Gut, metabolism and nutritional Support for COVID-19: Experiences from China

Abstract

There is little research that focuses on the relationship between the gut, metabolism, nutritional support and COVID-19. As a group of Chinese physicians, nutritionists and scientists working on the frontline treating COVID-19 patients, we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article. Based on our clinical observations and available evidence, we recommend the following practice. Firstly, the Nutritional Risk Screening 2002 tool should be used routinely and periodically; for patients with a score ≥3, oral nutritional supplements should be given immediately. Secondly, for patients receiving the antiviral agents lopinavir/ritonavir, gastrointestinal side effects should be monitored for and timely intervention provided. Thirdly, for feeding, the enteral route should be the first choice. In patients undergoing mechanical ventilation, establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs. Fourthly, we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission, with the energy target no more than 20 kcal/kg/day (for those on mechanical ventilation, this target may be lowered to 10–15 kcal/kg/day) and the protein target around 1.0–1.2 g/kg/day. If the inflammatory condition is significantly alleviated, the energy target may be gradually increased to 25–30 kcal/kg/day and the protein target to 1.2–1.5 g/kg/day. Fifthly, supplemental parenteral nutrition should be used with caution. Lastly, omega-3 fatty acids may be used as immunoregulators, intravenous administration of omega-3 fatty emulsion (10 g/day) at an early stage may help to reduce the inflammatory reaction.

Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review

“…[ 25 , 26 ] A review suggests an “initial permissive hyponutrition,” in which 20 kcal -1 kg -1 day -1 is prescribed for the entire first week, and only after the acute inflammatory phase has ceased, energy supply should be increased to 25–30 kcal -1 kg -1 day -1 . [9] This study also states that patients on MV should receive fewer calories, around 10–15 kcal -1 kg -1 day -1 . By contrast, some authors believe that the advancement of nutritional therapy should be done in stages, in this case, in days.…”

“…Multiple factors such as disease severity, phase of the pathogenic period, significant metabolic disturbances, tolerance of the organs involved in the digestive process, and prolonged permanence of an inflammatory response must be considered, especially while dealing with critically ill patients. [9] …”

“…Recent literature studies [ 9 , 15 , 16 , 23 , 25 , 26 , 29 ] showed that the protein value indicated for infected patients with mild-to-moderate symptoms may be different from that recommended for patients with more severe conditions. In a recent review, Aguila et al [29] proposed that patients in wards receive absolute values of 75–100 g of daily protein; whereas those admitted to ICUs should receive an amount relative to their body weight (1.2–2.0 g -1 kg -1 day -1 ).…”

“… [15] Other studies with critically ill patients proposed that reaching the protein goal should be in a ramp protocol, with a gradual increase. [ 9 , 16 , 23 , 25 , 26 ] The treatment should be started with normoproteic values of 0.8 g -1 kg -1 day -1 , which can be gradually increased to amounts close to 1.2 g -1 kg -1 day -1 at the end of the first week. Protein content can be increased after decreasing exacerbated inflammation, as this period appears to enjoy the benefits of high-protein nutritional therapy.…”

Major Characteristics of Severity and Mortality in Diabetic Patients With COVID-19 and Establishment of Severity Risk Score

“…Recent studies have shown that patients infected with COVID-19 who also have underlying chronic diseases ( 7 , 8 ), such as hypertension, cancer, cardiovascular diseases and diabetes, have a higher risk of severe disease and death. Among these chronic diseases, diabetes stood out, not only because it was reported to be the second most common comorbidity of COVID-19, but also because it had been proven by many other studies that diabetes contributes to the risk of mortality following COVID-19 infection.…”