Effect of Immuno-Nutrition on Malnutrition, Inflammatory Response and Clinical Course of Semi-Critically Ill COVID-19 Patients: A Pilot Perspective Study

Abstract

Background: The SARS-COV 2 pandemic has hit on our lives since early 2020. During different contagion waves, both malnutrition and overweight significantly correlated with patient mortality. Immune-nutrition (IN) has shown promising results in the clinical course of pediatric inflammatory bowel disease (IBD) and in both the rate of extubation and mortality of patients admitted to an intensive care unit (ICU). Thus, we wanted to assess the effects of IN on a clinical course of patients admitted to a semi-intensive COVID-19 Unit during the fourth wave of contagion that occurred at the end of 2021. Methods: we prospectively enrolled patients admitted to the semi-intensive COVID-19 Unit of San Benedetto General hospital. All patients had a biochemical, anthropometric, high-resolution tomography chest scan (HRCT) and complete nutritional assessments at the time of admission, after oral administration of immune-nutrition (IN) formula, and at 15 days interval follow-up. Results: we enrolled 34 consecutive patients (age 70.3 ± 5.4 years, 6 F, BMI 27.0 ± 0.5 kg/m2). Main comorbidities were diabetes (20%, type 2 90 %), hyperuricemia (15%), hypertension (38%), chronic ischemic heart disease (8 %), COPD (8%), anxiety syndrome (5%), and depression (5%). 58% of patients were affected as moderately-to-severely overweight; mini nutritional assessment (MNA) score (4.8 ± 0.7) and phase angle (PA) values (3.8 ± 0.5) suggestive of malnutrition were present in 15% of patients, mainly with a history of cancer. After 15 days upon admission, we recorded 3 deaths (mean age 75.7 ± 5.1 years, BMI 26.3 ± 0.7 kg/m2) and 4 patients were admitted to the ICU. Following IN formula administration, inflammatory markers significantly decreased (p < 0.05) while BMI and PA did not worsen. These latter findings were not observed in a historical control group that did not receive IN. Only one patient needed protein-rich formula administration. Conclusions: in this overweight COVID-19 population immune-nutrition prevented malnutrition development with a significant decrease of inflammatory markers.

Impact of Immuno-Nutrition on the Nutritional Status, Inflammatory Response and Clinical Outcome of Clinic-Admitted Mild-Intensity-COVID-19 Patients: A Pilot, Perspective-Concluding Study

“…In agreement with previous results from our research group [12,13], we have shown that a specific casein-rich immuno-nutrition formula is able to prevent the worsening of nutritional status in prevalently obese COVID-19 patients (namely, a reduction in the percentage of MN and OV patients). This was followed, in parallel, by an inflammatory response reduction.…”

“…This study has been the conclusion of our project exploring the nutritional and immunomodulatory potential of a whey-protein-rich formula that showed promising results in terms of reduced inflammatory state in pediatric IBD patients [14]. Starting from ICU patients [12], continuing through semi-intensive ones [13], and concluding with mild-intensity COVID-19 patients, we can report consistent results.…”

“…Further, data from semi-intensive obese COVID-19 patients have confirmed the preventive effect on sarcopenia and malnutrition of the same formula. This result was joined with a significant drop in inflammatory markers and cytokines [13]. In fact, the formula used in former studies by our group is rich in whey proteins and, in particular, in bioactive peptides able to modulate the immune response, especially in hyper-inflammatory diseases like COVID-19 [12,13].…”

“…The subsequent exploratory trial in semi-intensive, but obese, COVID-19 patients from our hospital showed that the orally administered immuno-nutrition was able to significantly reduce the inflammatory response of these sub-acute patients without affecting their mortality rate. Interestingly, this formula was able to prevent both malnutrition worsening and occurrence, although these patients were already suffering from sarcopenia [13].…”

Gut Microbiota and Critically Ill Patients: Immunity and Its Modulation via Probiotics and Immunonutrition

“…This group of patients, typically from the third wave of the SARS-CoV-2 pandemic, were obese in prevalence, thus with a significant percentage of subjects with sarcopenia. These patients showed a similar reduction of inflammatory response after immunonutrition and prevention of malnutrition development [ 103 ] ( Figure 1 ).…”