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1.
Curr Opin Clin Nutr Metab Care ; 23(4): 288-293, 2020 07.
Article in English | MEDLINE | ID: covidwho-1722683

ABSTRACT

PURPOSE OF REVIEW: The Covid-19 pandemic has daunted the world with its enormous impact on healthcare, economic recession, and psychological distress. Nutrition is an integral part of every person life care, and should also be mandatorily integrated to patient care under the Covid-19 pandemic. It is crucial to understand how the Covid-19 does develop and which risk factors are associated with negative outcomes and death. Therefore, it is of utmost importance to have studies that respect the basic tenets of the scientific method in order to be trusted. The goal of this review is to discuss the deluge of scientific data and how it might influence clinical reasoning and practice. RECENT FINDINGS: A large number of scientific manuscripts are daily published worldwide, and the Covid-19 makes no exception. Up to now, data on Covid-19 have come from countries initially affected by the disease and mostly pertain either epidemiological observations or opinion papers. Many of them do not fulfil the essential principles characterizing the adequate scientific method. SUMMARY: It is crucial to be able to critical appraise the scientific literature, in order to provide adequate nutrition therapy to patients, and in particular, to Covid-19 infected individuals.


Subject(s)
Coronavirus Infections , Nutrition Disorders , Nutrition Therapy/standards , Nutritional Physiological Phenomena , Pandemics , Pneumonia, Viral , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Nutrition Disorders/epidemiology , Nutrition Disorders/etiology , Nutrition Disorders/therapy , Nutrition Therapy/methods , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Risk Factors
2.
Nutrients ; 13(3)2021 Mar 06.
Article in English | MEDLINE | ID: covidwho-1383899

ABSTRACT

In 2020, with the advent of a pandemic touching all aspects of global life, there is a renewed interest in nutrition solutions to support the immune system. Infants are vulnerable to infection and breastfeeding has been demonstrated to provide protection. As such, human milk is a great model for sources of functional nutrition ingredients, which may play direct roles in protection against viral diseases. This review aims to summarize the literature around human milk (lactoferrin, milk fat globule membrane, osteopontin, glycerol monolaurate and human milk oligosaccharides) and infant nutrition (polyunsaturated fatty acids, probiotics and postbiotics) inspired ingredients for support against viral infections and the immune system more broadly. We believe that the application of these ingredients can span across all life stages and thus apply to both pediatric and adult nutrition. We highlight the opportunities for further research in this field to help provide tangible nutrition solutions to support one's immune system and fight against infections.


Subject(s)
COVID-19/immunology , Food Ingredients/analysis , Immune System/virology , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , COVID-19/therapy , Female , Functional Food/analysis , Humans , Infant , Infant Nutritional Physiological Phenomena/immunology , Male , Nutrition Therapy/methods
4.
Nutrients ; 13(7)2021 Jun 30.
Article in English | MEDLINE | ID: covidwho-1288968

ABSTRACT

Background & Aims: SARS-CoV2 infection is associated with an increased risk of malnutrition. Although there are numerous screening and nutritional management protocols for malnutrition, only few studies have reported nutritional evolution after COVID-19. The objectives of this study were to describe the evolution of nutritional parameters between admission and 30 days after hospital discharge, and to determine predictive factors of poor nutritional outcome after recovery in adult COVID-19 patients. Methods: In this observational longitudinal study, we report findings after discharge in 91 out of 114 patients initially admitted for COVID-19 who received early nutritional management. Nutritional status was defined using GLIM criteria and compared between admission and day 30 after discharge. Baseline predictors of nutritional status at day 30 were assessed using logistic regression. Results: Thirty days after discharge, 28.6% of patients hospitalized for COVID-19 were malnourished, compared to 42.3% at admission. Half of malnourished patients (53%) at admission recovered a normal nutritional status after discharge. Weight trajectories were heterogeneous and differed if patients had been transferred to an intensive care unit (ICU) during hospitalization (p = 0.025). High oxygen requirement during hospitalization (invasive ventilation p = 0.016 (OR 8.3 [1.6-61.2]) and/or oxygen therapy over 5 L/min p = 0.021 (OR 3.2 [1.2-8.9]) were strong predictors of malnutrition one month after discharge. Conclusions: With early nutritional management, most patients hospitalized for COVID-19 improved nutritional parameters after discharge. These findings emphasize the importance of nutritional care in COVID-19 patients hospitalized in medicine departments, especially in those transferred from ICU.


Subject(s)
COVID-19/diet therapy , Hospitalization , Malnutrition/epidemiology , Nutritional Status , Adult , Aged , Aged, 80 and over , Female , Humans , Intensive Care Units , Logistic Models , Longitudinal Studies , Male , Middle Aged , Nutrition Assessment , Nutrition Therapy/methods , Oxygen Inhalation Therapy/statistics & numerical data , Patient Discharge , Risk Factors , SARS-CoV-2 , Severity of Illness Index
5.
Diabetes Metab Syndr ; 15(4): 102189, 2021.
Article in English | MEDLINE | ID: covidwho-1284044

ABSTRACT

BACKGROUND: Vitamin-D is an immune-modulator which might be linked to disease severity by SARS-CoV-2. METHODS: Meta-analysis of RCTs and quasi-experimental studies, evaluating the role of vitamin-D supplementation in COVID patients was done. RESULTS: Total 5 studies (3 RCTs and 2 Quasi-experimental) including n = 467 patients were included. Vitamin D didn't reduce mortality (RR 0.55, 95%CI 0.22 to 1.39, p = 0.21), ICU admission rates (RR 0.20, 95% CI 0.01-4.26, p = 0.3) and need for invasive ventilation (RR 0.24, 95% CI 0.01-7.89, p = 0.42). CONCLUSION: No significant difference with vitamin-D supplementation on major health related outcomes in COVID-19. Well-designed RCTs are required addressing this topic.


Subject(s)
COVID-19/drug therapy , Dietary Supplements , Nutrition Therapy/methods , SARS-CoV-2/drug effects , Vitamin D/administration & dosage , Vitamins/administration & dosage , COVID-19/epidemiology , COVID-19/virology , Humans , Prognosis
6.
Nutrients ; 13(3)2021 Mar 06.
Article in English | MEDLINE | ID: covidwho-1244083

ABSTRACT

In 2020, with the advent of a pandemic touching all aspects of global life, there is a renewed interest in nutrition solutions to support the immune system. Infants are vulnerable to infection and breastfeeding has been demonstrated to provide protection. As such, human milk is a great model for sources of functional nutrition ingredients, which may play direct roles in protection against viral diseases. This review aims to summarize the literature around human milk (lactoferrin, milk fat globule membrane, osteopontin, glycerol monolaurate and human milk oligosaccharides) and infant nutrition (polyunsaturated fatty acids, probiotics and postbiotics) inspired ingredients for support against viral infections and the immune system more broadly. We believe that the application of these ingredients can span across all life stages and thus apply to both pediatric and adult nutrition. We highlight the opportunities for further research in this field to help provide tangible nutrition solutions to support one's immune system and fight against infections.


Subject(s)
COVID-19/immunology , Food Ingredients/analysis , Immune System/virology , Milk, Human/chemistry , SARS-CoV-2/immunology , Adult , COVID-19/therapy , Female , Functional Food/analysis , Humans , Infant , Infant Nutritional Physiological Phenomena/immunology , Male , Nutrition Therapy/methods
8.
J Acad Nutr Diet ; 121(5): 979-987, 2021 05.
Article in English | MEDLINE | ID: covidwho-1195340

ABSTRACT

Recent evidence examining adults infected with coronavirus disease 2019 (COVID-19) has indicated a significant impact of malnutrition on health outcomes. Individuals who have multiple comorbidities, are older adults, or who are malnourished, are at increased risk of being admitted to the intensive care unit and of mortality from COVID-19 infections. Therefore, nutrition care to identify and address malnutrition is critical in treating and preventing further adverse health outcomes from COVID-19 infection. This document provides guidance and practice considerations for registered dietitian nutritionists providing nutrition care for adults with suspected or confirmed COVID-19 infection in the hospital, outpatient, or home care settings. In addition, this document discusses and provides considerations for registered dietitian nutritionists working with individuals at risk of malnutrition secondary to food insecurity during the COVID-19 pandemic.


Subject(s)
COVID-19/complications , Dietetics/methods , Malnutrition/therapy , Nutrition Therapy/methods , Practice Guidelines as Topic , Adult , Aged , Aged, 80 and over , Dietetics/standards , Female , Food Insecurity , Humans , Male , Malnutrition/virology , Middle Aged , Nutrition Therapy/standards , SARS-CoV-2
9.
Nutrients ; 13(4)2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1187013

ABSTRACT

The novel severe acute respiratory syndrome coronavirus (COVID-19) has hit older adults harder due to a combination of age-related immunological and metabolic alterations. The aim of this review was to analyze the COVID-19 literature with respect to nutritional status and nutrition management in older adults. No studies only on people aged 65+ years were found, and documentation on those 80+ was rare. Age was found to be strongly associated with worse outcomes, and with poor nutritional status. Prevalence of malnutrition was high among severely and critically ill patients. The studies found a need for nutrition screening and management, and for nutrition support as part of follow-up after a hospital stay. Most tested screening tools showed high sensitivity in identifying nutritional risk, but none were recognized as best for screening older adults with COVID-19. For diagnosing malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended but were not used in the studies found. Documentation of olfactory and gustatory dysfunction in relation to nutritional status is missing in older adults. Other COVID-19-associated factors with a possible impact on nutritional status are poor appetite and gastrointestinal symptoms. Vitamin D is the nutrient that has attracted the most interest. However, evidence for supplementation of COVID-19 patients is still limited and inconclusive.


Subject(s)
Aging , COVID-19/epidemiology , Nutrition Assessment , Nutrition Therapy/methods , Nutritional Status , Age Factors , Aged , Aged, 80 and over , Agnosia/epidemiology , COVID-19/therapy , Cytokine Release Syndrome/epidemiology , Female , Gastrointestinal Diseases/epidemiology , Hospitalization , Humans , Male , Malnutrition/epidemiology , Middle Aged , Olfaction Disorders/epidemiology , Prevalence , Risk Factors , SARS-CoV-2 , Sarcopenia/epidemiology , Vitamin D/therapeutic use
10.
Nutrients ; 13(3)2021 Mar 22.
Article in English | MEDLINE | ID: covidwho-1146555

ABSTRACT

BACKGROUND: People with upper gastrointestinal cancer are at high risk for malnutrition without universal access to early nutrition interventions. Very little data exist on the attitudes and views of health professionals on providing nutrition care to this patient cohort delivered by electronic health methods. COVID-19 has fast-tracked the adoption of digital health care provision, so it is more important than ever to understand the needs of health professionals in providing health care via these modes. This study aimed to explore the perspectives of health professionals on providing nutrition care to upper gastrointestinal cancer patients by electronic methods to allow the future scaling-up of acceptable delivery methods. METHODS: Semi-structured qualitative interviews were conducted face-to-face or by telephone and recorded, de-identified and transcribed. Thematic analysis was facilitated by NVivo Pro 12. RESULTS: Interviews were conducted on 13 health professionals from a range of disciplines across several public and private health institutions. Thematic analysis revealed three main themes: (1) the ideal model, (2) barriers to the ideal model and (3) how to implement and translate the ideal model. Health professionals viewed the provision of nutrition interventions as an essential part of an upper gastrointestinal cancer patient's treatment with synchronous, telephone-based internal health service models of nutrition care overwhelmingly seen as the most acceptable model of delivery. Mobile application-based delivery methods were deemed too challenging for the current population serviced by these clinicians. CONCLUSION: The use of novel technology for delivering nutrition care to people receiving treatment for upper gastrointestinal cancers was not widely accepted as the preferred method of delivery by health professionals. There is an opportunity, given the rapid uptake of digital health care delivery, to ensure that the views and attitudes of health professionals are understood and applied to develop acceptable, efficacious and sustainable technologies in our health care systems.


Subject(s)
Attitude of Health Personnel , COVID-19/epidemiology , Gastrointestinal Neoplasms/therapy , Nutrition Therapy/methods , Adult , COVID-19/complications , Female , Health Services Accessibility , Humans , Interviews as Topic , Male , Middle Aged , Mobile Applications , Nutrition Therapy/psychology , Telemedicine/methods , Trust
11.
J Hum Nutr Diet ; 34(4): 660-669, 2021 08.
Article in English | MEDLINE | ID: covidwho-1140262

ABSTRACT

BACKGROUND: During the global COVID-19 pandemic, UK dietitians have delivered the best care to help patients recover from the infection. The present study examined the development and evaluation of care pathways to manage nutritional care of patients following COVID-19 infection prior to and after discharge. METHODS: Registered UK dietitians completed an online questionnaire comprising 26 questions about the development of a pathway, its use, evaluation and training needs. RESULTS: Of 57 responses from organisations, 37 (65%) were involved in the planning/management of nutritional care. Only 19 responses had a new or adapted COVID-19 pathway. Of these, 74% reported involvement of dietetic services, 47% reported > 1 eligibility criteria for pathway inclusion and 53% accepted all positive or suspected cases. All respondents used nutritional screening, first-line dietary advice (food first) and referral for further advice and monitoring. Weight and food intake were the most used outcome measure. All pathways addressed symptoms related to nutrition, with the most common being weight loss with poor appetite, not being hungry and skipping meals in 84% of pathways. Over half of respondents (54%) planned to evaluate their pathway and 83% reported that they were 'very or reasonably confident' in their team's nutritional management of COVID-19. Less than half (42%) reported on training needs. CONCLUSIONS: Despite challenges encountered, pathways were developed and implemented. Dietitians had adapted to new ways of working to manage nutritional care in patients prior to and after discharge from hospital following COVID-19 infection. Further work is needed to develop strategies for evaluation of their impact.


Subject(s)
COVID-19/diet therapy , Critical Pathways , Nutrition Therapy/statistics & numerical data , Nutritionists/statistics & numerical data , Patient Discharge , Humans , Length of Stay , Long-Term Care/methods , Long-Term Care/statistics & numerical data , Nutrition Therapy/methods , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom
12.
Nutr Clin Pract ; 36(2): 275-281, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1139279

ABSTRACT

Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC). Key evidence supporting the routine use of IC in the ICU includes (1) universal societal ICU nutrition guidelines recommending IC to determine energy requirements; (2) data showing predictive equations or body weight calculations that are consistently inaccurate and correlate poorly with measured energy expenditure, ultimately leading to routine overfeeding and underfeeding, which are both associated with poor ICU outcomes; (3) recent development and worldwide availability of a new validated, accurate, easy-to-use IC device; and (4) recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery. As we would not deliver vasopressors without accurate blood pressure measurements, the ICU community is only likely to embrace an increased focus on the importance of early nutrition delivery when we can consistently provide objective IC measures to ensure personalized nutrition care delivers the right nutrition dose, in the right patient, at the right time to optimize clinical outcomes.


Subject(s)
COVID-19/complications , Calorimetry, Indirect/standards , Critical Care/standards , Malnutrition/diagnosis , Nutrition Assessment , COVID-19/physiopathology , Calorimetry, Indirect/methods , Critical Care/methods , Critical Care Outcomes , Critical Illness/therapy , Energy Metabolism , Humans , Intensive Care Units , Malnutrition/prevention & control , Malnutrition/virology , Nutrition Therapy/methods , Nutrition Therapy/standards , Nutritional Requirements , Nutritional Status , SARS-CoV-2
13.
Nutr Hosp ; 37(5): 984-998, 2020 Oct 21.
Article in Spanish | MEDLINE | ID: covidwho-1128243

ABSTRACT

INTRODUCTION: Introduction: in SARS-CoV-2-infected patients nutritional requirements are increased. These patients present symptoms that make food intake and nutrient absorption difficult, therefore involving nutritional risk. On the other hand, acute respiratory complications require prolonged ICU stays, and this predisposes to increased malnutrition and loss of skeletal muscle mass and function, which can lead to poor quality of life, disability and morbidity long after discharge. For this reason, the world's leading nutrition societies and associations believe that nutritional therapy should be considered a part of the basic treatment of patients with COVID-19. Methods: we have reviewed and compared 9 expert recommendations (ER) published by nutrition societies and associations from China, Spain, Brazil, Europe, Colombia, Australia, America, and the United Kingdom, in relation to critical and non-critical hospitalized patients due to the COVID-19 pandemic. Conclusions: the 9 ERs reviewed agree on the importance of nutritional management in critical and non-critical hospitalized patients with COVID-19, as well as on the early detection of nutritional risk, the intervention, and subsequent follow-up. Even so, each published document has its own particularities and puts a special stress on some specific aspect.


INTRODUCCIÓN: Introducción: la infección por SARS-CoV-2 implica riesgo nutricional debido a la dificultad de cubrir los requerimientos nutricionales aumentados en presencia de una sintomatología que dificulta la ingesta y la absorción de nutrientes. Por otro lado, las complicaciones respiratorias agudas requieren estancias prolongadas en unidades de cuidados intensivos (UCI) y esto predispone a una mayor desnutrición y a pérdida de masa y función del músculo esquelético, que a su vez puede conducir a una mala calidad de vida, discapacidad y morbilidad mucho después del alta. Por este motivo, las principales sociedades y asociaciones de nutrición clínica del mundo consideran que la terapia nutricional debe considerarse parte del tratamiento básico de los pacientes con COVID-19. Métodos: se han revisado y comparado 9 recomendaciones de expertos (RE) publicadas por sociedades y asociaciones de nutrición clínica de China, España, Brasil, Europa, Colombia, Australia, América y Reino Unido, a raíz de la pandemia por COVID-19, en relación a los pacientes hospitalizados críticos y no críticos. Conclusiones: las 9 RE revisadas coinciden en la importancia del tratamiento nutricional en los pacientes hospitalizados críticos y no críticos con COVID-19, así como en la detección precoz del riesgo nutricional, la intervención y el seguimiento. Aun así, cada documento publicado tiene sus propias particularidades e incide especialmente en algún aspecto.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Inpatients , Malnutrition , Nutrition Therapy/standards , Nutritional Requirements , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Australia , Brazil , COVID-19 , China , Colombia , Coronavirus Infections/therapy , Europe , Humans , Malnutrition/diagnosis , Malnutrition/diet therapy , Nutrition Therapy/methods , Pandemics , Pneumonia, Viral/therapy , SARS-CoV-2
14.
J Am Coll Nutr ; 40(4): 397-399, 2021.
Article in English | MEDLINE | ID: covidwho-1080715

ABSTRACT

The American Nutrition Association's 61st annual summit, Personalized Nutrition 2020, convened thought leaders and stakeholders to discuss innovations in personalized nutrition (PN) technology, science, and practice. Evolutions in PN science and technology are enabling novel inroads and applications, leading the ANA to launch a new component of its annual gathering, the Personalized Nutrition Business Leaders Forum. In light of renewed global interest in immune health during the COVID-19 pandemic, the flagship Science and Practice Conference focused on the topic of immune resilience. Presentations highlighted emerging research suggesting that individuals may have unique immunological responses to exogenous insults and that immune system resilience can be optimized by the application of nutritional factors that regulate immune function. Thus, PN tools and services may uniquely enhance immune preparedness by optimizing immune system function and status. Furthermore, PN practitioners trained to utilize emerging techniques and services can help prepare society to meet our modern immune challenges.HighlightsIn order to be effectively implemented, personalized nutrition requires ongoing research, innovative tools and services, and a specialized health care workforcePersonalized nutrition will continue to grow as an economic driver as consumer and patient interest surgeThere has been increased interest in the role of nutrition in immune function in light of COVID-19 and its comorbidities.


Subject(s)
COVID-19/diet therapy , COVID-19/immunology , Nutrition Therapy/methods , Nutritional Physiological Phenomena/immunology , Precision Medicine/methods , Congresses as Topic , Humans , SARS-CoV-2 , United States
15.
J Acad Nutr Diet ; 121(12): 2524-2535, 2021 12.
Article in English | MEDLINE | ID: covidwho-1032438

ABSTRACT

During the current coronavirus disease 2019 (COVID-19) pandemic, health care practices have shifted to minimize virus transmission, with unprecedented expansion of telehealth. This study describes self-reported changes in registered dietitian nutritionist (RDN) practice related to delivery of nutrition care via telehealth shortly after the onset of the COVID-19 pandemic in the United States. This cross-sectional, anonymous online survey was administered from mid-April to mid-May 2020 to RDNs in the United States providing face-to-face nutrition care prior to the COVID-19 pandemic. This survey included 54 questions about practitioner demographics and experience and current practices providing nutrition care via telehealth, including billing procedures, and was completed by 2016 RDNs with a median (interquartile range) of 15 (6-27) years of experience in dietetics practice. Although 37% of respondents reported that they provided nutrition care via telehealth prior to the COVID-19 pandemic, this proportion was 78% at the time of the survey. Respondents reported spending a median (interquartile range) of 30 (20-45) minutes in direct contact with the individual/group per telehealth session. The most frequently reported barriers to delivering nutrition care via telehealth were lack of client interest (29%) and Internet access (26%) and inability to conduct or evaluate typical nutrition assessment or monitoring/evaluation activities (28%). Frequently reported benefits included promoting compliance with social distancing (66%) and scheduling flexibility (50%). About half of RDNs or their employers sometimes or always bill for telehealth services, and of those, 61% are sometimes or always reimbursed. Based on RDN needs, the Academy of Nutrition and Dietetics continues to advocate and provide resources for providing effective telehealth and receiving reimbursement via appropriate coding and billing. Moving forward, it will be important for RDNs to participate fully in health care delivered by telehealth and telehealth research both during and after the COVID-19 public health emergency.


Subject(s)
COVID-19/epidemiology , Nutrition Therapy/methods , Nutrition Therapy/statistics & numerical data , Nutritionists/statistics & numerical data , SARS-CoV-2 , Telemedicine/statistics & numerical data , Cross-Sectional Studies , Delivery of Health Care/economics , Delivery of Health Care/methods , Delivery of Health Care/statistics & numerical data , Dietetics/methods , Dietetics/statistics & numerical data , Humans , Nutritionists/economics , Reimbursement Mechanisms/economics , Reimbursement Mechanisms/statistics & numerical data , Surveys and Questionnaires , Telemedicine/economics , Telemedicine/methods , United States/epidemiology
17.
Trials ; 21(1): 1031, 2020 Dec 28.
Article in English | MEDLINE | ID: covidwho-992543

ABSTRACT

BACKGROUND: With the lack of effective therapy, chemoprevention, and vaccination against SARS-CoV-2, focusing on the immediate repurposing of existing drugs gives hope of curbing the COVID-19 pandemic. A recent unbiased genomics-guided tracing of the SARS-CoV-2 targets in human cells identified vitamin D among the three top-scoring molecules manifesting potential infection mitigation patterns. Growing pre-clinical and epidemiological observational data support this assumption. We hypothesized that vitamin D supplementation may improve the prognosis of COVID-19. The aim of this trial is to compare the effect of a single oral high dose of cholecalciferol versus a single oral standard dose on all-cause 14-day mortality rate in COVID-19 older adults at higher risk of worsening. METHODS: The COVIT-TRIAL study is an open-label, multicenter, randomized controlled superiority trial. Patients aged ≥ 65 years with COVID-19 (diagnosed within the preceding 3 days with RT-PCR and/or chest CT scan) and at least one worsening risk factor at the time of inclusion (i.e., age ≥ 75 years, or SpO2 ≤ 94% in room air, or PaO2/FiO2 ≤ 300 mmHg), having no contraindications to vitamin D supplementation, and having received no vitamin D supplementation > 800 IU/day during the preceding month are recruited. Participants are randomized either to high-dose cholecalciferol (two 200,000 IU drinking vials at once on the day of inclusion) or to standard-dose cholecalciferol (one 50,000 IU drinking vial on the day of inclusion). Two hundred sixty participants are recruited and followed up for 28 days. The primary outcome measure is all-cause mortality within 14 days of inclusion. Secondary outcomes are the score changes on the World Health Organization Ordinal Scale for Clinical Improvement (OSCI) scale for COVID-19, and the between-group comparison of safety. These outcomes are assessed at baseline, day 14, and day 28, together with the serum concentrations of 25(OH)D, creatinine, calcium, and albumin at baseline and day 7. DISCUSSION: COVIT-TRIAL is to our knowledge the first randomized controlled trial testing the effect of vitamin D supplementation on the prognosis of COVID-19 in high-risk older patients. High-dose vitamin D supplementation may be an effective, well-tolerated, and easily and immediately accessible treatment for COVID-19, the incidence of which increases dramatically and for which there are currently no scientifically validated treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344041 . Registered on 14 April 2020 TRIAL STATUS: Recruiting. Recruitment is expected to be completed in April 2021.


Subject(s)
COVID-19/therapy , Dietary Supplements , Nutrition Therapy/methods , Pandemics , Vitamin D/administration & dosage , Aged , COVID-19/epidemiology , Dose-Response Relationship, Drug , Female , Humans , Male , Risk Factors , SARS-CoV-2 , Time Factors , Treatment Outcome , Vitamins/administration & dosage
18.
Nutrition ; 82: 111048, 2021 02.
Article in English | MEDLINE | ID: covidwho-912519

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) carries a high risk for malnutrition owing to the state of debilitation that results from acute respiratory failure symptoms. The aim of this study was to provide an approach to reduce the risk for malnutrition and improve patients' clinical outcomes. METHODS: Short age-adjusted Nutritional Risk Screening was performed with 94 non-intensive care unit (ICU) patients admitted to the Giovanni Borea Civil Hospital in Sanremo. Forty-nine patients in the ICU were considered at risk for malnutrition without screening and were fed with enteral nutrition plus supplemental parenteral nutrition. In the non-ICU setting, patients underwent a personalized nutritional protocol, considering their conditions, which consisted of a high-protein and high-calorie pureed diet, oral nutritional supplements, and/or artificial nutrition or other personalized nutritional path. RESULTS: The nutritional treatment was well tolerated by the patients. Of the non-ICU patients, 19.1% died. They were mainly women, with higher body mass indices and older in age. Of the patients in the ICU, 53.1% died. Of the 94 non-ICU patients, 72 scored positive on at least one nutritional risk screening item (excluding age). Of the 94 non-ICU patients, 68 were >70 y of age. Non-ICU patients whose energy and protein needs were not met were older (P = 0.01) and had a higher death rate than patients whose needs were met (P < 0.001). CONCLUSIONS: This protocol should not be considered as a guideline; rather, it is intended to report the clinical experience of a nutrition team in an Italian reference center for the treatment of patients with COVID-19. Nutritional strategies should be implemented to prevent worsening of clinical outcomes.


Subject(s)
COVID-19/therapy , Malnutrition/prevention & control , Nutrition Therapy/methods , SARS-CoV-2 , Aged , COVID-19/blood , COVID-19/complications , Clinical Protocols , Dietary Supplements , Disease Outbreaks , Female , Hospitalization , Humans , Italy/epidemiology , Male , Malnutrition/virology , Middle Aged , Nutrition Assessment , Nutritional Status , Risk Assessment
19.
R I Med J (2013) ; 103(9): 30-33, 2020 Nov 02.
Article in English | MEDLINE | ID: covidwho-892698

ABSTRACT

BACKGROUND: Traditional rehabilitation services, whether they are cardiac, pulmonary, or vascular, consist of 6-36 center-based, supervised sessions; however, due to COVID-19, in-person visits were suspended. This study sought to implement a transitional home-based treatment plan (HBTP) to patients. METHOD: Patients enrolled in a rehabilitation service at the Miriam Hospital during the time of temporary closure were provided with a HBTP that was individualized to their needs and multi-disciplinary in nature. Patients were called weekly for continual guidance and support. RESULTS: Of the 129 patients that received a HBTP, 115 (89%) participated in follow-up correspondence (63±12 years, 83% white, 66% male, 81% enrolled in cardiac rehab). Nearly 70% of patients continued to participate in regular exercise and upon re-opening, 69 (60%) of patients returned to center-based care. Psychosocial factors appeared to inhibit treatment adherence. CONCLUSIONS: Patients are receptive to an HBTP and subsequent follow-up throughout temporary closure of rehabilitation services.


Subject(s)
Cardiac Rehabilitation/methods , Coronavirus Infections , Exercise Therapy/methods , Heart Diseases/rehabilitation , Lung Diseases/rehabilitation , Pandemics , Pneumonia, Viral , Vascular Diseases/rehabilitation , Adaptation, Psychological , Aged , Betacoronavirus , COVID-19 , Exercise Therapy/organization & administration , Female , Home Care Services/organization & administration , Humans , Male , Middle Aged , Nutrition Therapy/methods , Quality Improvement , Relaxation Therapy/methods , SARS-CoV-2
20.
Nutr Clin Pract ; 36(1): 105-109, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-888107

ABSTRACT

Acute respiratory distress syndrome (ARDS) is a complex disease characterized by inflammation, resulting in diffuse alveolar damage, proliferation, and fibrosis, and carries a high mortality rate. Recently, the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has overwhelmed healthcare systems worldwide, as many patients have required hospitalization for the management of respiratory failure similar in nature to ARDS. In addition to lung-protective ventilation strategies aimed to maintain an oxygen saturation >90%, a ratio of partial pressure of oxygen to fraction of inspired oxygen >200, a pH of 7.25-7.40, and a plateau pressure <35 cm H2 O, prone positioning has emerged as an effective treatment strategy for severe ARDS by improving oxygenation and secretion clearance. Although early nutrition assessment and intervention are recommended for acutely and critically ill patients, rotational therapy may present challenges in providing this care. Here, we will describe the pathophysiology of ARDS and the rationale for use of prone positioning and review the considerations and challenges of providing nutrition therapy for patients in the prone position.


Subject(s)
COVID-19/drug therapy , COVID-19/physiopathology , COVID-19/therapy , Nutrition Therapy/methods , Prone Position , COVID-19/virology , Humans , Respiration, Artificial/methods , SARS-CoV-2
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