The reshaping of the future by the Covid 19 pandemic: an assessment of the impact on population and resources

The WHO declared Covid 19 as a pandemic on the eleventh of March, 2020. This led to individuals, governments, institutions and businesses asking what impact this pandemic would have on the future. What imprint would this outbreak leave on human civilisation? Pandemics can alter the course of history. Pandemics impact people, governments, policies and economies. The pandemic has broken out at a time of significant demographic transition. 2020 was the first year in documented human history where the global population of people over the age of 60 is more than the population of children younger than 5 years of age. The richer countries have high concentrations of aging populations. Historically, pandemics have had significant impacts on cities and urban areas. Public health institutions, garbage collection, sanitation, scientific drainage and hospitals all developed to varying extents in urban responses to epidemics. The covid 19 pandemic has also brought about changes. In 2019, the United Nations reported that there had been a 33 percent increase in the population of migrants across the world. The international migrant population was put at 270 million. The previous forecast was for this population level to be attained in 2050. But the pandemic has slowed the growth of migration. The impact of the pandemic on energy markets was immediate and cataclysmic. Large parts of the global economy were forced to close down. The demand for petroleum fell by 25 percent in the United States. The demand for public transport fell by 70 percent in San Francisco, 60 percent in London and 80 percent in Italy and France between March and May 2020. Pandemics and changes in climate are inextricably linked. As humans encroach further into the wild, the United Nations expects more animal viruses to infect and affect humans. 75 percent of all emerging infectious diseases originate in animals. 60 percent of viruses infecting humans come from wildlife and livestock. Zoonotic epidemics are triggered by flooding, climate variability and other extreme weather events linked to climate change. Climate change has also expanded the span of geographies susceptible to zoonoses. Even though this pandemic has brought to the fore these dangers, steps to effectively tackle climate change and to implement practices in agriculture that are more sustainable have halted. The global food system is responsible for fulfilling the nutrition requirements of 80 percent of the world's population. This system has been greatly disturbed by the pandemic. 4 shocks account for this great disturbance: 1. The movement of agricultural goods has been disturbed by restrictions on transport. 2. Supply chains have been seriously damaged by borders being sealed and bans on exports. 3. Overall production has been reduced because of major disruptions in the supply of agricultural raw material, labor and services. 4. Food purchasing power has reduced dramatically because of job losses, especially among the socioeconomically disadvantaged sections of society.Copyright © 2020 Ubiquity Press. All rights reserved.

Our Experience Establishing Food Insecurity Screening in the Pediatric Endocrinology Clinic During the Beginning of the COVID-19 Pandemic

Objectives In 2019, food insecurity was estimated to affect approximately one fifth of the Pittsburgh population. Food insecurity may be linked to other barriers affecting the care of children with chronic health conditions including endocrinopathies. We established a systematic, sustainable method of screening to determine the prevalence of food insecurity in our practice. Methods For 12 months, beginning in May 2020, a written version of the validated questionnaire, The Hunger Vital SignTM (Hager et al), was administered during the patient triage process. The results were documented in the EMR. Patients and families with positive screens met with a social worker and received information about local resources. Screening rates and the frequency of positive screens for food insecurity were reviewed weekly. Results The screening rate was 26% in the first month after implementation;screening increased to 80% by the third month of the project, as the clinic visits transitioned from telemedicine to face-toface (Figure 1). The prevalence of food insecurity in our patient population in this year was 3.5%, which was lower than the reported prevalence in the city of 19.4% in 2018 (Feeding America, 2018) and the projected prevalence for the city, 15.4%, for 2020. Forty-one percent of the patients with food insecurity were attending diabetes clinic and 59% were attending endocrinology clinic. Sixteen percent of the families with food insecurity also reported issues with paying rent/utilities and 14% identified transportation as a barrier to attending medical appointments. Thirteen percent identified negative financial repercussions of COVID-19 such as job loss or reduction of work hours. Approximately 8% identified the patient's medical diagnosis and related dietary requirements as factors contributing to food insecurity. Conclusions Ascertaining food insecurity in our clinic provided a valuable tool to identify and address socioeconomic determinants influencing health. Families appreciated the printed materials and verbal education regarding available local resources. This screening method was sustainable, has been incorporated into EMR, and will continue to support our patients' families. Future studies will increase understanding how food insecurity impacts management of chronic pediatric endocrine conditions.

Meeting nutritional requirements in critically-ill patients with COVID-19: Does the patient's position really matter?

Introduction: Prone positioning and veno-venous extracorporeal membrane oxygenation (VV-ECMO) can improve oxygenation in patients with COVID 19-induced acute respiratory distress syndrome (ARDS).1 Enteral feeding in the prone position has challenges, including possible aspiration risk of gastric contents and potential for disruption to enteral feeding.2 National guidelines2 were implemented locally;including a reduction in the maximum acceptable gastric residual volume (GRV) and the avoidance of bolus feeding while patients were in prone position. Objectives: • To explore the nutritional adequacy of patients in the prone position with COVID-19 on our critical care unit during the second surge (November 2020-April 2021) • To compare nutritional adequacy of days when patients were in prone versus supine position • To identify any factors that impacted on nutritional adequacy • To provide recommendations for improvement Methods: Patients with COVID-19 who required intubation, were placed in prone position at any time during their admission and had been assessed by the dietitian, were included. Total daily energy and protein intakes, from enteral (EN) and parenteral nutrition (PN), propofol and intravenous glucose were obtained from our computerised information system (Metavision) for each full day. If nutritional aims were not met then reasons for this were investigated. Nutritional adequacy was defined as ≥ 80% of energy and protein received per day.3 Results: Data for 34 patients was collected (see Table 1). A total of 1142 ICU days were included: 106 (9.3%) prone position days and 1036 (90.7%) supine position days. Patients received EN on 1098 days (96.1%) and PN on 44 days (3.9%). Only 4 of the 44 PN days occurred whilst a patient was in the prone position (0.4%). On prone position days, patients received an average 80% of their prescribed energy and 56% of their prescribed protein requirements, compared with 95% prescribed energy and 84% prescribed protein on supine position days. The average received across both prone and supine position days was 94% energy and 82% of protein. The 4 most frequent barriers to meeting protein requirements when in prone position were: • Reduction of NG feed rate when GRV's were higher than maximum acceptable volume • Use of a standard 4g protein/100ml 'Out of Hours' enteral feed • Fasting for procedures • Failure to give protein supplement boluses when patient returned to supine position Conclusion: Patient position affected nutritional intake, with energy and protein intake being lower on prone position days compared with supine position days. As only 9.3% of total ICU days were prone position days, average energy and protein received across all days still achieved nutritional adequacy. An increase in a patient's prone position days during ICU admission is likely to result in greater nutritional deficit, particularly for protein. Recommendations to improve nutritional adequacy on prone position days: • Consider use of post-pyloric feeding to increase feed tolerance • Use of a higher protein 'out of hours' enteral feed • Raised awareness of standard fasting times to ensure minimum disruption to feeding • Consider administration of protein supplement boluses in prone position when GRV's are within the accepted range .

A Quality Improvement Project to optimise nutrition in COVID-19 patients receiving CPAP therapy in a ward based setting

Patients receiving Continuous Positive Airway Pressure (CPAP) therapy for severe COVID-19 are at high risk of malnutrition1,2. This is related to poorer outcomes and longer durations of hospital stay3. British Dietetic Association guidance recommends nasogastric (NG) feeding for all COVID-19 patients on CPAP4. The aim of this Quality Improvement Project (QIP) was to optimise nutrition in COVID-19 patients receiving CPAP therapy in a ward-based setting at a UK District General Hospital. The QIP included 222 patients in total across four QI cycles. Four domains: meeting nutritional requirements (outcome measure), dietitian review, accurate weight and NG feeding (process measures) were studied. Whether patients were reviewed by dietitians, weighed and NG fed was determined for all 222 patients. Meeting of estimated nutritional requirements could be determined in 108 patients. Interventions included use of a local nutrition pathway, COVID-19 diet sheet, NG feeding and involvement of dietitians at a daily multi-disciplinary meeting. Descriptive statistical analysis in the form of a Chi- Squared test was used to compare the first two COVID19 waves. No ethical approval was required. Results showed significant improvement in the proportion of patients reviewed by dietitians, accurately weighed and NG fed between the first two waves of COVID19 (p<0.05). Comparing the 1st to the 4th QI cycle;meeting requirements improved from 50% to 68%, dietitian review from 29% to 91%, accurate weights from 44% to 87% and NG feeding from 6% to 65%. These improvements were achieved through novel approaches, rapid implementation of new guidance and multi-disciplinary working. Next steps should include introduction of a standardised care proforma and study in future QI cycles. These interventions could be trialled in other inpatient wards to deliver wider benefit. This QIP was successful in optimising nutrition in this cohort of patients and thereby delivering better patient care. References 1. Turner P, Montgomery H, Stroud M, et al. (2021) Malnutrition risk in hospitalised COVID-19 patients receiving CPAP. Lancet 397:1261. 2. Terzi N, Darmon M, Reignier J, et al. (2017) Initial nutritional management during noninvasive ventilation and outcomes: a retrospective cohort study. Crit Care 21:293. 3. Singer P, Blaser AR, Berger MM, et al. (2019) ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 38:48–79. 4. BDA Critical Care Specialist Group COVID-19 Best Practice Guidance: Feeding Patients on Critical Care Units in the Prone Position (awake and sedated). Second Edition. [accessed 31st May 2021]

The challenge of meeting protein requirements in critically ill patients in the COVID era

Critically ill patients often face progressive and rapid losses of body and muscle mass due to hypermetabolism and increased protein catabolism. Certain population groups (such as obese patients or those requiring Continuous Renal Replacement Therapy (CRRT) require a higher protein provision as advised by both ASPEN1 and ESPEN2. Furthermore, critically ill patients often receive significant energy provision from non-nutritional sources such as propofol. As a consequence, calorie provision via enteral feed is commonly restricted to avoid overfeeding, and protein provision to the patient is further compromised. Retrospective data was collected for 58 patients who were either confirmed or suspected of COVID-19 and admitted to the Intensive Care Unit (ICU) during April 2020. 31% (n=18) of patients were unable to meet their protein requirements from the feed formula alone, based on initial dietetic assessment. Recommended protein requirements were not achieved in any patients who were obese (n=10;defined as BMI ≥30 kg/m2) or receiving CRRT (n=6). The maximum protein provision for obese patients was 1.5g/kg IBW and 1.6g/kg for patients receiving CRRT. The situation was exacerbated for patients receiving high dose propofol (defined as >10 ml/hr), where protein provision decreased to 0.8 – 1.2g/kg and 1.1 – 1.3g/kg respectively. [Formula presented] In the non-obese, non-CRRT ICU population, the available enteral feeding regimes were appropriate to meet the majority of patients’ protein requirements (as shown in Figure 1). However the review almost certainly overestimates protein provision, as percentage feed delivery was not assessed and the results assume 100% feed delivery. We know from previous audits on our unit that feed delivery is often <80% of target, and although this review was based on COVID-19 patients, the ‘typical’ patients in ICU often have specific nutrition requirements, which includes high protein. The challenges faced during COVID-19 has raised awareness of the importance of protein delivery in ICU and our review highlights the need to continually monitor and augment protein delivery in critically ill patients. The findings support the need for a high protein supplement in specific population groups;particularly those who may be obese, require CRRT or are receiving high dose propofol in an ICU setting. 1 McClave S A, Taylor B E, Martindale R G et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenter Enteral Nutr 2016;40(2): 159-211. 2 Singer P, Blaser A R, Berger M M et al. ESPEN Guideline on clinical nutrition in the intensive care unit Clin Nut 2019;38: 48-79

Applying learning from 1st to the 3rd wave of the COVID19 pandemic: nutritional provision in critical care

The aim of this analysis was to compare route and adequacy of nutrition support in patients with COVID19 admitted to an intensive care unit (ICU) between March-June 2020 (T1) compared to January-April 2021 (T2). Parameters related to nutrition support were collected from the records of all patients admitted to ICU with COVID19 with length of stay of ≥7days on mechanical ventilation requiring artificial nutrition support. Data was collected during the late acute phase which was defined as day 4-7 post intubation. Energy and protein intake was compared to calculated estimated nutritional requirements. 35 patients met the inclusion criteria in T1, 94% were on enteral nutrition (EN), 3% parenteral nutrition (PN) and 3% EN+PN. In T2, there were 54 patients (92% EN, 2% PN and 6% EN+PN). [Formula presented] Of patients who achieved <70% of energy and protein requirements in T1 (n=17) 35% had constipation or ileus and 47% had GI intolerance (high gastric residual volumes or vomiting). In T2 (n=19), 84% experienced constipation or ileus and 63% had GI intolerance. 35% of patients in T1 had hypernatraemia vs. 47% in T2 and 41% in T1 had hyperglycaemia vs. 100% in T2 despite only 12% and 32% of patients respectively having a history of diabetes. Despite a higher incidence of GI intolerance in T2, a statistically significant improvement in achieving energy targets was noted. Learning from T1 showed that where strategies to improve GI tolerance are unsuccessful supplementary PN should be considered without delay to optimise nutritional intake. There was a clinically significant trend in protein intake which may be attributed to prompt initiation of modular protein supplements or perhaps an earlier transition from fat-based sedation. Meeting protein requirements while preventing overfeeding remains a challenge in the ICU. Disclosure of Interest: None Declared

Nutrition in critical care: An audit of protein and energy intakes compared to international recommendations

Adequate protein and energy provision in critical care is associated with better clinical outcomes. The aim of this audit was to evaluate compliance with achieving recommended protein and energy targets in our Intensive Care Unit (ICU) and to explore the reasons for any deficits identified. Nutrition parameters were collected on patients admitted to our ICU between March and May 2021. Inclusion criteria were requirement for nutritional support and mechanical ventilation with an ICU length of stay ≥ 4 days. Patients with COVID19 were excluded. Protein and energy intakes were compared to best practice guidelines1. 51 patients met the inclusion criteria: 53% male, 47% female. Mean age was 59.6 years and mean length of stay was 19.9 days (range 5-61 days). Protein and energy intakes achieved as follows: [Formula presented] Of the patients who received < 80% of their nutritional requirements, the main barriers to achieving targets identified were fasting and constipation in this cohort. Cumulative deficit ranged from 0 - 903g protein and 0 - 12717kcal over duration of ICU stay. Mean deficit was 315g protein and 2945kcal. Of concern, 12 patients had a deficit of > 500g protein and 7 patients had > 5000kcal deficit. While 69% of patients met ≥ 80% protein requirements and 77% of patients met ≥ 80% energy requirements, we have identified areas to consider to improve nutritional adequacy including increasing awareness of minimising fasting times and the introduction of a bowel management protocol. References 1. Singer P, Blaser AR, Berger MM. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019 1;38(1):48-79. Disclosure of Interest: None Declared

Malnutrition risk and the need for dietetic intervention post COVID-19 infection on a care of the elderly rehab ward

Patients recovering from COVID-19 are at high risk of malnutrition, reduced nutritional intake and decline in muscle mass and strength with many requiring significant rehabilitation. The aim of this service evaluation is to quantify the risk of malnutrition and provide an overview of nutritional status and outcomes with dietetic input on a care of the elderly rehab ward. Demographics were collected from patient electronic records. Malnutrition risk, handgrip strength and Vitamin D levels were measured along with calculation of nutritional requirements. Of sixteen patients on the rehab wards post COVID-19, 81% (n=13) required dietetic input. [Formula presented] There was an average weight loss of 5.1kg (6.6%) (p=0.64). Eighty one percent had a reduction in their BMI, with 31% moving into a lower BMI category. Measurably reduced and impaired muscle function was evident when handgrip strength was measured. Eighty five percent required oral nutrition support. Additional advice for dysphagia, diabetes and renal disease was provided to 65% of patients. Following dietetic intervention, energy and protein intake improved in all patients. Sixty four percent were either insufficient or deficient in Vitamin D. The data obtained demonstrates the high prevalence of malnutrition in patients on a rehab ward post COVID-19. Furthermore the data highlights the clear need for dietetic intervention in this nutritionally vulnerable group to optimize nutritional status. References I. Stam. HJ, Stucki.G, Bickenbach.J. COVID-19 and post intensive care syndrome: A call for action. Journal of Rehabilitation Medicine. 2020;52 (4)

Is nasojejunal feeding as effective as we think? An evaluation of nasojejunal feeding in the Intensive Care Unit

Early enteral feeding is important in maintaining the integrity of the gastrointestinal tract mucosal barrier and associated with less bacterial translocation and decreased stimulation of the systemic inflammatory response and subsequent improved outcomes in intensive care (ICU) patients. Enteral feeding by nasogastric (NG) tubes is the preferred route of nutritional support for most ICU patients. However, ICU patients with delayed gastric emptying and poor intestinal motility may not tolerate gastric feeding and may therefore benefit from post-pyloric feeding via nasojejunal (NJ) tubes1. We reviewed the effectiveness of 35 NJ tube placement in 24 patients on ICU between January and March 2021. The M:F ratio was 4:1, median age 69 years (30–80 years) and 54% of patients were non-White British. 10 patients (42%) had diabetes and 54% had COVID-19 as part of their admitting diagnoses. The median BMI was 25 (range 20 – 32.3) and none of the patients were identified as high risk for refeeding syndrome at the time of NJ tube insertion. Nutritional information was unavailable on 5 patients. Of the remaining 19 patients, 26% of patients (n=5) were commenced on parenteral nutrition (PN) within 48 hours of NJ insertion. Only 1 patient was able to meet their nutritional requirements enterally via NJ tube at 5 days;a further 2 patients had their nutritional requirements met with supplemental PN. In 8 of 22 referrals the indication for NJ tube insertion was because an NG tube could not be passed. The evaluation revealed discrepancies in adherence to protocols for high gastric residual volumes and prokinetic use. Documentation surrounding decision making, requesting and inserting an NJ tube was poor and probably reflects the complexity of the patients, involvement of multiple clinical teams, and various documentation modalities (i.e., verbal, written and different electronic systems). There was clinical dispute regarding the indication for NJ tube insertion in 23% of cases (documented in 3 of 13 referrals for NJ tube insertion). Where documentation was available 43% of patients (n=10) had an NJ tube placed on the day of request;the median time from request to insertion was 1 day (range 0-10). 5 patients had more than one NJ tube inserted (median 3;range 2–5). There was variation in experience and expertise of the endoscopists placing the NJ tubes. NJ tube feeding is considered to be less expensive and have less complications than PN2. However, our evaluation has revealed a range of issues relating to both the insertion and use of NJ tubes in an ICU setting. The true resource ‘cost’ of NJ tube insertion is probably underestimated in the literature and the complications of PN probably overestimated in the context of modern ICU and nutrition support team clinical practices. We suspect that our clinical experience is not unique and that more research is needed in this area. We are using this work to educate clinical teams, standardise documentation, provide better support and supervision for endoscopists, and raise awareness of the benefit and need for supplemental PN where nutritional requirements are not consistently reached enterally. 1 Schröder S, Hülst S V, Claussen M et al. Postpyloric feeding tubes for surgical intensive care patients. Anaesthetist 2011;60 (3): 214-20. 2 Lochs H, Dejong C, Hammarqvist F et al. ESPEN Guidelines on enteral nutrition: Gastroenterology. Clin Nutr 2006;25(20: 260-74.

Dietetic-led critical care nutrition interventions provided to critically ill patients with COVID-19 in a large London teaching hospital from March 2020 to April 2021

Many patients admitted to critical care with COVID-19 were at risk of malnutrition due to pre-existing chronic diseases associated with underlying poor nutritional intake and sarcopenia (1). Combined with increased energy expenditure and catabolism (2), alterations to gastrointestinal function and deficits in nutritional delivery during critical illness all risked declining nutritional status and subsequent poorer functional ability. International nutrition guidelines (3-6) recommend providing early enteral nutrition support using protocols. The UK and Australian versions created during the pandemic (3;4) recommend for individualised nutrition therapy by registered dietitians to anticipate and manage the complications commonly seen in these patients that can impact on the provision and type of nutrition support. The aim of this study is to evaluate the role of the dietitian in the nutrition interventions provided to patients with COVID-19 during critical illness and compare with recommended guidelines (3;4). Data was collected and analysed for adult patients with COVID-19 admitted to the intensive care units (ICU) requiring advanced respiratory support and enteral or parenteral nutrition support for longer than 48 hours during the period March 2020 to April 2021. Patients were followed from ICU admission to ward step down. Data was available for 453 critically ill patients. Demographic data presented as mean (SD);age 60 years old (12), 67% male, weight 84kg (20), BMI 29kg/m2 (6) for 20 ICU days (18), mortality of 55%. 167 patients (37%) were classified as high nutritional risk as determined by experienced critical care dietitians for whom nutritional requirements were individually determined by the dietitian within 24 hours of ICU admission. The remaining patients were seen within a mean of 72hrs. 99% (447/453) were enterally fed and the remaining received parenteral nutrition. Patients received on average 5.2 (4.5) dietetic interventions over the ICU stay, irrespective of nutritional risk. Reasons for dietetic interventions were adjustment of feed to account for calorie provision according to metabolic phase (74%);calories derived from sedation (55%);gastrointestinal dysfunction (32%);weaning from enteral nutrition to oral (32%);and renal, fluid and electrolyte adjustments (26%). A range of enteral feeds were used - the majority of patients (93%) received high protein (6.3-7.5grams protein per 100ml), concentrated (18.5%) (200 kcal per 100ml), peptide (9.5%) and protein supplementation (60%). On average those patients who survived lost 8.2kg (6.4) equating to 8.8% (6.9) of total weight over the ICU stay. A dietetic handover was provided for 100% of patients who transferred to the ward. In this study 100% of patients required dietetic input as their nutritional needs could not be met with protocol alone. A significant number were identified as nutritionally at risk, were prioritised as urgent and seen within the guideline timeframes. The dietitian was needed to tailor dietetic interventions to manage complications common in patients with COVID-19. They were also actively involved in adjusting nutrition interventions to facilitate patients’ nutritional recovery and rehabilitation. Patients lost weight over the ICU stay and all patients were handed over to ward dietitians for further dietetic management. References 1. Zhu N, Zhang D et al. A novel coronavirus from patients with pneumonia in China. NEJM 2020:382:727-33 2. Whittle, J., Molinger, J., MacLeod, D., et al. Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19. Critical Care 2020: 24(1) 1-4. 3. Critical Care Specialist Group (CCSG) of the BDA Guidance on management of nutrition and dietetic services during the COVID-19 pandemic. 2020. (accessed 24.6.21) 4. Chapple, L. A. S., Fetterplace, K., Asrani, V., et al. Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. Nutrition & Dietetics,2020: 77(4), 426-436. 5. Barazzoni, R., Bischoff, S. C., Breda, J et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clinical Nutrition, 2020: 39 (6), 1631-1638 6. Martindale, R., Patel, J. J., Taylor, B., et al. Nutrition Therapy in Critically Ill Patients with Coronavirus Disease (COVID-19). Journal of Parenteral and Enteral Nutrition. 2020: 44 (7), 1174-1184

Nutritional status of COVID-19 patients one year post-ICU stay

Introduction: Our aim was to describe nutritional status (NS) of critically ill COVID-19 patients 1 year post-ICU stay. Malnutrition and weight loss were observed during hospitalization. Post-ICU discharge patients often continue to suffer from physical complaints and poor nutritional intake, which can negatively affect NS. Methods: Observational study including adult COVID-19 patients 1 year post-ICU stay. NS assessment (nutrient balance, body composition and physical status) was performed. Nutritional intake (energy and protein), nutrition related complaints and losses were examined. Indirect calorimetry (Q-NRG +) was performed to determine nutritional requirements. Body composition (e.g. fat mass, fat free mass) was measured with bio-electrical impedance analysis (InbodyS10). Fat-free mass index (FFMI) and fat mass index (FMI) were calculated. Physical status was determined with handgrip strength (HGS). Overall values ≤ 10th percentile were considered too low and ≥ 90th too high. Descriptive statistics were used for analysis. Results: 48 patients were included (72% male;median age 60 years [IQR 52;65]). Median ICU stay was 19 days [IQR 10;30]. Median weight loss during ICU stay was 13% [IQR - 10;- 16] and 12% of this loss [IQR 7;16] was regained after 1 year. BMI was 26 kg/m2 [IQR 23;30] 1 year post-ICU, of which 24% was obese (BMI > 30 kg/m2). Normometabolism was predominantly observed (62%), followed by hypermetabolism (30%). Mean nutritional intake was 78% of calculated requirements. Nutrition related complaints occurred in < 5% of the patients. Most patients had a high FMI (55%) and minority had low FFMI (35%). Combination of a high FFMI and FMI was present in 17%. Three patients (6%) had low HGS. Conclusions: Weight loss was almost fully regained 1 year post-ICU, often in combination with a high fat mass. A minority had low physical function. Whereas reported calculated requirements were not met, lifestyle coaching remains indicated to optimize NS.