ABSTRACT
Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.
ABSTRACT
Introduction: Dietary therapy for eosinophilic esophagitis (EoE) is an effective first-line treatment aimed at identifying triggers by systematically removing then reintroducing food groups. Success on diet therapy can be augmented by working with a dietitian, but this is not a universal clinical resource. Virtual or telehealth approaches to nutrition care may offer opportunities to implement diet therapy for EoE. We conducted a retrospective study at a tertiary center with six GI dietitians to compare real-world standard in-person versus virtual EoE nutrition practices in terms of access, follow-up< and disease control. Method(s): We identified adults with EoE referred to GI nutrition through query of the electronic medical record by ICD-10 diagnoses and confirmed by chart review. As all nutrition visits prior to the COVID pandemic were performed in-person, standard care was defined as care established in January-December 2019 and virtual care in January-December 2021. Associations were analyzed using Chi-squared and Student's t test (Table). Result(s): A total of 204 patients were included;99 referred for standard in-person and 105 virtual nutrition care. The cohorts did not differ significantly by gender, age at the time of referral, race, and distance lived to our center. Of these, 55.6% (55) standard and 48.6% (51) virtual visits were completed with a dietitian (p=0.341) and 4-food elimination diet was the most commonly planned diet. The majority initiated the diet (80.0% standard, 78.4% virtual, p=0.842) and among them, half successfully attained histologic remission with the elimination phase (63.6% standard, 47.5% virtual, p=0.324). Ultimate treatments plans included remaining on dietary therapy (25.5% standard, 23.5% virtual, p=0.728), no treatment or lost to follow-up (34.6% standard, 25.5% virtual), and medication (25.5% standard, 41.2% virtual). Conclusion(s): There is a growing demand for nutrition care in EoE and in our tertiary practice, we found no differences in the success and response rate on elimination diet or follow-up between patients receiving standard or virtual nutrition care. Virtual approaches to implementing EoE dietary therapy may serve to complement in-person care and offer opportunities for those lacking local dietitian access. However, up to one-third of patients are lost to follow-up or remain untreated, also highlighting a need to identify, understand, and overcome barriers to treatment uptake and disease control .
ABSTRACT
The incidence of Eosinophilic Oesophagitis (EoE) is increasing worldwide in the paediatric population. Management of these children is complex, and includes elimination diet (2/4/6 food), steroids etc. It is recommended to perform endoscopies between each reintroduction to assess disease activity. In our centre dietary exclusion is the standard practice. Since 2019 we follow a step-up approach with regards to elimination diet starting with 2 food exclusion diet (FED) and building up as required. Food is reintroduced gradually with significant dietetic support and proactive monitoring including endoscopy. Objectives We looked at the outcomes of children with EoE referred to Maidstone and Tunbridge Wells NHS Trust from Kent and East Sussex. Methods Retrospective review of case notes of paediatric patients diagnosed with EoE between January 2015 and December 2020. Data collected included symptoms, endoscopy findings and histology at diagnosis and compared the same after dietary intervention. Results 21 patients were diagnosed with EoE between January 2015 and December 2020 between 5-16 yrs Median age at diagnosis 11years. Frequently seen in boys (65%). Dysphagia was the predominant symptom (76%) followed by vomiting (60%), abdominal pain (50%), and choking (20%). Features of EoE were seen during endoscopy in 71% and oesophagus looked endoscopically normal in 29% of patients. Diagnosis was made on eosinophil count as per ESPGHAN guidance. The frequency and timing of repeat endoscopies following dietary intervention varied due to a multitude of factors including COVID-19 restrictions (between 4-9 months median 4 months). Histological remission (Eosinophils <15 pHPF) was achieved in 15/21 (70%) of patients. 7/10 children on 2FED, 3/3 patients on 4FED and 5/5 children on 6FED achieved histological resolution. The 6FED group took significantly longer to identify the causative food, establish long term dietary management and required more endoscopies. Food was reintroduced gradually on an individual basis with the aim of introducing back all food groups. 13/15 continue to be on milk free diet, 5/15 remain on milk and wheat free diet, 1/15 on soya and egg free diet and the other patient remains on 4FED (parental choice). 2 patients have started steroids due to on-going symptoms findings on surveillance endoscopy and histological following re-introduction. Summary and Conclusion Dysphagia was the predominant symptom in our cohort of patients. Furrowing and oedema was the major finding during endoscopy. With dietary exclusion endoscopic resolution was seen in 62% and histological resolution seen in 70% of patients at first surveillance endoscopy. Re-introduction continues to remains a major challenge and we have not been able to introduce all the food groups in any of our patients due to either symptoms or recurrence on endoscopy/histology.
ABSTRACT
The prolonged immobilization associated with COVID-19 infection and the restrictions imposed by the pandemic have determined major changes in physical activity and eating habits, with a negative impact on physical performance. This study monitored non-pharmacological interventions (diet therapy and probiotics) in managing sarcopenia for patients with recent SARS-CoV-2 history (14 days). A prospective study was performed on 200 patients (between December 2020-December 2021), with SPPB score < 9, randomly divided into: Group K-DP (93 patients) with dietary therapy (protein 1.2-1.5 g/kg) and probiotics for two months; and Group K-non-DP (107 patients) without diet therapy and probiotics. All patients were included in a specific physical training program (40 min), three sessions per week. Skeletal muscle index (SMI), serum albumin, and hemoglobin were determined. The SMI was initially low for both groups without significant statistical differences (6.5 ± 0.52 kg/m2 for Group K-non-DP vs. 6.7 ± 0.57 Kg/m2 for Group K-DP, p = 0.135). After two months, significant difference between initial and final SMI values was determined for Group K-DP (6.92 ± 0.50 kg/m2 vs. 6.77 ± 0.56 kg/m2, p = 0.048). In Group K-DP, at end of study, were more patients with normal SMI (n = 32 â N = 70) values (p < 0.001) and fewer sarcopenia patients (p < 0.001). The initial serum albumin means values in the two groups (Group K-non-DP, 4.17 ± 1.04 g/dL, and Group K-DP, 3.95 ± 0.98 g/dL) were not statistically significantly different (p = 0.122). The hemoglobin level improved significantly following a hyper protein diet enriched with pro-biotics (p = 0.003). Diet therapy, consisting of increased protein intake and specific probiotics and specific physical therapy, demonstrated superiority in improving the functional status of patients with recent COVID-19 infection.