A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic

Krznarić, Željko; Bender, Darija Vranešić; Laviano, Alessandro; Cuerda, C.; Landi, Francesco; Monteiro, Rosário; Pirlich, Matthias; Barazzoni, Rocco

doi:10.1016/j.clnu.2020.05.006

Cited by 72 publications

(69 citation statements)

References 38 publications

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“…However, our findings support the notion that even individuals managing or recovering from COVID-19 symptoms at home should receive counselling on how to maintain an adequate intake of calories, protein, and fluids [ 49 ]. Strategies such as using remote nutritional screening tools recently developed for primary practise [ 50 ] should be implemented to improve the nutritional management of patients managed at home.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study

et al. 2021

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Background & aims Coronavirus disease 2019 (COVID-19) may associate with clinical manifestations, ranging from alterations in smell and taste to severe respiratory distress requiring intensive care, that might associate with weight loss and malnutrition. We aimed to assess the incidence of unintentional weight loss and malnutrition in COVID-19 survivors. Methods In this post-hoc analysis of a prospective observational cohort study, we enrolled all adult (age ≥18 years) patients with a confirmed diagnosis of COVID-19 who had been discharged home from either a medical ward or the Emergency Department of San Raffaele University Hospital, and were re-evaluated after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to May 11, 2020. Demographic, anthropometric, clinical and biochemical parameters upon admission were prospectively collected. At follow-up, anthropometrics, the mini nutritional assessment screening and a visual analogue scale for appetite were assessed. Results A total of 213 patients were included in the analysis (33% females, median age 59.0 [49.5–67.9] years, 70% overweight/obese upon initial assessment, 73% hospitalised). Sixty-one patients (29% of the total, and 31% of hospitalised patients vs . 21% of patients managed at home, p = 0.14) had lost >5% of initial body weight (median weight loss 6.5 [5.0–9.0] kg, or 8.1 [6.1–10.9]%). Patients who lost weight had greater systemic inflammation (C-reactive protein 62.9 [29.0–129.5] vs .48.7 [16.1–96.3] mg/dL; p = 0.02), impaired renal function (23.7% vs . 8.7% of patients; p = 0.003) and longer disease duration (32 [27–41] vs . 24 [21–30] days; p = 0.047) as compared with those who did not lose weight. At multivariate logistic regression analysis, only disease duration independently predicted weight loss (OR 1.05 [1.01–1.10] p = 0.022). Conclusions COVID-19 might negatively impact body weight and nutritional status. In COVID-19 patients, nutritional evaluation, counselling and treatment should be implemented at initial assessment, throughout the course of disease, and after clinical remission. Clinicaltrials.gov registration NCT04318366 .

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Section: Discussionmentioning

confidence: 99%

COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study

et al. 2021

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“…For countries in which telemedicine is authorized, nutritional screening can be conducted at a distance. To this end, Krznarić et al [ 93 ] proposed a simple and practical protocol for assessing malnutrition in adult and older adults. The Remote Malnutrition App (R-MAPP) includes assessment of nutritional risk with MUST adaptation and can be used in primary health care settings.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

et al. 2020

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Coronavirus disease 2019 (COVID-19) is associated with high risk of malnutrition, primarily in older people; assessing nutritional risk using appropriate screening tools is critical. This systematic review identified applicable tools and assessed their measurement properties. Literature was searched in the MEDLINE, Embase, and LILACS databases. Four studies conducted in China met the eligibility criteria. Sample sizes ranged from six to 182, and participants’ ages from 65 to 87 years. Seven nutritional screening and assessment tools were used: the Nutritional Risk Screening 2002 (NRS-2002), the Mini Nutritional Assessment (MNA), the MNA-short form (MNA-sf), the Malnutrition Universal Screening Tool (MUST), the Nutritional Risk Index (NRI), the Geriatric NRI (GNRI), and modified Nutrition Risk in the Critically ill (mNUTRIC) score. Nutritional risk was identified in 27.5% to 100% of participants. The NRS-2002, MNA, MNA-sf, NRI, and MUST demonstrated high sensitivity; the MUST had better specificity. The MNA and MUST demonstrated better criterion validity. The MNA-sf demonstrated better predictive validity for poor appetite and weight loss; the NRS-2002 demonstrated better predictive validity for prolonged hospitalization. mNUTRIC score demonstrated good predictive validity for hospital mortality. Most instruments demonstrate high sensitivity for identifying nutritional risk, but none are acknowledged as the best for nutritional screening in older adults with COVID-19.

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“…Bearing in mind that sarcopenia may play a relevant role in COVID-19 outcome, Krznaric and colleagues ( 142 ) recently proposed the utilization of 2 clinical tools to assess nutritional risk and loss of muscle mass and function remotely by incorporating them into telemedicine processes and digital platforms. For a simple, preliminary diagnosis of sarcopenia, the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire, which evaluates muscle strength, assistance with walking, rise from a chair, climbing stairs, and falls, may be adopted ( 143 ).…”

Section: Aging and Nutrition And Covid-19mentioning

confidence: 99%

Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link?

Silvério

Gonçalves

Andrade

et al. 2021

Advances in Nutrition

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Coronavirus disease 2019 (COVID-19) is an emerging disease that has reached pandemic status by rapidly spreading worldwide. Elderly individuals and patients with comorbidities such as obesity, diabetes, and hypertension show a higher risk of hospitalization, severe disease, and mortality by acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. These patients frequently show exacerbated secretion of proinflammatory cytokines associated with an overreaction of the immune system, the so-called cytokine storm. Host nutritional status plays a pivotal role in the outcome of a variety of different infectious diseases. It is known that the immune system is highly affected by malnutrition, leading to decreased immune responses with consequent augmented risk of infection and disease severity. Body composition, especially low lean mass and high adiposity, has consistently been linked to worsened prognosis in many different diseases. In this review, evidence concerning the impact of nutritional status on viral infection outcomes is discussed.

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A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic

Cited by 72 publications

References 38 publications

COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study

COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study

Nutritional Risk Screening Tools for Older Adults with COVID-19: A Systematic Review

Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link?

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