Enhanced diet

If you are underweight, it is important to make sure that you get enough energy from food.

This diet is recommended if you have experienced involuntary weight loss within one month or your BMI is less than 20 kg/m2 (underweight).

This diet is suitable for you if you suffer from the flare-up of a respiratory disease or are affected by a respiratory infection or malnutrition, and you have been eating less due to, for example, loss of appetite or nausea. 

The goal of this diet is to increase your weight or at least stop weight loss with high-energy and high-protein meals and moderate portion sizes. It is not necessary, however, to increase the amount of carbohydrates, as a high proportion of carbohydrates in the diet can be harmful. In brief, you need: 

  • plenty of energy 
  • plenty of protein 
  • several small meals and snacks throughout the day. 

Read the labels and compare the fat and calorie content of various products. Choose high-energy and protein-rich options that you like. If you have been diagnosed with malnutrition, have lost a significant amount of weight, or are unable to stop your weight loss, ask your doctor for a referral to a dietitian. 

If you are underweight, you can eat your favourite foods. You can use a moderate amount of salt and sugar to add flavour to your food because the food should taste good to you. Uneaten food has no nutritional value.

Enhanced diet  

  • Monitor your weight weekly. If you lose more than half a kilogramme in a week or a couple of kilogrammes in a month, you need to increase your daily energy intake by at least 500–600 kilocalories.  
  • Eat frequently 6–8 times per day and invest in the quality of the food.  
  • When following an enhanced diet, it is important to eat at least 10 servings of protein-rich foods daily. Try to eat 25–30 grammes of protein at least 4–5 times a day. Always eat other high-energy foods with protein-rich foods so that your body will use the protein as building blocks instead of just energy. The amount of protein you need per day is 1.3–1.5 grammes of protein for every kilogramme of body weight. 
  • Incorporate fats in every meal. Choose vegetable oil-based spreads, liquid margarine, vegetable oil-based creams, and cooking oil for visible fat.  
  • Try to eat fish 2–3 times a week.  
  • Grain products, potatoes, pasta, and rice are important sources of energy. They taste mild and are easy to eat even when your appetite is poor. Fibre-rich options, in particular, are also sources of various essential minerals.  
  • Drink juice, milk, and soy-based drinks instead of water. 
  • If your appetite is extremely low or you can only eat small portions, try the supplemental nutrition drinks and fat supplements sold at pharmacies. You can leave them out once your weight has improved.  
  • Use vegetables, fruits, and berries wisely as they contain, apart from a few exceptions (bananas, avocados, legumes, nuts, and almonds), mostly water and are therefore low in energy. A small amount of vegetables is enough to add some colour and flavour to your meal.  

If you are 65 or older or spend a lot of time indoors in the summer, you need a vitamin D supplement of 10–20 microgrammes per day. People over 65 are recommended to take vitamin D supplements all year round. You can also take one multivitamin and mineral supplement daily.  

How to increase the energy content of your meals:

  • Choose fatty options from dairy and meat products. 
  • Add vegetable oil spreads, cooking oil, or cream to your meals.
  • If you do not like bread, switch to porridge.
  • Make your porridge and gruel with milk and add some fat, cottage cheese, and maltodextrin. You can buy maltodextrin at pharmacies and in the sports nutrition aisle of your supermarket. 
  • Choose easy-to-eat mashed potatoes, potato and pasta-based casseroles, and thickened soups. Add plenty of sauce to rice and pasta to make it easier to eat and increase your energy intake. These foods do not require a lot of chewing, which makes them easier to eat if you tend to run out of breath or if your appetite is weak.
  • Add plenty of oil, salad dressing, and mayonnaise to your vegetables and make vegetable gratins.
  • Use berries and fruits in milkshakes, smoothies, quarks, and desserts. Fruits as such are a very light snack, but baked apples with ice cream would be a great choice. Nuts are a great snack because they contain both fat and protein. Compared to an apple, a banana has twice as much energy and an avocado five times more energy.  

Snacks to include in your enhanced diet:  

  • flavoured quark, creamy yoghurts, sour cream, or ice cream  
  • dairy- or soy-based berry and fruit shakes and cheeses 
  • Karelian pies with egg butter; small sandwiches or crackers
  • pancakes, waffles, pasties, or pastries
  • nuts
  • supplemental nutrition drinks, milk-based coffee drinks, cocoa drinks, or 100% fruit juice. 

An imbalance between food intake and energy expenditure leads to weight loss and underweight. Severe respiratory diseases and flare-ups in particular can trigger a stress metabolism that depletes muscles. Keep in mind that the body requires more protein than usual during respiratory disease exacerbations and infections. For a person who suffers from a respiratory disease and weighs 75 kilogrammes, the daily protein requirement would rise to 98–112 grammes per day.

Laboured breathing and illness-induced stress metabolism increase the need for food. However, at the same time you may be eating less due to side effects of medication that interfere with your eating, such as loss of appetite, changes in taste, and nausea. Your portion size may also become smaller and nutrient intake may be poor. The solution is an enhanced diet that is based on small portion sizes and foods that are high in energy and protein.  

Being underweight and losing just a few kilogrammes in one month slow down recovery and negatively affect the immune system. If your body does not get enough protein from food, it will use your muscles as a source or protein. Among people with respiratory diseases, this is particularly significant, because the lungs are muscle tissue and muscle loss makes it more difficult to breathe and function. With poor nutrition, the body does not have the capacity to heal, and strength training is unsuccessful.