\trehabilitation\tand\tnutrition\tcounseling\tare\nthe\tmainstays\tof\tCOPD\ttreatment\tin\tsuch\tpatients\t(
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] |
the\tmainstays\tof\tCOPD\ttreatment\tin\tsuch\tpatients\t(\nItoh\tet\tal,\t2013\n).\tSarcopenia\tand\tcachexia\tresult\nfrom\tthe\taccelerated\tloss\tof\tlean\ttissue\t(\nRaguso\tand\tLuthy,\t2011\n).\tThis\tmuscle\twasting\thas\ta\ndetrimental\teffect\ton\tthe\trespiratory\tfunction\t(\nCollins\tet\tal,\t2012\n).
|
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Collins\tet\tal,\t2012\n).\nOsteoporosis\texists\tas\ta\tsignificant\tproblem\tin\t24%\tto\t69%\tof\tpatients\twith\tadvanced\tCOPD\t(\nEvans\nand\tMorgan,\t2014\n).\tAny\tsudden\tdrop\tin\theight\tis\ta\tmark\tof\tdeveloping\tosteoporosis.\tAs\tCOPD\nprogresses,\tosteoporosis\tresults\tbecause\tof\timmobility,\twhich\talso\tleads\tto\tdeconditioning\tand
|
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] |
dyspnea.\tSmoking,\tlow\tBMI,\tlow\tskeletal\tmuscle\tmass,\tand\tcorticosteroid\tusage\tcan\tlead\tto\tbone\nloss\talong\twith\n\tlow\tserum\tvitamin\tD\tlevels\t(\nEvans\tand\tMorgan,\t2014\n)\t(\nBox\t33.2\n).\nBOX\t33.2\nPlanning\tthe\tDiet\tfor\tthe\tPatient\twith\tPulmonary\tCachexia\nEnergy\trequirements\tduring\thealing\t=\t30\tkcal/kg\tof\tusual\tbody\tweight\tor\t13.7\tcal/usual\tbody
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] |
weight\t(pounds)\nProtein\t(g)/day\tduring\thealing\t=\t[(1.2\tg\t−\t1.4\tg)\t×\tbody\tweight\t(kg)\tor\t0.55\t×\tusual\tbody\nweight\t(pounds)\nFluid\trequirements\t=\tbody\tweight\t(lb)/2\n\t=\tounces\tper\tday\tor\tbody\tweight\t(lb)\t×\t9/16\t=\tcups
|
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] |
per\tday\nFluid\trequirements\tare\tincreased\tbecause\tof\tfever,\tchemotherapy\tregimen,\toxygen\tuse,\tand\npresence\tof\tchronic\tobstructive\tpulmonary\tdisease\t(COPD).\tLack\tof\tenergy\tor\tdehydration\nincreases\tfatigue\tand\tconstipation.\tFluid\tdeficits\tof\t1%\tbody\tweight\tlower\tmetabolic\tfunction\tby\n5%.\nLevin\tRM:\t\nNutrition\tin\tthe\tpatient\twith\tlung\tcancer,\tcaring
|
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] |
5%.\nLevin\tRM:\t\nNutrition\tin\tthe\tpatient\twith\tlung\tcancer,\tcaring\n\tambassadors\tlung\tcancer\tchoices\n\t(website).\nhttp://lungcancercap.org/wp-content/uploads/2014/10/Chapter_8_2014.pdf\n,\t2012.\nPulmonary\thypertension\nPulmonary\thypertension\t(PH)\n\tis\tdefined\tas\televated\tpressure\twithin\tthe\tpulmonary\tcirculation
|
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] |
is\tdefined\tas\televated\tpressure\twithin\tthe\tpulmonary\tcirculation\nthat\tincludes\tthe\tpulmonary\tartery,\tcapillaries,\tand\tpulmonary\tveins.\tThe\tpulmonary\tartery\ttakes\ndeoxygenated\tblood\tfrom\tthe\tright\tventricle\tinto\tthe\n\tsmall\tcapillaries,\twhere\tgas\texchange\ttakes\nplace,\tand\toxygenated\tblood\treturns\tvia\tthe\tpulmonary\tvein\tinto\tthe\tleft\tatrium.
|
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] |
Patients\twith\tPH\tusually\tcomplain\tof\tshortness\tof\tbreath,\tmainly\ton\texertion.\tAs\tthe\tdisease\nadvances,\tthe\tshortness\tof\tbreath\tbecomes\tmore\tprominent\teven\tat\trest,\tand\tpatients\thave\nsymptoms\trelated\tto\thypoxia\tsuch\tas\theadache,\tdizziness,\tand\tchest\tpain.\tUpon\tevaluation\n\tby\ta
|
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by\ta\npulmonologist\tor\tcardiologist,\tsome\tof\tthe\timportant\tsigns\tto\tlook\tfor\twould\tinclude\tcardiac\tmurmur,\nright-sided\tventricular\theave\t(the\theel\tof\thand\tlifts\toff\tthe\tchest\twith\tevery\tbeat,\tindicating\tan\nenlarged\tright\tventricle),\tloud\theart\tsound,\tand\tan\televated\tjugular\tvein\tpressure.\t\nCyanosis\n\tcan\tbe
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Cyanosis\n\tcan\tbe\nevident\twith\tworsening\thypoxia.\tCyanosis\toccurs\twhen\themoglobin\tis\tinadequately\tsaturated\twith\noxygen,\tand\tit\tis\tcharacterized\tby\ta\tbluish\tdiscoloration\tof\tthe\tskin,\tnails,\tlips,\tor\taround\tthe\teyes.\nAn\techocardiogram\t(ECHO)\tis\tusually\tthe\tscreening\ttool\tfor\tPH.\tECHO\tis\tused\tto\tmeasure\tthe
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right\tventricle\tfunction\tand\tto\tmeasure\tthe\tright\tventricle\tsystolic\tpressure\t(RVSP),\twhich\tcan\tbe\nused\tto\testimate\tpulmonary\tartery\tsystolic\tpressure.\tA\tRVSP\t>50\tmm\tHg\tsuggests\tan\televated\npulmonary\n\tsystolic\tpressure\tand\twill\tneed\tconfirmation\tby\tdirect\tmeasurements\tof\tthe\tpulmonary\nartery\tpressure,\tusing\tright\theart\tcatheterization.
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] |
artery\tpressure,\tusing\tright\theart\tcatheterization.\nElevated\tpulmonary\tcirculation\tpressure\tcan\toccur\tdue\tto\tprimary\tpulmonary\tartery\tdisease\n(primary\tPH)\tor\tsecondary\tto\tpulmonary\tor\textrapulmonary\tdiseases.\tIn\t2013\tthe\tWorld\tHealth\nOrganization\t(WHO)\tclassified\tPH\tinto\tfive\tcategories\t(\nHopkins\tand\tRubin,\t2018\n).
|
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] |
Hopkins\tand\tRubin,\t2018\n).\nCategory\t1:\tPulmonary\tarterial\thypertension;\tPH\tdue\tto\tautoimmune\tdisorders,\thuman\nimmunodeficiency\tvirus\t(HIV),\ttoxins,\tdrugs,\tsickle\tcell\tdisease;\tporto-PH\nCategory\t2:\tPH\tdue\tto\tleft\theart\tdisease\nCategory\t3:\tPH\tdue\tto\tunderlying\tlung\tdisease\tsuch\tas\tCOPD,\t\ninterstitial\tpulmonary\nfibrosis\n\t(scar\ttissue\tin\tthe\tlungs)
|
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] |
interstitial\tpulmonary\nfibrosis\n\t(scar\ttissue\tin\tthe\tlungs)\nCategory\t4:\tchronic\tthromboembolic\tPH\nCategory\t5:\tmultifactorial\tand\n\tunclear\tmechanisms\tleading\tto\tPH.\tExamples\tinclude\nsarcoidosis\t(a\tcondition\tthat\tcan\tlead\tto\tinflammation\tprimarily\tin\tthe\tlung\tand\tthe\tlymph\nnodes)\nMedical\tmanagement
|
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nodes)\nMedical\tmanagement\nTreatment\tof\tPH\tlargely\tdepends\ton\tthe\tcause\tof\tthe\televated\tpulmonary\tpressure.\tThose\twith\ncategory\t1\tcan\tbenefit\tfrom\tkeeping\toxygen\tabove\t90%\tand\twith\tmedical\ttherapy\tto\treduce\tthe\npressure\tby\tacting\tdirectly\ton\tpulmonary\n\tcirculation.\tThose\twith\tcategories\t2\tand\t3\twill\tneed\tto\ttreat
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circulation.\tThose\twith\tcategories\t2\tand\t3\twill\tneed\tto\ttreat\nthe\tunderlying\tcause.\tPatients\twith\tcategory\t4\trequire\tanticoagulation\ttherapy\tand\tmay\tbenefit\tfrom\nmechanical\tor\tmedical\tthrombolysis\tof\ttheir\tclots.\tTreatment\tfor\tpatients\tin\tcategory\t5\tdepends\ton\nthe\tunderlying\tdisorder.\nMedical\tnutrition\ttherapy
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] |
statuses\tranging\tfrom\tmalnutrition\tto\tovernutrition,\tso\tnutrition\tinterventions\tshould\tbe\tdesigned\tto\ndiagnose\tand\tcorrect\tthese\tissues\taccordingly.\nDiffuse\tparenchymal\tlung\tdisease\nDiffuse\tparenchymal\tlung\tdisease\t(DPLD)\t(also\tknown\tas\t\ninterstitial\tlung\tdiseases\n\t[ILD])\tis
|
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] |
interstitial\tlung\tdiseases\n\t[ILD])\tis\ncommon\tand\tmore\trecognized\tnow\twith\tadvances\tthat\thave\tbeen\tmade\tin\timaging.\tDPLD\tcomprises\na\tlong\tlist\tof\tdiseases\tand\tcan\tbe\tprimary\tor\tsecondary\tdue\tto\tother\tsystemic\tdisorders\tor\nmedications.\tPatients\ttypically\tcomplain\tof\tchronic\tshortness\tof\tbreath,\tnonproductive\tcough,\tand\nfatigue.\tIf\tthe\tdisease
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] |
fatigue.\tIf\tthe\tdisease\n\tadvances,\tpatients\tbecome\thypoxic,\trequiring\toxygen,\tand\tare\tlimited\tin\ttheir\nphysical\tactivity.\tThe\tprognosis\tfor\tthese\tdiseases\tvary\tdue\tto\tthe\tunderlying\tcause\tand\tthe\tresponse\nto\ttreatment.\nIdiopathic\tpulmonary\tfibrosis\t(IPF)\n\tis\tthe\tmost\tcommon\tILD\tand\tis\tassociated\twith\tthe\tworst
|
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0.04231671988964081,
0.03502214699983597,
0.022255370393395424
] |
is\tthe\tmost\tcommon\tILD\tand\tis\tassociated\twith\tthe\tworst\nprognosis.\tIPF\tis\ta\tchronic\tprogressive\tdisease\tcharacterized\tby\tprogressive\tlung\tscarring.\tThe\nincidence\tof\n\tIPF\tis\t0.22\tto\t8.8/100,000\tin\tthe\tUnited\tStates.\tMen\tare\taffected\tmore\tthan\twomen.\nPatients\twith\tIPF\tcommonly\tpresent\tin\tthe\tsixth\tand\tseventh\tdecades\tof\tlife.\tTypical\tsymptoms\tare
|
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] |
chronic\tshortness\tof\tbreath\tthat\tprogresses\tand\tnonproductive\tcough.\tPulmonary\tfunction\ttests\nshow\trestrictive\tpattern\twith\treduced\tvolumes.\tThe\tdiagnosis\tof\tIPF\tincludes\tthe\tfollowing:
|
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] |
1.\t\nExclusion\tof\tknown\tcauses\n\tof\tILD\tsuch\tas\tmedication,\tenvironmental\texposure,\tor\tsystemic\ndisorders\n2.\t\nSymptoms\tthat\tare\tconsistent\twith\tIPF\tsuch\tas\tchronic\tprogressive\tshortness\tof\tbreath,\nnonproductive\tcough,\tand\thypoxia\n3.\t\nCT\tscan\tconsistent\twith\tIPF\tpattern\n4.
|
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] |
3.\t\nCT\tscan\tconsistent\twith\tIPF\tpattern\n4.\t\nIf\tdiagnosis\tremains\tuncertain,\tthen\topen\tlung\tbiopsy\tand\thistologic\tconfirmation\tare\nnecessary\nPathophysiology\nMost\tcases\tof\tIPF\tare\tsporadic\talthough\n\tsome\tgenetic\tcomponent\thas\tbeen\tdescribed.\tRisk\tfactors\nfor\tIPF\tinclude\tsmoking\tand\texposures\tto\tmetals\tand\tsome\torganic\tdusts.\tGastroesophageal\treflux
|
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may\tcontribute\tto\tthe\tprogression\tof\tthe\tdisease\t(\nLederer\tand\tMartinez,\t2018\n).\nMedical\tmanagement\nThe\tevaluation\tand\tmanagement\tof\tIPF\trequires\ta\tpulmonologist,\tradiologist,\tand\tpathologist.\nInvestigations\tneed\tto\trule\tout\tother\tdiseases\tthat\n\tcould\tmimic\tIPF\tand\tto\tassess\tthe\tseverity\tof\tthe
|
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could\tmimic\tIPF\tand\tto\tassess\tthe\tseverity\tof\tthe\ndisease.\tLung\tbiopsy\tis\tnot\talways\trequired\tif\tsecondary\tcauses\twere\texcluded\tand\tCT\tscan\tis\nconsistent\twith\tall\tthe\tradiographic\tfeatures\tof\tIPF.\nThe\tmedical\tmanagement\tof\tIPF\tcan\tbe\tdivided\tinto\tacute\tand\tchronic\tcourses.\tIPF\tslowly
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progresses\tover\ttime\twithout\tclear\tunderstanding.\tPatients\tare\tusually\trecommended\tto\tstart\ntreatment\twith\tantifibrotic\n\tmedications\tearly\tin\tthe\tcourse\twith\tthe\tgoal\tto\tslow\tdown\tprogression\tof\nthe\tdisease.\tCurrently,\ttwo\tantifibrotic\tmedications\tare\tused\tin\tthe\tUnited\tStates\t(pirfenidone,
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nintedanib).\tPirfenidone\tis\tassociated\twith\trash,\tphotosensitivity,\tand\tpossible\tgastrointestinal\ndisturbances\tsuch\tas\tdiarrhea,\tnausea,\tvomiting,\tor\tabdominal\tdiscomfort.\tDose\tadjustment\tmay\nhelp\trelieve\tsome\tof\tthese\n\tsymptoms.\tNintedanib\tis\tassociated\twith\tmore\tgastrointestinal\tside\teffects
|
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0.09431777894496918,
0.07442948967218399,
0.08436836302280426,
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] |
with\tdiarrhea\toccurring\tin\tup\tto\t60%\tof\tthe\tpatients;\tconsequently,\tantidiarrheal\tagents\tare\tusually\nprescribed\tat\tthe\tsame\ttime.\tOther\tless\tcommon\tadverse\teffects\tinclude\tnausea,\tvomiting,\tand\nelevated\tliver\tenzymes.\nThose\twith\tacute\tpresentation\tusually\tare\tadmitted\tto\tthe\tintensive\tcare\tunit\t(ICU)\tdue\tto\nincreased\toxygen
|
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] |
increased\toxygen\n\trequirements.\tTheir\tmanagement\tis\tmost\toften\tsupportive\tcare.\tHigh\tdoses\tof\nsteroids\twere\tused\tin\tthe\tpast\twith\tconflicting\tresults\tand\ttherefore\tare\tnot\talways\trecommended.\nPatients\twho\tbecome\tmore\tsymptomatic\tand\tworsen\tquickly\tmight\tbenefit\tfrom\tan\tearly\treferral\tto\ta\nlung\ttransplant\tcenter.\nPulmonary\tdiagnostic\ttests
|
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] |
lung\ttransplant\tcenter.\nPulmonary\tdiagnostic\ttests\nPulmonary\tFunction\tTests\t(PFT):\tincludes\tspirometry,\tmeasuring\tlung\n\tvolumes,\tand\tdiffusion\ncapacity.\tUsed\tto\tdiagnose\tasthma\tand\tCOPD\tand\tto\tassess\tseverity\tof\tlung\tdisease\tsuch\tas\nILD.\nChest\tRadiograph\t(chest\tx-ray)
|
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] |
ILD.\nChest\tRadiograph\t(chest\tx-ray)\nComputed\tTomography\t(CT)\tScan:\tscans\tcross-section\tof\tchest.\tMore\taccurate\tand\thigher\nsensitivity\tand\tspecificity\tcompared\twith\tchest\tx-ray.\tGreater\tradiation\texposure\tthan\tchest\nx-ray.\nBronchoscopy:\tScope\twith\ta\tcamera\tis\tinserted\tin\tthe\tmouth\n\tor\tnose\tand\tgoes\tthrough\tthe
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or\tnose\tand\tgoes\tthrough\tthe\nupper\tairways\tand\ttrachea.\tUsed\tfor\tairway\texamination,\tsampling\tfluid\tfor\tinfection\nworkup,\tand\tbiopsies\tto\trule\tout\tmalignancies\tor\tsarcoidosis.\nLung\tBiopsy:\teither\tby\tbronchoscopy\tor\tmore\tinvasive\tapproach\tin\tthe\toperating\troom\tby\nusing\tvideo-assisted\tthoracoscopic\tsurgery\t(VATS)\tand\trequiring\tgeneral\tanesthesia.
|
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Medical\tnutrition\tmanagement\nAt\tthis\ttime,\n\tthere\tare\tneither\tevidenced-based\tguidelines\tnor\tresearch\tstudies\tspecifically\tfor\npatients\twith\tIPF.\tPatients\twith\tIPF\tcan\thave\tweights\tvarying\tfrom\tbeing\tunderweight\tto\tobese,\tso\nnutrition\tinterventions\tshould\tbe\tdesigned\tto\tdiagnose\tand\tcorrect\tnutritional\tabnormalities.
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Pulmonary\tcachexia\tsyndrome\tcan\toccur\tsimilar\tto\tthat\tseen\tin\tpersons\twith\tCOPD\tand\tis\tdue\tto\nhypoxemia,\tlow-grade\tinflammation,\n\tand\tcorticosteroid\tuse\t(\nAllen\tet\tal,\t2017\n).\tAs\tshortness\tof\tbreath\nworsens,\toral\tintake\tbegins\tto\tdecline\tso\tthe\tsuggestions\tfor\timproving\tintake\tfor\tpersons\twith\tCOPD\nmay\tbe\tappropriate\tfor\tpatients\twith\tIPF:\n•
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may\tbe\tappropriate\tfor\tpatients\twith\tIPF:\n•\t\nsmall\tfrequent\tmeals\n•\t\nconsumption\tof\tmain\tmeal\twhen\tenergy\tlevel\tis\tat\tits\thighest\n•\t\nadequate\tcalories,\tprotein,\tvitamins,\tand\tminerals\tto\tachieve\tappropriate\tweight\n•\t\nuse\tof\tfoods\n\tthat\tare\teasily\tprepared\t(i.e.,\tmicrowave)\n•
|
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•\t\nuse\tof\tfoods\n\tthat\tare\teasily\tprepared\t(i.e.,\tmicrowave)\n•\t\nuse\tof\tprotein\tand\tcalorie\tdense\tliquid\tnutritional\tsupplements,\thomemade\tor\tpremade,\tif\noral\tintake\tis\tpoor\nSometimes,\tchewing\tbecomes\ttiring\tfor\tpatients\twho\tare\tshort\tof\tbreath.\tChanging\tthe\tdiet\tto
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softer\tfoods\tor\trelying\tmore\ton\tnutritionally\tadequate\tliquid\tsupplements\tto\tensure\tadequate\nnutrition\tmay\tbe\tnecessary\tnutrition\tinterventions.\nTuberculosis\nMycobacterium\ttuberculosis\n,\tthe\tcausative\torganism\tof\t\ntuberculosis\t(TB)\n,\tis\tan\tintracellular
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] |
,\tthe\tcausative\torganism\tof\t\ntuberculosis\t(TB)\n,\tis\tan\tintracellular\nbacterial\tparasite,\thas\ta\tslow\trate\tof\tgrowth,\tis\tan\tobligate\taerobe,\tand\tinduces\ta\tgranulomatous
|
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] |
response\tin\tthe\ttissues\tof\ta\tnormal\thost.\nEven\tthough\tTB\tis\tnot\tas\tcommon\tin\tthe\tUnited\tStates\tas\tin\tsome\tother\tcountries,\tthere\thas\tbeen\ta\nresurgence\tassociated\twith\tHIV\tand\tdrug-resistant\n\tforms\tof\tTB\t(see\t\nChapter\t36\n).\tIn\t2017\tthe\tWHO\nestimated\tapproximately\t10.4\tmillion\tindividuals\tbecame\till\twith\tTB\tand\t1.7\tmillion\tdied.\tAccording
|
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] |
to\tthe\tWHO,\tmultidrug\tresistant\tTB\taccounted\tfor\tapproximately\t600,000\tcases\tof\tTB\tworldwide.\nPathophysiology\nWhen\tan\tinfectious\tTB\tpatient\tcoughs,\tthe\tcough\tdroplets\tcontain\ttuberculous\tbacilli.\tSmall\tparticles\npenetrate\tdeep\tinto\tthe\tlungs.\tEach\n\tof\tthese\ttiny\tdroplets\tmay\tcarry\t1\tto\t5\tbacilli,\twhich\tare\tenough
|
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air\tto\tenter\tthe\troom\tbut\tnot\tleave\tit).\tThis\tform\tof\tisolation\tshould\tcontinue\tuntil\tpatients\tbecome\nnoninfectious.\tIn\tabout\t5%\tof\tcases,\n\tthe\tinfection\tprogresses\tand\tproduces\tactive\tTB.\tIn\t95%\tof\ncases\twhen\ta\thost\thas\tan\teffective\tcell-mediated\timmune\tresponse,\tthe\tinfection\tis\tcontained.\tWhen
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patients\twith\tactive\tTB\tare\tleft\tuntreated,\tthey\tcan\tdie\tas\ta\tresult\tof\tprogression\tand\tcomplications\n(\nHood,\t2013\n).\nAlthough\tthere\tmay\tbe\tminimal\tsymptoms\tand\tthe\tdiagnosis\tis\tsuspected\tbecause\tof\tan\tabnormal\nchest\tradiograph,\tmost\tpatients\n\twith\tpulmonary\tTB\tpresent\twith\tchronic\tcough,\tprolonged\tfever,\nnight\tsweats,\tanorexia,\tand\tweight\tloss.
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0.08141708374023438,
0.06633847951889038,
0.005316725466400385
] |
night\tsweats,\tanorexia,\tand\tweight\tloss.\nMedical\tmanagement\nAn\timportant\tcomponent\tof\tmanagement\tis\tto\tplace\tthese\tpatients\tin\trespiratory\tisolation\tto\tprevent\nspread\tof\tinfection\tuntil\tthe\tsmear\tfor\tsputum\tacid\tfast\tbacillus\t(AFB)\tcomes\tback\tnegative.\tAs\tsoon\nas\tthe\tdiagnosis\tis\testablished,\ttreatment\twith\tfour\tanti-TB\tmedications—INH,\n\trifampin,
|
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] |
rifampin,\npyrazinamide,\tand\tethambutol—is\tstarted.\tEach\tdrug\thas\tfood-nutrient\tinteractions\t(see\t\nAppendix\n13\n).\tThese\tmedications\tare\tcontinued\tfor\t2\tmonths,\tand\tthen\tonly\trifampin\tand\tINH\tare\tcontinued\nfor\tan\tadditional\t4\tmonths.\tDuration\tof\ttreatment\tmay\tbe\tlonger\tin\tsome\tpatients.\nMedical\tnutrition\ttherapy
|
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0.0226680189371109
] |
Medical\tnutrition\ttherapy\nMalnutrition\tis\tcommon\tin\tpatients\twith\tpulmonary\tTB,\tand\tnutritional\tsupplementation\n\tis\tnecessary.\nProtein\tstatus\tcan\tbe\tassessed\tby\tlooking\tat\tblood\tlevels\tof\tacute\tphase\treactants\t(inflammatory\nproteins)\t(see\t\nTable\t5.4\n\tin\t\nChapter\t5\n),\tanthropometric\tindices,\tand\tthe\tmicronutrient\tstatus\tof\tTB\npatients\t(
|
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] |
patients\t(\nMiyata\tet\tal,\t2013\n).\nTB\tleads\tto\tor\tworsens\tany\tpreexisting\tcondition\tof\tmalnutrition\tand\tincreases\tcatabolism.\tThe\nWHO\tguidelines\tsuggest\thospitalization\tof\tpatients\twho\tare\n\tseverely\tundernourished\tdue\tto\nincreased\trisk\tof\tdeath.\tDietary\tsupplementation\tis\trecommended\tuntil\tthe\tpatient\tachieves\ta\tBMI\tof\n18.5\t(\nBhargava\tet\tal,\t2013\n).
|
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] |
18.5\t(\nBhargava\tet\tal,\t2013\n).\nActive\tTB\tis\tassociated\twith\tweight\tloss,\tcachexia,\tand\tlow\tserum\tconcentration\tof\tleptin.\tThere\tis\na\tsynergistic\tinteraction\tbetween\tmalnutrition\tand\tinfection.\tRecurrent\tinfection\tleads\tto\tworsening\nnutritional\tstatus\tand\tloss\tof\tbody\n\tnitrogen.\tThe\tresulting\tmalnutrition,\tin\tturn,\tcreates\ta\thigher
|
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] |
nitrogen.\tThe\tresulting\tmalnutrition,\tin\tturn,\tcreates\ta\thigher\nsusceptibility\tto\tinfection\t(\nMiyata\tet\tal,\t2013\n).\nIn\tthe\tshort\tterm,\tmalnutrition\tincreases\tthe\trisk\tof\tinfection\tand\tearly\tprogression\tof\tinfection\tto\nproduce\tactive\tTB.\tIn\tthe\tlong\tterm,\tmalnutrition\tincreases\tthe\trisk\tof\treactivation\tof\tthe\tTB\tdisease.
|
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] |
Malnutrition\talso\tcan\tlower\tthe\teffectiveness\tof\tthe\tanti-TB\tdrug\tregime,\twhich\n\tpatients\thave\tto\tbe\non\tfor\tseveral\tmonths.\tThe\tefficacy\tof\tBacillus\tCalmette-Guerin\t(BCG)\tvaccine\tcan\talso\tbe\timpaired\nby\tmalnutrition.\nUpon\tcorrection\tof\tnutritional\tdeficiencies,\tmalnutrition-induced\tloss\tof\tcertain\timmune\tprocesses
|
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can\tbe\treversed\trapidly.\tNutritional\tintervention\tin\tcombination\twith\tappropriate\tmedications\tdoes\nimprove\tthe\toutcome\tof\tmalnourished\tTB\tpatients.\nEnergy\nCurrent\n\tenergy\trecommendations\tare\tthose\tfor\tundernourished\tand\tcatabolic\tpatients,\t35\tto\t40\nkcal/kg\tof\tideal\tbody\tweight.\tFor\tpatients\twith\tany\tconcomitant\tinfections\tsuch\tas\tHIV,\tenergy
|
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-0.01755288429558277,
0.01989280804991722,
0.07459026575088501,
-0.01727469265460968,
-0.03656553849577904,
0.004479127936065197,
0.11759062111377716,
0.024687813594937325,
-0.061020709574222565,
-0.04475576803088188,
0.06951181590557098,
0.060850393027067184,
-0.0813310295343399,
0.0009624160011298954,
0.07883607596158981,
0.010116929188370705,
-0.037958431988954544,
-0.07352989166975021,
0.0783901959657669,
0.056819114834070206,
0.000535702973138541,
0.016037417575716972,
0.00296036247164011,
0.10099425166845322,
0.0653933435678482,
0.04289180785417557,
-0.024392137303948402
] |
requirements\tincrease\tby\t20%\tto\t30%\tto\tmaintain\tbody\tweight.\nProtein\nProtein\tis\tvital\tin\tpreventing\tmuscle\twasting,\tand\tan\tintake\tof\t15%\tof\tenergy\tneeds\tor\t1.2\tto\t1.5\tg/kg\nideal\tbody\tweight,\tapproximately\t75\tto\t100\n\tg\tper\tday,\tis\trecommended.\nVitamins\tand\tminerals
|
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2.1436476612068473e-33,
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0.05855255201458931,
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0.011594493873417377,
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0.012756109237670898,
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0.027720389887690544,
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0.008506783284246922,
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0.033841732889413834,
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0.015895364806056023,
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0.001577631221152842,
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0.05327256768941879,
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0.044610317796468735,
0.006089136004447937,
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0.016405660659074783,
0.044989656656980515,
0.03970406949520111,
0.033981967717409134,
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0.12039004266262054,
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0.03497821465134621,
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0.12854117155075073,
0.11799974739551544,
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0.09597832709550858,
0.018971754238009453,
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0.030272873118519783,
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0.04942051321268082,
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0.006118194665759802,
0.09743452817201614,
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0.014420443214476109,
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0.18681776523590088,
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0.045253198593854904,
0.01582753285765648,
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0.038682278245687485,
0.05407913774251938,
0.05785356089472771,
0.03606670722365379,
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0.021223071962594986,
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0.040324434638023376,
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0.0011427666759118438,
0.09687282890081406,
0.048301685601472855,
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0.027346063405275345,
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0.008481791242957115,
0.023678598925471306,
0.0036082081496715546,
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0.09451141953468323,
0.0647381916642189,
0.0036467737518250942,
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0.01929106004536152,
0.019021037966012955,
0.04776338115334511,
0.007919211871922016
] |
g\tper\tday,\tis\trecommended.\nVitamins\tand\tminerals\nPoor\tnutritional\tintake\tassociated\twith\tTB\twill\tlikely\tpromote\tmicronutrient\tdeficiencies\t(\nKant\tet\tal,\n2015\n).\tProviding\tsupplemental\tzinc,\tvitamin\tD,\tvitamin\tE,\tand\tselenium\twill\tprobably\tincrease\tserum\nlevels\tof\tthese\tnutrients\tbut\tthe\tevidence\thas\tnot\tdemonstrated\tsignificant\tclinical\tbenefit\t(
|
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] |
Grobler\net\tal,\t2016\n).\tSupplementing\tthese\tnutrients\n\tabove\tthe\trecommended\tdaily\tamounts\tseems\tto\tbe\nunnecessary\tdue\tto\tthe\tunreliable\tevidence\t(\nGrobler\tet\tal,\t2016\n).\nIsoniazid\tis\tan\tantagonist\tof\tvitamin\tB\n6\n\t(pyridoxine)\tand\tis\tfrequently\tused\tin\tTB\ttreatment.\tIt\tmay
|
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] |
6\n\t(pyridoxine)\tand\tis\tfrequently\tused\tin\tTB\ttreatment.\tIt\tmay\ncause\trare\tinstances\tof\tperipheral\tneuropathy\tresulting\tfrom\tthe\tnutritional\tdepletion\tof\tvitamin\tB\n6\n.\nA\tstandard\tprocedure\tis\tto\tsupplement\tadults\twith\t25\tmg\tof\tvitamin\tB\n6\n\tper\tday\n\tto\tovercome\tthis\ndrug-nutrient\tinteraction.\tVitamin\tB\n6
|
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] |
6\n\tper\tday\n\tto\tovercome\tthis\ndrug-nutrient\tinteraction.\tVitamin\tB\n6\n\tsupplementation\twill\tbe\tneeded\tfor\texclusively\tbreastfed\ninfants,\tmalnourished\tchildren,\tand\tHIV-infected\tchildren\tand\tadolescents\t(\nRodà\tet\tal,\t2016\n).\nResearch\tindicates\tsome\thealthy\tchildren\tcould\tdevelop\tmild\tsymptom-free\tpyridoxine\tdeficiency\n(\nRodà\tet\tal,\t2016\n).
|
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] |
Studies\thave\tdocumented\tan\tincreased\tprevalence\tof\tanemia\tin\tTB\tpatients,\n\twhich\tis\tassociated\nwith\tincreased\trisk\tof\tdeath.\tTo\tguide\tclinical\tdecision\tmaking\tand\tprovide\ttreatment\nrecommendations,\tfactors\tthat\tcontribute\tto\tthe\tTB-associated\tanemia\thave\tto\tbe\tdetermined.
|
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] |
Although\tother\tcauses\tdo\tcoexist,\tiron\tdeficiency\tanemia\tis\tthe\tmost\timportant\tcontributor\tin\tthe\ndevelopment\tof\tanemia\tin\tTB\tpatients\t(\nIsanaka\tet\tal,\t2012\n).\nIron\tis\tan\tessential\tmicronutrient\tnot\n\tonly\tfor\thumans\tbut\talso\tfor\tbacteria\tsuch\tas\t\nM.\ttuberculosis\n;\nTB\tis\tdependent\ton\tthe\thost’s\tiron\tsupply\t(\nCarver,\t2018
|
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;\nTB\tis\tdependent\ton\tthe\thost’s\tiron\tsupply\t(\nCarver,\t2018\n).\tProviding\tiron\teither\tas\ta\tsupplement\tor\nblood\ttransfusion\tcould\tincrease\trisk\tof\tinfection\tbut\tat\tthis\ttime\tthis\tis\tcontroversial\t(\nCarver,\t2018\n).\nThe\tuse\tof\tiron\ttherapy\tis\tnot\tuniversally\trecommended.\tHowever,\tif\tiron\tstudies\tshow\tiron\ndeficiency,\tiron\ttherapy\tis\tthen\tinitiated
|
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] |
deficiency,\tiron\ttherapy\tis\tthen\tinitiated\n\t(see\t\nChapter\t31\n\tfor\tmanagement\tof\tiron\tdeficiency\tanemia).\nLung\tcancer\nLung\tcancer\tremains\tthe\tleading\tcause\tof\tcancer\tdeaths\tfor\tmales\tand\tfemales\tin\tthe\tUnited\tStates.\nIn\t2012\t1.8\tmillion\tpatients\tworldwide\twere\tdiagnosed\twith\tlung\tcancer\t(\nMannino,\t2014\n).
|
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] |
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