رجل عمره ٧٢ سنة عنده انسداد رئوي مزمن، وزنه ٥٢ كغ وطوله ١٧٥ سم، ونقص وزنه ٤ كغ في ٣ أشهر. يقول إنه يتعب ويضيق نفسه أثناء الأكل فيترك الوجبة قبل أن يشبع. التشبع ٩١٪. أي نصيحة غذائية أنسب؟

A 72-year-old man with COPD weighs 52 kg at 175 cm and has lost 4 kg in 3 months. He says he tires and gets breathless while eating and stops before he is full. SpO2 91%. Which dietary advice is most appropriate?

1. Small frequent high-calorie, high-protein meals
2. Plenty of fluids with each meal before eating
3. Three large meals to reduce eating episodes
4. Less protein to ease breathlessness

Answer: A) Small frequent high-calorie, high-protein meals. Large meals press on the diaphragm and worsen dyspnoea. Small frequent energy- and protein-rich meals are better, with rest before eating and fluids between meals rather than before.