Nutrition Strategies Pre-infection, during, and Post-infection with Coronavirus Disease

Coronavirus disease is a serious viral infection that is characterized by severe inflammation and lymphopenia. The virus attacks many organs causing acute respiratory distress and malfunctioning of the organs leading to death. Through strengthening of the innate immune system, a balanced diet plays a critical role in defense against bacterial and viral diseases. A healthy diet before, during and after an infection can lessen the severity of the symptoms and speed up the recovery of damaged cells. Due to the Mediterranean diet's high concentration of bioactive polyphenols, which have antioxidant, anti-inflammatory, and antithrombic properties, numerous studies have suggested that it is a preventative dietary strategy against many diseases including coronavirus disease. Nutrition and herbal plants play a key role to enhance the immunity of people to protect and fight against coronavirus. Diet rich in antioxidants and phytochemicals represents perfect barrier to the virus through elevation of the innate immunity of the body. In addition, gut microbiota including prebiotics, probiotics, and synbiotics were found to enhance immunity to reduce the symptoms of the disease during infection. Protein-rich foods and honey bee products reported significant role during and post-coronavirus infection. This review presents updated information from original pre-clinical and clinical researches, and review articles as well to expose the nutritive strategies including breastfeeding benefits to infants pre-infection, during, and post-infection with coronavirus.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.

Clinical usefulness of the Patient-Generated Subjective Global Assessment and modified Glasgow Prognostic Score in decision making concerning the indication of enteral nutritional therapy in patients with incurable cancer receiving palliative care.

OBJECTIVES: This study aimed to identify the clinical usefulness of assessing nutritional status using validated tools for the indication of enteral nutrition for patients with incurable cancer in palliative care. METHODS: In this prospective cohort study, patients were assessed for nutritional risk using the Patient-Generated Subjective Global Assessment and for cancer cachexia (CC) using the modified Glasgow Prognostic Score upon enrollment and after ∼30 d. The outcome was stable or improved Karnofsky Performance Status. Logistic regression models were used, providing the odds ratio (OR) and 95% confidence interval (CI). RESULTS: A total of 180 patients participated. The only nutritional status parameter that was associated with function was CC. The less severe the CC, the more likely Karnofsky Performance Status was to remain stable or improve over 30 d (non-cachectic: OR = 1.95; 95% CI, 1.01-3.47; malnourished: OR = 1.06; 95% CI, 1.01-1.42). Furthermore, white skin color (OR = 1.79; 95% CI, 1.04-2.47), higher educational level (OR = 1.39; 95% CI, 1.13-2.78), and inadequate calorie intake (OR = 1.96; 95% CI, 1.02-2.81) were also associated with the outcome. CONCLUSIONS: Using the modified Glasgow Prognostic Score to identify the existence and severity of CC, which is associated with function, has the potential to help clinical decision making concerning the indication of enteral nutrition in patients with incurable cancer receiving palliative care.

Could Telenutrition Be Applied Interchangeably with the Face-to-Face Interview for Dietary Intake Assessment in Patients with Type 2 Diabetes During the COVID-19 Pandemic?

Background: COVID-19 pandemic has caused limitations, in patients' accessibility in clinical and research settings. We sought whether telenutrition could be applied interchangeably with face-to-face interview for dietary intake assessment by 24-hour recall in patients with type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic. Method(s): Sixty-eight females with T2DM aged 50-55 years were enrolled randomly in a descriptive-analytic cross-sectional study. The patients completed three consecutive 24-hour dietary recalls. The first one was a face-to-face interview, and the subsequent two recalls were conducted by telephone call. The total energy and 18 selected nutrients intake were calculated for the three interviews. Result(s): The mean (+/- SD) age of participants was 53.97 +/- 2.14 years. The face-to-face interview resulted in significantly higher total energy and 18 selected nutrients intake than the two telenutrition interviews (P value range: 0.031-0.001). No significant differences were found between the data provided from the two telenutrition interviews. Conclusion(s): Telenutrition underreports and underestimates the total energy and nutrient intakes compared with the face-to-face interview in the 24-hour dietary recall. Therefore, it cannot be recommended to be applied interchangeably with a face-to-face interview for dietary intake assessment during the COVID-19 pandemic, especially in patients whose nutrition assessment is of clinical importance. A combination of the two methods using new communication applications (e.g. WhatsApp) may cover the defects of telenutrition method.Copyright © 2023, Kerman University of Medical Sciences. All rights reserved.

Influence of perioperative oral nutritional supplementation on short-term efficacy of laparoscopic sleeve gastrectomy for obesity patients: a prospective study

Objective: To investigate the effect of perioperative oral nutritional supplementation on the short-term curative effect of obese patients after laparoscopic sleeve gastrectomy (LSG). Methods: A prospective research method was adopted. The clinical data of 218 obese patients who underwent LSG in Ningxia Medical University General Hospital from January 2018 to December 2021 were selected. The patients who received oral nutritional supplement therapy during the perioperative period were set as the experimental group, and those who received conventional treatment were set as the control group. Observation indicators: (1) Grouping of enrolled patients. (2) Postoperative and follow-up situation. (3) Nutrition-related indicators. (4) Diet compliance. (5) Status of weight loss-related indicators. Follow-up visits were conducted by telephone, We Chat and outpatient visits. The patients were followed up once 30 days after discharge, including albumin (Alb), hemoglobin (Hb), dietary compliance and weight loss-related indicators. The follow-up time will end in February 2022. The measurement data with normal distribution were expressed as x+or-s, and the comparison between groups was performed by independent sample t test. The measurement data is represented by M (range), and the comparison between groups is performed by Mann?Whitney U test. Enumeration data were expressed as absolute numbers or percentages, and the X2 test was used for comparison between groups. Repeated measures data were analyzed by repeated measures analysis of variance. The rank sum test was used to compare the rank data. Results (1) Grouping of the enrolled patients. Screened 218 eligible patients;42 males and 176 females;age (32+or-9) years;body mass index (BMI) (39+or-7) kg/m2. Among the 218 patients, there were 109 cases in the test group and 109 cases in the control group. Gender (male, female), age, BMI, preoperative Alb, and preoperative Hb of patients in the test group were 17 and 92 cases, (33+or-9) years old, (39+or-7) kg/m2, (40.6+or-4.8) g /L, (141.7+or-13.9) g/L;the above indicators in the control group were 25 and 84 cases, (31+or-8) years old, (39+or-8) kg/m2, (40.9+or-4.2) g/L, (142.9+or-9.7) g/L;there was no significant difference in the above (X2=1.89, t=-1.52, 0.51, 0.40, 0.71, P > 0.05). (2) Postoperative and follow-up situation. The first hospitalization time and first hospitalization expenses of the patients in the experimental group were (9.1+or-2.9) d and (3.6+or-0.5) ten thousand yuan respectively;the above indicators of the patients in the control group were (4.9+or-1.0) ten thousand yuan respectively;There were statistically significant differences in the above indicators between the two groups (t=5.58, 12.38, P < 0.05). Among the 218 patients, 119 were followed up, including 62 in the experimental group and 57 in the control group. The 119 patients were followed up for 31.0 (25.0-38.0) days. Among the 218 patients, 14 cases had postoperative complications and led to rehospitalization, including 2 cases in the experimental group, 1 case of nausea and vomiting and 1 case of intestinal obstruction;12 cases in the control group, 10 cases of nausea and vomiting, gastric fistula 2 cases;there was a statistically significant difference between the two groups in hospital readmission (X2=7.63, P < 0.05). The time interval between re-admission and first discharge of 14 patients was (22.0+or-6.7) days. (3) Nutrition-related indicators. The Alb and Hb levels of 62 patients in the experimental group who were followed up before operation, before the first discharge, and 1 month after operation were (40.4+or-5.5) g/L, (35.9+or-3.8) g/L, (45.4+or-2.9) g/L, respectively and (140.8+or-13.9) g/L, (130.5+or-16.9) g/L, (147.8+or-17.2) g/L;the above indicators of 57 patients in the control group were (41.2+or-3.9) g/L, (34.2 +or-3.9) g/L, (42.7+or-5.3) g/L and (143.0+or-9.7) g/L, (122.9+or-12.8) g/L, (139.0+or-11.4) g/L;There was a statistically significant difference between the Alb and Hb groups from preoperative to postoperative 1 mont

The nutrition management of patients with Coronavirus disease 2019 in the hospital: An expert opinion (2020).

To prevent coronavirus disease 2019 (COVID-19) and enhance the nutrition management for patients, the Beijing Quality Control and Improvement Center for Clinical Nutrition Therapy organized relevant experts to formulate "The Nutrition Management of Patients with Coronavirus Disease 2019 in the Hospital: An Expert Opinion (2020)". It clearly stated that food safety, food hygiene, and nutrition management should be incorporated into the whole process of prevention, control, treatment, and rehabilitation of COVID-19. The reasonable and standardized pathway of nutrition management, which includes nutrition-risk screening, malnutrition diagnosis, nutritional support therapy and nutrition monitoring, should be established to improve the immune status, clinical outcome, and quality of life of patients with COVID-19.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Development Of Technology for Obtaining Natural Nutriceutics in Solid Form

This article discusses development of technology for obtaining natural nutriceutics in solid form. Currently, a healthy lifestyle, a healthy diet and the body's resistance to external negative factors have become topical issues, especially after the outbreak of the global COVID-19 pandemic. Basically, the prevention and treatment of diseases occurs due to the replenishment of the complex of bioactive substances that the body receives from healthy food. Otherwise, if the tissues and organs do not receive the elements necessary for the normal functioning of the body, then the strength to fight the disease decreases. Here, dietary supplements, that is, nutraceuticals, play an important role, they are consumed with food and are mainly obtained from products of natural origin: vegetable, animal and bacterial.Copyright © 2023, Codon Publications. All rights reserved.

Handgrip Strength Test and Bioelectrical Impedance Analysis in SARS-CoV-2 Patients Admitted to Sub-Intensive Unit.

Hospitalized patients with respiratory failure due to SARS-CoV-2 pneumonia are at increased risk of malnutrition and related mortality. The predictive value of the Mini-Nutritional Assessment short form (MNA-sf®), hand-grip strength (HGS), and bioelectrical impedance analysis (BIA) was determined with respect to in-hospital mortality or endotracheal intubation. The study included 101 patients admitted to a sub-intensive care unit from November 2021 to April 2022. The discriminative capacity of MNA-sf, HGS, and body composition parameters (skeletal mass index and phase angle) was assessed computing the area under the receiver operating characteristic curves (AUC). Analyses were stratified by age groups (<70/70+ years). The MNA-sf alone or in combination with HGS or BIA was not able to reliably predict our outcome. In younger participants, HGS showed a sensitivity of 0.87 and a specificity of 0.54 (AUC: 0.77). In older participants, phase angle (AUC: 0.72) was the best predictor and MNA-sf in combination with HGS had an AUC of 0.66. In our sample, MNA- sf alone, or in combination with HGS and BIA was not useful to predict our outcome in patients with COVID-19 pneumonia. Phase angle and HGS may be useful tools to predict worse outcomes in older and younger patients, respectively.

Nutritional status of patients with COVID-19 1-y post-ICU stay: A prospective observational study.

OBJECTIVES: Patients discharged from the intensive care unit (ICU) often experience physical complaints and poor nutritional intake, which negatively affect their nutritional status (NS). The aim of this study was to describe the NS of patients with COVID-19 1-y post-ICU stay. METHODS: This was an observational study of adult patients with COVID-19 1-y post-ICU stay. NS assessment (nutrient balance, body composition, and physical status) was performed. We examined nutritional intake and nutrition-related complaints. Nutritional requirements were determined with indirect calorimetry and body composition with bioelectrical impedance. Fat-free mass index (FFMI) and fat mass index (FMI) were calculated. Physical status was determined using handgrip strength, the 6-min walk test, and the 1-min sit-to-stand test. Descriptive statistics and paired sample t tests were used for analysis. RESULTS: We included 48 patients (73% men; median age 60 y [IQR 52;65]). Median weight loss during the ICU stay was 13%. One-y post-ICU stay, 12% of weight was regained. Median body mass index was 26 kg/m2 and 23% of the patients were obese (body mass index >30 kg/m2 and high FMI). Of the patients, 50% had high FMI and 19% had low FFMI. Median reported nutritional intake was 90% of measured resting energy expenditure. Nutrition-related complaints were seen in 16%. Percentages of normal values reached in physical tests were 92% of handgrip strength, 95% of 6-min walking distance, and 79% of 1-min sit-to-stand test. CONCLUSIONS: Despite almost fully regained weight and good physical recovery in adult patients 1-y post-ICU stay, NS remained impaired because of elevated FMI, even though reported nutritional intake was below the estimated requirements.

Feasibility, Safety and Efficacy of a Combined Supervised Physical Exercise and Nutritional Program in a Selected Population of Luminal Metastatic Breast Cancer Patients: Oncare01 Pilot Study

Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.

Poor nutritional status and dynapenia are highly prevalent in post-acute COVID-19

Malnutrition estimates range between 5 and 69% in acute Coronavirus disease 2019 (COVID-19) patients. With respect to body composition (BC) and muscle function, low values of phase angle (PhA) and handgrip strength (HGS) have been related to poor disease outcomes. Little evidence is available in post-acute patients. We aimed to combine the evaluation of nutritional status, BC, and muscle strength in a real-life cross-sectional cohort of post-acute COVID-19 patients referred to a rehabilitation center after hospital discharge. The study population included 144 patients (M=95;mean age 64.8yrs), of which 37% bedridden (M=60%). Nutritional status was evaluated with the Mini-Nutritional Assessment (MNA) and Controlling Nutritional status (CONUT) scores. Fat-free mass (FFM), skeletal muscle (SM), and raw variables, i.e. PhA, were estimated with bioelectrical impedance analysis. HGS was measured with a digital handle dynamometer for both dominant and non-dominant body sides. Dynapenia was identified according to the 2019 EWGSOP criteria. According to MNA, 18% of patients were malnourished and 62% at risk of malnutrition. As for CONUT, 21% of patients had moderate-severe malnutrition, while 58%light malnutrition. Overall, malnutrition was highly prevalent in older patients with more comorbidities. Marked abnormalities of PhAand HGSwere more frequent in bedridden or malnourished patients, and when FFM or SM were low. Dynapenic patients were 65% males and 47% females. Malnutrition, BC alterations, and low HGS occur in post-acute COVID-19 patients. Future studies will help to tailor screening algorithms for full nutritional status assessment to appropriate care processes and rehabilitation strategies.

Evaluation of COVID-19 fear and nutrition habits in healthcare workers

Aim: This study aims to evaluate the COVID-19 fear level and nutrition habits of healthcare workers. Material(s) and Method(s): This research was conducted with 208 healthcare workers in Konya City Hospital and Meram State Hospital. Participants filled out the sociodemographic information form, COVID-19 Phobia Scale and Three-Factor Eating Questionnaire. The SPSS 22,0 program was used for data analysis. Result(s): Among participants between the ages of 18-65 included in the study, 59.1% (n=123) were female and 40.9% (n=85) were male. The average age of participants was found to be 29.32 +/-0.43 years. In the COVID-19 Phobia Scale, scores of women in psychological (p<0.001), somatic (p=0.001), social (p=0.001), economic (p=0.001) sub-dimensions and total score (p=0.026) were found to be higher than those of men. Fear levels of married participants were higher in somatic (p=0.018) and economic (p=0.044) sub-dimensions. Scores of obese and overweight participants' in psychological (p=0.002), somatic (p=0.017), social (p=0.028), economic (p=0.011) sub-dimensions and in total score (p=0.001) were found to be lower. The total score of the Three-Factor Nutrition Questionnaire (p=0.017) and emotional eating levels (p=0.006) of healthcare workers who had COVID-19 before were found to be higher. It was detected that there was a positive correlation between the degree of emotional eating and the social sub-dimension (p=0.048), and there was a negative relationship between the degree of consciously restricting eating and the psychological sub-dimension (p=0.009). Discussion(s): Nutritional habits have changed due to isolation conditions, sedentary lifestyles and the need for supplemental food. The stressful and risky working environment of healthcare workers affected their fear levels. With the increase in the fear level, eating habits have also changed. As in all pandemics, policies should be followed to reduce the level of fear of healthcare workers, who are among risky groups, during the COVID-19 pandemic process. In this process, the importance of nutrition should be emphasized and negative habits should be avoided.Copyright © 2022, Derman Medical Publishing. All rights reserved.

The effect of lifestyle on the course of COVID-19 infection

Aim: Our study's goal was to see how pre-illness lifestyle affected the course of COVID-19 infection in patients hospitalized with COVID-19. Material(s) and Method(s): From January to May 2021, 66 patients aged 50 years and older whose PCR tests were positive for COVID-19 were studied in the pandemic service. The Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment (MNA) scale, and International Short Physical Activity Questionnaire (IPAQ) were utilized to examine the impact of COVID-19 infected individuals lifestyles such as sleep, nutrition and physical activities on the illness before the infection. Result(s): According to the PSQI scale;the increases in discharged lymphocyte measurements were significant compared to the first hospitalization in the good and bad sleep group cases. A higher increase in NLR for the first hospitalization was seen in the bad sleep group compared to good sleep group. According to the MNA scale, all three groups had increased lymphocyte counts in discharge disposition in comparison to the first hospitalization. Patients at risk of malnutrition had higher increases in lymphocytes at discharge than malnourished individuals (p=0.049). Normal nutritional status had greater platelet measures than patients at risk of malnutrition (p=0.028). According to the IPAQ survey, very active cases had higher platelet measurements than minimally active cases. Discussion(s): In our study on the effect of lifestyle on the course of COVID-19 infection, patients with proper nutrition, good sleep quality, and sufficient physical activity did not require treatment in the ICU. This finding revealed the importance of adopting and maintaining a healthy lifestyle.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Bioavailability of iron and its potential to improve the immune system and ward off COVID-19: a review

Iron is a mineral that plays an important role, especially to prevent anaemia through the production of red blood cells. Iron also plays a role in physiological processes, such as the activation of enzymes and hormones, as well as increasing the immune system in warding off various viral infections. Therefore, iron bioavailability needs to be considered to take the greatest benefit of iron. This review discussed the factors that can affect the bioavailability of iron, various technologies to increase the bioavailability, and its potential in enhancing the immune system. Iron bioavailability can be increased by fortification, fermentation, the addition of vitamin C, and iron encapsulation. Under conditions of adequate iron intake, iron plays an important role in enhancing the immune system through controlling lymphocytes and T cell proliferation. However, excess iron consumption can be at risk of weakening the host's immune response to viruses. Therefore, the appropriate level of iron intake must be maintained accurately to be used optimally and has the potential to ward off viral infections, including the Sars-CoV-2 virus as the cause of COVID-19.Copyright © 2023, Rynnye Lyan Resources. All rights reserved.

The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients.

BACKGROUND & AIMS: Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality. METHODS: This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72 h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values < 50th percentile for sex and age were considered low. CC values of ≤33 cm for women and ≤34 cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected. RESULTS: A total of 249 patients were included (53.4% men, 62.2 ± 13.9 years of age, SOFA severity score 9.6 ± 3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p < 0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR = 2.63; 95% CI 1.65-4.18) or reduced MAC (HR = 2.11; 95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age. CONCLUSION: Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality.

Can PNI and CONUT Scores Predict One-year Survival Both in Older and Younger Hospitalized Patients with COVID-19?

Objective: This study aimed to find out the prognostic effect of the prognostic nutritional index (PNI) and controlling nutritional status (CONUT) score for 1-year mortality prediction in older (≥65 years) and younger (<65 years) hospitalized Coronavirus disease-2019 (COVID-19) patients, separately. Materials and Methods: This retrospective and the observational study included 368 patients who were admitted to a single tertiary care university hospital due to COVID-19 disease with positive severe acute respiratory syndrome-coronavirus-2 real-time reverse transcriptase-polymerase chain reaction test. Multivariable Cox regression analyses were performed to predict 1-year mortality prediction for the older and younger groups. Results: Among 368 patients, 112 (30.4%) patients were 65 years and older. There were 45 (12.2%) deaths at the end of the 1-year follow-up. The 1-year mortality rate was higher in the older group (23.2% vs 7.4%). When all patients were analyzed (n=368), PNI [hazard ratio (HR)=0.924, 95% confidence interval (CI)=0.877-0.974, p=0.003] and CONUT (HR=1.423, 95% CI=1.194-1.696, p<0.001) scores were significantly associated with 1-year mortality in multivariable model. When older and younger groups were assessed separately;PNI and CONUT scores failed to estimate 1-year mortality in the older group. On the other hand, the independent estimating capacities of PNI (HR=0.899, 95% CI=0.836-0.966, p=0.004) and CONUT (HR=1.944, 95% CI=1.478-2.557, p<0.001) scores increased when the only younger group was taken into analysis. Conclusion: PNI and CONUT scores as indicators of nutritional and immune status, predicted 1-year mortality in hospitalized COVID-19 patients. However, their prognostic effects in older patients with COVID-19 may be less prominent. Future, large sample studies are needed to provide data about geriatric COVID-19 patients. © Copyright 2022 by the Academic Geriatrics Society / European Journal of Geriatrics and Gerontology published by Galenos Publishing House.

Biochemical and Anthropometric Nutritional Assessment in Children Infected with COVID-19: A Cross-sectional Study

BACKGROUND: Severe acute respiratory syndrome has led to a pandemic of coronavirus disease 2019 (COVID-19). Malnutrition either biochemically or anthropometrically is a well-known risk factor for COVID-19 and may be the vice versa AIM: The objectives of this study were to investigate the prevalence of malnutrition in children infected with COVID-19 through evaluating the nutritional biomarkers such as serum electrolytes, serum albumin, and hemoglobin together with the anthropometric assessment. METHODS: A cross-sectional study that was conducted at El-Matria Teaching Hospital for all children admitted with confirmed COVID-19 for 6 months from February 1, 2021 to the end of July, 2021. Nutritional biochemical evaluation included serum electrolytes particularly the potassium and other nutritional biomarkers such as serum albumin and hemoglobin. Nutritional anthropometric evaluation depended on body mass index, the height/length, weight for length, and weight for height. The prevalence of malnutrition esp. hypokalemia was the main outcome. RESULTS: Hypokalemia was present in 21.8% of the study participants. Other nutritional biomarkers were found as hyponatremia, hypocalcemia, hypophosphatemia, and hypomagnesemia were detected in 49.1%, 38.2%, 21.8%, and 34.5% of the study subjects, respectively. Anthropometric malnutrition was present in most of the enrolled children with COVID-19 in the study (65.5 % [n = 36]) through which overweight and obese children occupied a greater percentage. CONCLUSION: Malnutrition either biochemically or anthropometrically could be linked to COVID-19 in children. COVID-19 could have negative outcomes on the nutritional status such as electrolytes disturbances. Both malnutrition and COVID-19 are considered synergistic associations.

Assessing the relationship between malnutrition and length of stay in the hospital in patients with COVID 19

Malnutrition is a particularly serious problem, which indicates a poor outcome in terms of morbidity, quality of life, length of stay in the hospital and mortality1. This study was conducted to assess the relationship between malnutrition and hospitalized duration in patients with COVID-192. [Formula presented] An epidemiological study was conducted where in total 250 COVID hospitalised patients from 3 hospitals in MultiSpeciality hospitals in urban setting were included in the study from December 2020 to April 2021 with mean age 59 ± 8.8 yrs. Nutritional assessment on admission was done using the “Global leadership Initiative on Malnutrition (GLIM)” assessment tool. In accordance with the GLIM criteria, patients were divided into 2 groups- well-nourished and under nourished. On comparing the two groups, under nourished patients had a longer hospitalization time (16.36±5.81 days versus 31.04±6.91 days, P = 0.001). Kaplan-Meier analysis showed patients with malnutrition were more likely to be hospitalized longer compared to those with normal nutrition. Elderly patients in malnutrition group were higher than in well-nourished group, and similar pattern was seen with higher proportion of diabetics (22.8% versus 56%, p= 0.002), the proportion of low lymphocytes was higher (14.0% versus 34.4%, p=0.047), the neutrophil/lymphocyte ratio (NLR) was higher (1.88[1.15, 2.29] versus 2.39[1.81, 4.20], p=0.001). The current findings revealed that malnutrition played a role in predicting the likelihood of prolonged hospitalisation in COVID-19 infection patients, who should be given special attention and precautions throughout clinical treatments. Malnutrition assessment in inpatients with nutritional risk thus is important and nutritional support treatment should be started as soon as possible. References 1. Li T, Zhang Y, Gong C, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020, 74(6): 871–875. 2. Coats KG, Morgan SL, Bartolucci AA, Weinsier RL. Hospital-associated malnutrition: a reevaluation 12 years later. J Am Diet Assoc. 1993, 93(1): 27–33.

MAPPING DATA OPPORTUNITIES RELATING TO FOOD, NUTRITION AND HEALTH IN THE COVID-19 PANDEMIC

Background The COVID-19 pandemic has impacted the nutrition and health of individuals, households, and populations globally. Through exposing fragilities in food, health, and social welfare systems, the negative influence of COVID-19 continues to affect the global burden of malnutrition. The nature and scale of these impacts are not yet well understood thus the body of evidence for informing policy is limited. Collating and monitoring relevant data in real-time from multiple levels, sectors and sources is essential in preparing and responding to the ongoing COVID-19 pandemic. Objectives To identify key data sources related to food, nutrition, and health indicators in the context of the COVID-19 pandemic. Methods A COVID-19, food, nutrition and health framework was developed through multiple iterative rounds of online multidisciplinary discussions including the NNEdPro COVID- 19 taskforce and the Swiss Re Institute's Republic of Science, which comprised researchers and clinicians with expertise in data science, food, nutrition, and health. Results The proposed framework encompasses five socio-ecological levels which were further sub-divided by six categories of the food and nutrition ecosystem, including food production & supply, food environment & access, food choices & dietary patterns, nutritional status & comorbidities, health & disease outcomes, health & nutrition services. A limited number of exemplar variables for the assessment of global status of food, nutrition and health are identified under each category. Discussion/Conclusion This collaborative framework is the first step towards the development of a better understanding of the impact of COVID-19 on food, nutrition, and health systems. Limited data availability and disruption in routine data collection as well as other nutrition assessments during the pandemic are challenges that might limit the potential of the proposed framework. Next steps will include formal research and data gap analysis and the identification, as well as utilisation, of other indicators that could be used as proxies of the variables identified. (Table Presented).

Predictive toxicity markers in elderly patients underwent RT and managed by an oncogeriatric model

Purpose or Objective A growing number of elderly patients every year is treated with radiation therapy (RT), but little is known about side effects and outcome of irradiation in this potentially frail population. The identification of predictive factors of toxicity and frailty could offer a personalized treatment approach, thanks also to a multidisciplinary management of patients with increased risk of adverse outcomes. In this study we investigated the correlation of patient parameters with acute toxicities in elderly aged > 75 years treated with curative RT. Materials and Methods A prospective observational study was designed in our Center for patients with > 75years, candidate for curative RT. To these patients the radiation oncologist submitted the Geriatric 8 questionnaire (G8q) before and at the end of RT. Patients with G8 score < 14 were then evaluated by a multidimensional geriatric assessment, investigating cognitive (MMSE, GDS), functional (ADL, IADL, Tinetti) and nutritional (MNA short) domains, to define the frailty phenotype. In this setting, we retrospectively analyzed parameters like body mass index (BMI), number of comorbidities, total blood count, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR) and basal G8 score, and correlated these parameters to acute toxicity. Results G8q was administered to 150 patients from December 2019 to April 2021. In this study we included 98 patients who started and completed RT in our Unit in this period. Of them, 38 (38.8%) had a baseline G8 score < 14 (range 4-14) and 23 agreed to underwent a multidimensional assessment, while 15 could not be evaluated due to COVID-19 dispositions or their refusal. Eleven patients resulted fit, while 12 patients were classified as vulnerable. Acute toxicity grade was < grade 2 in 67 patients (68.4%) (Table 1). We evaluated associations between BMI, number of comorbidities, total blood count, NLR, PLR, G8 score and acute toxicity (Table 2). Total blood count, NLR, PLR and G8 score resulted not significantly correlated to toxicity. Instead, a higher BMI was associated with worse acute toxicity (p=0.031): considering the 31 patients reporting toxicity > grade 2, 17 patients were over-weighted (54.8%), 1 patient was under-weighted (3.2%). Overall, the 63.3% of population (62 patients) was over-weighted, with a median BMI of 26.3. (Table Presented) (Table Presented) Conclusion Although G8q considers under-weight as a possible responsible of frailty, our study suggested that attention should be paid to over-weight too, due to its prevalence in elderly patients. Furthermore our results suggested that in elderly patients > 75years the BMI correlates with worse acute toxicity, according to literature data. The 38.8% of patients needed a multidimensional evaluation;this approach resulted useful in order to obtain compliance to the treatment without increased toxicity. The study is still ongoing and further analysis will be done.