Developing a consensus to support health and social care professionals and patients manage nutrition in the context of COVID-19 recovery.

BACKGROUND: The long-term effects on people who have had COVID-19 affect nutrition and can be influenced by diet conversely. Specific nutritional guidelines, however, were scarce at the beginning of 2020, and empirical literature was also lacking. Conventional research methodologies needed to be adapted to review the available literature that could be relevant to the United Kingdom and policy documents as well as collect the views of health and care staff. The aim of this paper is to describe the method to develop consensus statements from experts to address the necessary nutritional support and what emerged from this. METHODS: A nominal group technique (NGT) was adapted to the virtual world; we purposefully selected a range of professionals (dietitians, nurses, occupational therapists, etc.) and patients with long-term effects of COVID to present them with the most updated evidence and aim to reach key guidelines to address COVID-19 recovery. RESULTS: We were able to reach consensus statements that were developed and reviewed by relevant healthcare staff at the front line to address the nutritional needs of patients recovering from COVID-19 and those suffering from its long-term effects. This adapted NGT process led us to understand that a virtual repository of concise guidelines and recommendations was needed. This was developed to be freely accessed by both patients recovering from COVID-19 and health professionals who manage them. CONCLUSIONS: We successfully obtained key consensus statements from the adapted NGT, which showed the need for the nutrition and COVID-19 knowledge hub. This hub has been developed, updated, reviewed, endorsed and improved across the subsequent 2 years.

Strategies to ensure continuity of nutritional care in patients with COVID-19 infection on discharge from hospital: A rapid review.

BACKGROUND & AIMS: The risk of malnutrition in people with COVID-19 is high; prevalence is reported as 37% in general medical inpatients, 53% in elderly inpatients and 67% in ICU. Thus, nutrition is a crucial element of assessment and treatment. This rapid review aimed to evaluate what evidence is available to inform evidence-based decision making on the nutritional care of patients hospitalised with COVID-19 infection. METHODS: Cochrane Rapid Reviews guidance was followed; the protocol was registered (CRD42020208448). Studies were selected that included patients with COVID-19, pneumonia, respiratory distress syndrome and acute respiratory failure, in hospital or the community, and which examined nutritional support. All types of studies were eligible for inclusion except non-systematic reviews, commentaries, editorials and single case studies. Six electronic databases were searched: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PubMed, CINAHL and MedRxiv. RESULTS: Twenty-six articles on COVID-19 were retrieved, including 11 observational studies, five guidelines and 10 opinion articles. Seven further articles on pneumonia included three RCTs, one unblinded trial, three observational studies, and one systematic review on rehabilitation post-ICU admission for respiratory illness. The evidence from these articles is presented narratively and used to guide the nutritional and dietetic care process. CONCLUSIONS: Older patients with COVID-19 infection are at risk of malnutrition and addressing this may be important in recovery. The use of nutritional management strategies applicable to other acute conditions are recommended. However, traditional screening and implementation techniques need to be modified to ensure infection control measures can be maintained. The most effective nutritional interventions require further research and more detailed guidance on nutritional management post-discharge to support long-term recovery is needed.

A UK survey of nutritional care pathways for patients with COVID-19 prior to and post-hospital stay.

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.

Complex Enterally Tube-Fed Community Patients Display Stable Tolerance, Improved Compliance and Better Achieve Energy and Protein Targets with a High-Energy, High-Protein Peptide-Based Enteral Tube Feed: Results from a Multi-Centre Pilot Study.

This pilot study evaluated a high-energy, high-protein, peptide-based, (medium-chain triglycerides) MCT-containing enteral tube feed (Nutrison Peptisorb Plus HEHP®, Nutricia Ltd., Trowbridge, BA14 0XQ, UK.) containing 1.5 kcal/mL and 7.5 g protein/100 mL. Fifteen community-based, enterally tube-fed adults (42 (SD 16.3) years) received the intervention feed daily for 28 days, with gastrointestinal tolerance, compliance and nutrient intake assessed at baseline and after the intervention period. Incidence and intensity of constipation (p = 0.496), nausea (p = 1.000), abdominal pain (p = 0.366) and bloating (p = 0.250) remained statistically unchanged, yet the incidence and intensity of diarrhoea improved significantly after receiving the intervention feed (Z = -2.271, p = 0.023). Compliance with the intervention feed was significantly greater compared to the patient's baseline regimens (99% vs. 87%, p = 0.038). Compared to baseline, use of the intervention feed enabled patients to significantly increase total energy (1676 kcal/day (SD 449) to 1884 kcal/day (SD 537), p = 0.039) and protein intake (73 g/day (SD 17) to 89 g/day (SD 23), p = 0.001), allowing patients to better achieve energy (from 88% to 99%, p = 0.038) and protein (from 101% to 121%, p < 0.001) requirements. This pilot study demonstrates that a high-energy, high-protein, peptide-based, MCT-containing enteral tube feed maintains gastrointestinal tolerance and improves compliance, energy and protein intake in complex, enterally tube-fed, community-based adult patients, though more work is recommended to confirm this.