Manual of Clinical Nutrition Management III- 104 Copyright © 2013 Compass Group, Inc.
PNEUMONIA
Discussion
Pneumonia is defined as inflammation and consolidation of lung tissue in response to an infectious agent (1).
Several organisms and disease conditions have been identified to infect or inflame the lungs. The
epidemiology of the disease has changed due to changes in the microorganisms and modalities used to treat
the condition. The incidence of pneumonia requiring hospitalization is highest among the elderly (2).
Subgroups at risk for pneumonia include individuals with chronic obstructive pulmonary disease (COPD),
diabetes mellitus, asthma, alcoholism, and heart failure and diseases that affect the immune system (eg, HIV
disease/AIDS and cancer). Mechanically ventilated patients are at most risk for developing hospital-acquired
pneumonia.
Approximately 50% of pneumonia cases are caused by viruses and tend to be less severe than those of
bacterial origin (1-3). Pneumococcus (Streptococcus pneumoniae) is the most common cause of bacterial
pneumonia (4). Aspiration pneumonia results when solid or liquid food passes into the lungs, causing
infection. Aspiration pneumonia results in approximately 50,000 deaths per year, mostly in the elderly (1).
Nosocomial pneumonia is the leading cause of death from hospital-acquired infection in the United States (2).
Prevention of pneumonia primarily includes maintenance of immune status and pneumococcal vaccination.
Treatment of pneumonia involves a combination of pharmacologic therapy (eg, antibiotics), pulmonary
rehabilitation, and maintenance of nutritional status. Protein energy malnutrition (PEM) is associated with
involuntary weight loss, functional impairment and impaired immunity (3). It has been demonstrated that
nutritional status plays a critical role in the modulation of immune function. In a study of 277 patients
admitted to the hospital for treatment of community-acquired pneumonia, the most important factor
independently associated with fatal disease was a low serum albumin level (4). In the same study, a serum
albumin level under 3.0 g/dL during treatment of the pneumonia was also associated with death due to
pneumonia after discharge. Craven and colleagues identified malnutrition as a risk factor for nosocomial
pneumonia in hospitalized patients (5).
Approaches
The primary goal of medical nutrition therapy in the management of pneumonia is to preserve lean body
mass and immune function, prevent unintentional weight loss, and maintain nutritional status. For detailed
intervention strategies, refer to the Pneumonia Medical Nutrition Therapy Protocol in Medical Nutrition
Therapy Across the Continuum of Care (6).
Energy: Provide enough energy to maintain reasonable body weight. Increased energy may be needed for
patients with infection, fever, or weight loss.
Protein: Provide enough protein to maintain visceral protein status and meet the demands of infection.
Fluid: Fluids are encouraged, unless contraindicated. From 3 to 3.5 L of fluid per day has been
recommended to liquefy secretions and help lower temperature in febrile patients (7).
Nutrients and the immune system: Several nutrients have been linked to the preservation and maintenance
of immune function. Nutrients that have been identified include vitamins A, E, and B 6 , zinc, copper, selenium,
the amino acids glutamine and arginine, and omega-3 fatty acids. These nutrients all seem to modulate
specific aspects of human immune function (8). Current studies do not demonstrate a direct cause and effect
relationship with the incidence of pneumonia. The current thought is that these nutrients may play a key role
in the immune function, leading to less of a risk of developing pneumonia (9). Currently, supplementation
with these identified nutrients is not warranted. However, it is recommended to increase the consumption of
foods that provide these nutrients as good sources, such as fruit, vegetables, grains, meats, and fish.
Aspiration risk reduction: Instituting feeding techniques that prevent risk for aspiration may be indicated
in patients who demonstrate symptoms of aspiration, such as coughing before, during, or after consumption
of solids, liquids or medications; drooling; pocketing food in the mouth; and repetitive movement of the
tongue from front to back of the mouth. To reduce the risk of aspiration, consider the following strategies (10):
Position patient at a 90o angle during meals.
Serve food at appropriate temperatures.
Limit mealtime distractions.