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1.
Nutrients ; 13(9)2021 Aug 27.
Article in English | MEDLINE | ID: covidwho-1374476

ABSTRACT

The virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the disease coronavirus disease 2019 (COVID-19). The cumulative number of cases reported globally is now nearly 197 million and the number of cumulative deaths is 4.2 million (26 July to 1 August 2021). Currently we are focusing primarily on keeping a safe distance from others, washing our hands, and wearing masks, and the question of the effects of diet and diet-dependent risk factors remains outside the center of attention. Nevertheless, numerous studies indicate that diet can play an important role in the course of COVID-19. In this paper, based on select scientific reports, we discuss the structure and replication cycle of SARS-CoV-2, risk factors, dietary standards for sick patients, and the roles of the microbiome and dietary components supporting the immune system in preventing COVID-19.


Subject(s)
COVID-19/diet therapy , Feeding Behavior , Gastrointestinal Microbiome/immunology , Nutritional Support/methods , SARS-CoV-2/immunology , COVID-19/epidemiology , COVID-19/immunology , COVID-19/prevention & control , Humans , Micronutrients/administration & dosage , Probiotics/administration & dosage , Risk Factors , Severity of Illness Index , Virus Replication/immunology
2.
Br J Nurs ; 30(13): S12-S18, 2021 Jul 08.
Article in English | MEDLINE | ID: covidwho-1311465

ABSTRACT

The need to offer nutritional support to children and young people is commonplace for health professionals. This article explores the use and indication of nasogastric tubes (NGT) in children and young people, before explaining the process of inserting NGTs and the ongoing management of this method of nutritional support.


Subject(s)
Enteral Nutrition , Intubation, Gastrointestinal , Nutritional Support , Adolescent , Child , Enteral Nutrition/nursing , Humans , Intubation, Gastrointestinal/nursing , Nutritional Support/methods , Nutritional Support/nursing
3.
Clin Nutr ESPEN ; 44: 173-187, 2021 08.
Article in English | MEDLINE | ID: covidwho-1283999

ABSTRACT

COVID-19 has re-established the significance of analyzing the organism through a metabolic perspective to uncover the dynamic interconnections within the biological systems. The role of micronutrient status and metabolic health emerge as pivotal in COVID-19 pathogenesis and the immune system's response. Metabolic disruption, proceeding from modifiable factors, has been proposed as a significant risk factor accounting for infection susceptibility, disease severity and risk for post-COVID complications. Metabolomics, the comprehensive study and quantification of intermediates and products of metabolism, is a rapidly evolving field and a novel tool in biomarker discovery. In this article, we propose that leveraging insulin resistance biomarkers along with biomarkers of micronutrient deficiencies, will allow for a diagnostic window and provide functional therapeutic targets. Specifically, metabolomics can be applied as: a. At-home test to assess the risk of infection and propose nutritional support, b. A screening tool for high-risk COVID-19 patients to develop serious illness during hospital admission and prioritize medical support, c(i). A tool to match nutritional support with specific nutrient requirements for mildly ill patients to reduce the risk for hospitalization, and c(ii). for critically ill patients to reduce recovery time and risk of post-COVID complications, d. At-home test to monitor metabolic health and reduce post-COVID symptomatology. Metabolic rewiring offers potential virtues towards disease prevention, dissection of high-risk patients, taking actionable therapeutic measures, as well as shielding against post-COVID syndrome.


Subject(s)
COVID-19/complications , Malnutrition/complications , Malnutrition/therapy , Micronutrients , Nutritional Status , Nutritional Support/methods , Humans , Risk Assessment , SARS-CoV-2 , Severity of Illness Index
4.
Clin Nutr ESPEN ; 44: 38-49, 2021 08.
Article in English | MEDLINE | ID: covidwho-1260690

ABSTRACT

BACKGROUND: Nutritional status is an often-overlooked component in infectious disease severity. Hospitalized or critically ill patients are at higher risk of malnutrition, and rapid assessment and treatment of poor nutritional status can impact clinical outcomes. As it relates to the COVID-19 pandemic, an estimated 5% of these patients require admission to an ICU. Per clinical practice guidelines, nutrition therapy should be a core component of treatment regimens. On account of the urgent need for information relating to the nutritional support of these patients, clinical practice guidance was published based on current critical care guidelines. However, a growing body of literature is now available that may provide further direction for the nutritional status and support in COVID-19 patients. This review, intended for the health care community, provides a heretofore lacking in-depth discussion and summary of the current data on nutrition risk and assessment and clinical practice guidelines for medical nutrition therapy for hospitalized and critically ill patients with COVID-19.


Subject(s)
COVID-19/complications , COVID-19/therapy , Critical Care/methods , Inpatients , Malnutrition/complications , Malnutrition/therapy , Nutritional Support/methods , Critical Illness , Hospitalization , Humans , Nutritional Status , Pandemics , Prevalence , Risk Assessment , SARS-CoV-2
5.
Clin Nutr ESPEN ; 44: 469-471, 2021 08.
Article in English | MEDLINE | ID: covidwho-1252603

ABSTRACT

BACKGROUND & AIMS: Evidence suggests the existence of an association between the institution of nutritional therapy and clinical outcomes in patients with critical COVID-19. Thus, the aim of this study was to evaluate the influence of nutritional assistance on COVID-19 mortality in patients admitted to intensive care units (ICU). METHODS: This is a subset of the cohort "Influence of nutritional therapy on clinical prognosis in patients with COVID-19: a multicenter retrospective cohort study". Clinical and nutrition assistance information (type of assistance, evaluation of anthropometric status, and time of introduction of nutritional therapy) and presence of diabetes, hypertension and previous respiratory disease were collected from electronic medical records. To evaluate the association between the variables of interest and mortality, the hazard ratio was estimated. RESULTS: We evaluated 153 critically ill patients ≥18 years old, affected by COVID-19, with a rate of mortality of 77.8%. Among non survivors 58.8% were female, 52.9% aged <65 years, 66.4% had arterial hypertension, 46.2% diabetes mellitus and 81.5% had an early onset of nutritional support. Initiation of nutritional therapy after 48 h (HR: 2.57; 95% CI: 1.57-4.20) and the presence of obesity (HR: 1.55; 95% CI: 1.04-2.31) were associated with higher mortality, even after adjustment for potential confounders. CONCLUSIONS: Our data suggests that the provision of early nutritional therapy should be prioritized, with greater attention directed to obese patients, and the nutritional assistance can contribute favorably to the clinical evolution and prognosis of critically ill patients with COVID-19.


Subject(s)
COVID-19/mortality , Critical Care/methods , Nutritional Support/mortality , Nutritional Support/statistics & numerical data , Aged , Brazil/epidemiology , Cohort Studies , Critical Care/statistics & numerical data , Critical Illness , Female , Humans , Male , Middle Aged , Nutritional Support/methods , Retrospective Studies , SARS-CoV-2
6.
Clin Nutr ; 40(3): 895-900, 2021 03.
Article in English | MEDLINE | ID: covidwho-1198670

ABSTRACT

There are reports of children COVID-19 or COVID-19 like symptoms with hyperinflammatory multisystem syndrome, ARDS, gastrointestinal and atypical Kawasaki disease presenting to PICU worldwide temporally associated with COVID-19, for which there are important nutrition support considerations. As a result, the European Society of Pediatric and Neonatal Intensive Care - Metabolism, Endocrine and Nutrition group (ESPNIC-MEN) and paediatric nutritionists working in PICUs are being consulted regarding nutrition management of critically ill children with COVID-19 or COVID-19 like symptoms. Therefore, the aim of this short report is to provide a summary of nutrition support recommendations for critically ill children with COVID-19. They are based on the ESPNIC-MEN section recommendations published in January 2020 and surviving sepsis recommendations from February 2020.


Subject(s)
COVID-19/therapy , Nutritional Support/methods , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/therapy , Child , Critical Care/methods , Critical Illness , Enteral Nutrition/methods , Humans , Intensive Care Units, Pediatric , Nutritional Status
7.
Nutr Clin Pract ; 36(2): 268-274, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1151955

ABSTRACT

Clinicians have widely recognized that indirect calorimetry (IC) is the "gold standard" for measuring energy expenditure (EE) and thus would intuitively anticipate that its use would be needed to provide optimal nutrition support in critical illness. Recent studies in the literature as well as dramatic changes in clinical practice over the past decade, though, would suggest that such a precise measure by IC to set energy goals is not required to maximize clinical benefit from early feeding in the intensive care unit (ICU). Results from randomized controlled trials evaluating permissive underfeeding, use of supplemental parenteral nutrition to achieve tight calorie control, and caloric density of formulas to increase energy delivery have provided an important perspective on 3 pertinent issues. First, a simple weight-based predictive equation (25 kcal/kg/day) provides a clinically useful approximation of EE. Second, a precise measure of EE by IC does not appear to improve outcomes compared with use of this less accurate estimation of energy requirements. And third, providing some percentage of requirements (50%-80%), achieves similar clinical benefit to full feeding (100%) in the early phases of critical illness. The value from IC use lies in the determination of caloric requirements in conditions for which weight-based equations are rendered inaccurate (anasarca, amputation, severe obesity) or the clinical state is markedly altered (such as the prolonged hyperinflammatory state of coronavirus disease 2019 [COVID-19]). In most other circumstances, routine use of IC would not be expected to change clinical outcomes from early nutrition therapy in the ICU.


Subject(s)
COVID-19/therapy , Clinical Decision Rules , Nutrition Assessment , Nutritional Support/methods , Body Weight , Calorimetry, Indirect , Critical Illness/therapy , Energy Metabolism , Humans , Intensive Care Units , Nutritional Requirements , Nutritional Status , SARS-CoV-2
11.
Clin Nutr ; 40(4): 1843-1850, 2021 04.
Article in English | MEDLINE | ID: covidwho-882503

ABSTRACT

BACKGROUND: In polymorbid patients with bronchopulmonary infection, malnutrition is an independent risk factor for mortality. There is a lack of interventional data investigating whether providing nutritional support during the hospital stay in patients at risk for malnutrition presenting with lower respiratory tract infection lowers mortality. METHODS: For this secondary analysis of a randomized clinical trial (EFFORT), we analyzed data of a subgroup of patients with confirmed lower respiratory tract infection from an initial cohort of 2028 patients. Patients at nutritional risk (Nutritional Risk Screening [NRS] score ≥3 points) were randomized to receive protocol-guided individualized nutritional support to reach protein and energy goals (intervention group) or standard hospital food (control group). The primary endpoint of this analysis was all-cause 30-day mortality. RESULTS: We included 378 of 2028 EFFORT patients (mean age 74.4 years, 24% with COPD) into this analysis. Compared to usual care hospital nutrition, individualized nutritional support to reach caloric and protein goals showed a similar beneficial effect of on the risk of mortality in the subgroup of respiratory tract infection patients as compared to the main EFFORT trial (odds ratio 0.47 [95%CI 0.17 to 1.27, p = 0.136] vs 0.65 [95%CI 0.47 to 0.91, p = 0.011]) with no evidence of a subgroup effect (p for interaction 0.859). Effects were also similar among different subgroups based on etiology and type of respiratory tract infection and for other secondary endpoints. CONCLUSION: This subgroup analysis from a large nutrition support trial suggests that patients at nutritional risk as assessed by NRS 2002 presenting with bronchopulmonary infection to the hospital likely have a mortality benefit from individualized inhospital nutritional support. The small sample size and limited statistical power calls for larger nutritional studies focusing on this highly vulnerable patient population. CLINICAL TRIAL REGISTRATION: Registered under ClinicalTrials.gov Identifier no. NCT02517476.


Subject(s)
Malnutrition/diet therapy , Malnutrition/epidemiology , Nutritional Support/methods , Respiratory Tract Infections/epidemiology , Aged , Cohort Studies , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Switzerland/epidemiology
13.
Clin Nutr ESPEN ; 39: 74-78, 2020 10.
Article in English | MEDLINE | ID: covidwho-720471

ABSTRACT

BACKGROUND & AIMS: COVID-19 pandemic had resulted in a massive increase in the number of patients admitted to intensive care units (ICUs). This created significant organizational challenges including numerous non-specialist ICU caregivers who came to work in the ICU. In this context, pragmatic protocols were essential to simplify nutritional care. We aimed at providing a simple and easy-to-prescribe nutritional protocol and evaluated its usefulness with questionnaires sent to physicians involved in the care of ICU COVID-19 patients. METHODS: A simplified nutrition protocol was distributed to all physicians (n = 122) of the ICU medical team during COVID-19 pandemic. Clinical dieticians estimated energy targets for acute and post-acute phases at patient's admission and suggested adaptations of nutrition therapy. More complex situations were discussed with clinical nutrition doctors and, if required, a clinical evaluation was performed. To further facilitate the procedure, a chart with prescription aids was also distributed to the whole medical ICU team. At the end of the current pandemic wave, a 13-item questionnaire was emailed to the ICU medical team to obtain their opinion on the suggested nutritional therapy. RESULTS: Answers were received from 81/122 medical doctors (MDs) (66% response rate), from intensive care physicians (41%), anaesthesiologists (53%) and MDs from other specialties (6%). Thirty-two percent of MDs felt that their knowledge of nutrition management was insufficient and 45% of the physicians surveyed did not face nutrition management in their daily practice prior to the pandemic. The initially proposed nutritional protocol, the chart with prescription aids and the suggested nutritional proposals were considered as useful to very useful by the majority of physicians surveyed (89.9, 90.7 and 92.1% respectively). The protocol was followed by 92% of MDs, and almost all participants (95%) were convinced that adaptations of nutritional therapy had beneficial effects on patients' outcomes. CONCLUSIONS: Nutritional therapy in critically ill COVID-19 patients is a challenge and the implementation of this specific pandemic simplified nutritional protocol was assessed as useful by a great majority of physicians. Pragmatic and simplified protocols are useful for ensuring the quality of nutritional therapy and could be used in future studies to assess its actual impact on the clinical outcomes of COVID-19 patients.


Subject(s)
Coronavirus Infections/therapy , Critical Care/methods , Nutritional Support/methods , Pneumonia, Viral/therapy , Attitude of Health Personnel , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/metabolism , Coronavirus Infections/virology , Critical Illness/therapy , Female , Humans , Intensive Care Units , Male , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/metabolism , Pneumonia, Viral/virology , Prescriptions , SARS-CoV-2 , Surveys and Questionnaires , Switzerland/epidemiology
14.
Nutr Clin Pract ; 35(5): 792-799, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-710161

ABSTRACT

Worldwide, as of July 2020, >13.2 million people have been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The spectrum of coronavirus disease 2019 (COVID-19) ranges from mild illness to critical illness in 5% of cases. The population infected with SARS-CoV-2 requiring an intensive care unit admission often requires nutrition therapy as part of supportive care. Although the various societal guidelines for critical care nutrition meet most needs for the patient with COVID-19, numerous factors, which impact the application of those guideline recommendations, need to be considered. Since the SARS-CoV-2 virus is highly contagious, several key principles should be considered when caring for all patients with COVID-19 to ensure the safety of all healthcare personnel involved. Management strategies should cluster care, making all attempts to bundle patient care to limit exposure. Healthcare providers should be protected, and the spread of SARS-CoV-2 should be limited by minimizing procedures and other interventions that lead to aerosolization, avoiding droplet exposure through hand hygiene and use of personal protective equipment (PPE). PPE should be preserved by decreasing the number of individuals providing direct patient care and by limiting the number of patient interactions. Enteral nutrition (EN) is tolerated by the majority of patients with COVID-19, but a relatively low threshold for conversion to parenteral nutrition should be maintained if increased exposure to the virus is required to continue EN. This article offers relevant and practical recommendations on how to optimize nutrition therapy in critically ill patients with COVID-19.


Subject(s)
Coronavirus Infections/therapy , Critical Care/methods , Nutritional Support/methods , Patient Care Bundles/methods , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Betacoronavirus , COVID-19 , Critical Care/standards , Enteral Nutrition/methods , Enteral Nutrition/standards , Humans , Nutritional Support/standards , Pandemics , SARS-CoV-2
15.
Nutr Clin Pract ; 35(5): 800-805, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-645182

ABSTRACT

Although Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease, growing evidence shows that it can affect the digestive system and present with gastrointestinal (GI) symptoms. Various nutrition societies have recently published their guidelines in context of the pandemic, and several points emphasize the impact of these GI manifestations on nutrition therapy. In patients with COVID-19, the normal intestinal mucosa can be disrupted by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, and this could result in GI symptoms and a compromise in nutrient absorption. Optimization of oral diet is still recommended. However, given the GI effects of COVID-19, a fraction of infected patients have poor appetite and would not be able to meet their nutrition goals with oral diet alone. For this at-risk group, which includes those who are critically ill, enteral nutrition is the preferred route to promote gut integrity and immune function. In carrying this out, nutrition support practices have been revised in such ways to mitigate viral transmission and adapt to the pandemic. All measures in the GI and nutrition care of patients are clustered to limit exposure of healthcare workers. Among patients admitted to intensive care units, a significant barrier is GI intolerance, and it appears to be exacerbated by significant GI involvement specific to the SARS-CoV-2 infection. Nevertheless, several countermeasures can be used to ease side effects. At the end of the spectrum in which intolerance persists, the threshold for switching to parenteral nutrition may need to be lowered.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Care/methods , Gastrointestinal Diseases/therapy , Nutritional Support/methods , Pneumonia, Viral/therapy , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Gastrointestinal Diseases/virology , Gastrointestinal Tract/virology , Humans , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2
16.
Medicina (Kaunas) ; 56(6)2020 Jun 12.
Article in English | MEDLINE | ID: covidwho-602396

ABSTRACT

The epidemic that broke out in Chinese Wuhan at the beginning of 2020 presented how important the rapid diagnosis of malnutrition (elevating during intensive care unit stay) and the immediate implementation of caloric and protein-balanced nutrition care are. According to specialists from the Chinese Medical Association for Parenteral and Enteral Nutrition (CSPEN), these activities are crucial for both the therapy success and reduction of mortality rates. The Chinese have published their recommendations including principles for the diagnosis of nutritional status along with the optimal method for nutrition supply including guidelines when to introduce education approach, oral nutritional supplement, tube feeding, and parenteral nutrition. They also calculated energy demand and gave their opinion on proper monitoring and supplementation of immuno-nutrients, fluids and macronutrients intake. The present review summarizes Chinese observations and compares these with the latest European Society for Clinical Nutrition and Metabolism guidelines. Nutritional approach should be an inseparable element of therapy in patients with COVID-19.


Subject(s)
Coronavirus Infections , Malnutrition , Nutritional Status , Nutritional Support , Pandemics , Pneumonia, Viral , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diet therapy , Coronavirus Infections/epidemiology , Critical Care/methods , Humans , Malnutrition/diagnosis , Malnutrition/etiology , Malnutrition/prevention & control , Nutritional Support/methods , Nutritional Support/standards , Pneumonia, Viral/complications , Pneumonia, Viral/diet therapy , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , SARS-CoV-2
18.
J Formos Med Assoc ; 119(11): 1702-1709, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-72076

ABSTRACT

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic threatening global public health. In the current paper, we describe our successful treatment of three COVID-19 pneumonia patients cases including severe cases and cases with mortality risk factors. One 32-year-old male COVID-19 patient was diagnosed with severe COVID-19 pneumonia and moderate ARDS. The second COVID-19 pneumonia patient had a history of diabetes and chronic bronchitis. The third case of COVID-19 pneumonia was an 82-year old female patient. All three cases had severe COVID pneumonia and therefore were aggressively managed with a multidisciplinary and personalized therapeutic approach that included nutritional support, antiviral pharmacotherapy, active control of comorbidities, prevention of complication development and psychological intervention. Our experience highlights the importance of the use of a multidisciplinary therapeutic approach that tailors to the specific condition of the patient in achieving a favorable clinical outcome.


Subject(s)
Antiviral Agents/administration & dosage , Betacoronavirus/isolation & purification , Coronavirus Infections , Diabetes Mellitus, Type 2 , Pandemics , Patient Care Management/methods , Patient Care Team/organization & administration , Pneumonia, Viral , Pulmonary Disease, Chronic Obstructive , Tomography, X-Ray Computed , Adult , Aged , COVID-19 , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Female , Humans , Lung/diagnostic imaging , Male , Medicine, Chinese Traditional/methods , Middle Aged , Nutritional Support/methods , Oxygen Inhalation Therapy/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Psychological Techniques , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , SARS-CoV-2 , Symptom Assessment/methods , Tomography, X-Ray Computed/methods , Treatment Outcome
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