Nutritional intake and gastro-intestinal symptoms in critically ill COVID-19 patients

Lakenman, P.L.M.; Schie, J.C. van; Hoven, B. van der; Baart, Sara J.; Eveleens, Renate; Bommel, Jasper van; Olieman, Joanne; Joosten, Koen

doi:10.1016/j.clnu.2022.04.001

Cited by 8 publications

(8 citation statements)

References 39 publications

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“…Predictive formulas were used in case of contraindications for indirect calorimetry (ie, fraction of inspired oxygen >70%) to compare results. Estimation of the total energy requirement was made individually and ranged from 10% to 30% 8,9 . To examine hypometabolism and hypermetabolism, the mREE was compared with the predicted REE (mREE/predicted REE × 100%), in which hypometabolism was defined as <90% and hypermetabolism as >110%.…”

Section: Methodsmentioning

confidence: 99%

“…Estimation of the total energy requirement was made individually and ranged from 10% to 30%. 8,9 To examine hypometabolism and hypermetabolism, the mREE was compared with the predicted REE (mREE/predicted REE × 100%), in which hypometabolism was defined as <90% and hypermetabolism as >110%. The calculated protein requirement ranged from 1.3 to 1.7 g/kg, taking protein losses into account, with an average of 1.5 g/kg.…”

Section: Tailored Nutrition Supportmentioning

confidence: 99%

“…6,27 The actual measured bodyweight (kilograms), if indicated as corrected for fluid overload, was used to determine optimal nutrition requirements. 8,9 Optimal tailored nutrition support was defined as >80% of the nutrition requirement received. In accordance to our nutrition protocol, enteral nutrition was started 24-48 h after admission via nasogastric tubes and feeding was gradually increased based on the European Society for Clinical Nutrition and Metabolism guidelines.…”

Section: Tailored Nutrition Supportmentioning

confidence: 99%

“…4,5 It has been shown that critically ill patients with COVID-19 can be fed adequately with acceptable feeding (in)tolerance during ICU stay. 8,9 Most of these patients, however, were demonstrated to be persistently hypermetabolic 8,[10][11][12] with a negative urinary protein balance in both the acute and late phases. 8 These results indicate that critically ill patients with COVID-19 persist in a catabolic state for an extended period, which may further negatively impact body composition over time (decline of muscle mass).…”

Section: Introductionmentioning

confidence: 99%

“…Adequate nutrition support (70%–100% of requirements) during critical illness may reduce this loss, 6 and it is associated with improved clinical outcomes in ICU patients with COVID‐19 4,5 . It has been shown that critically ill patients with COVID‐19 can be fed adequately with acceptable feeding (in)tolerance during ICU stay 8,9 . Most of these patients, however, were demonstrated to be persistently hypermetabolic 8,10–12 with a negative urinary protein balance in both the acute and late phases 8 .…”

Section: Introductionmentioning

confidence: 99%

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Association between fat‐free mass and survival in critically ill patients with COVID‐19: A prospective cohort study

Lakenman,

van Marwijk,

van der Hoven

et al. 2023

J Parenter Enteral Nutr

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BackgroundMost critically ill patients with COVID‐19 experience malnutrition and weight loss associated with negative clinical outcomes. Our primary aim was to assess body composition during acute and late phase of illness in these patients in relation to clinical outcome and secondary to tailored nutrition support.MethodsThis prospective cohort study included adult critically ill patients with COVID‐19. Body composition (fat‐free mass [FFM] [exposure of interest], fat mass [FM], skeletal muscle mass [SMM], and phase angle [PA]) was determined with multifrequency bioelectrical impedance analyses in the acute and late phase. Nutrition support data were collected simultaneously. Clinical outcome was defined as ICU survival (primary outcome) and 30–90 days thereafter, duration of mechanical ventilation, and length ICU stay and of hospital stay (LOS). Nonparametric tests and regression analyses were performed.ResultsWe included 70 patients (73% male, median age 60 years). Upon admission, median BMI was 30 kg/m2, 54% were obese (BMI > 30 kg/m2). Median weight change during ICU stay was −3 kg: +3 kg FM and −6 kg FFM (−4 kg SMM). Body composition changed significantly (P < 0.001). Regarding clinical outcome, only low PA was associated with prolonged LOS (odds ratio = 0.83, 95% CI = 0.72–0.96; P = 0.015). Patients with optimal protein intake (>80%) during acute phase maintained significantly more FFM (2.7 kg, P = 0.047) in the late phase compared with patients who received <80%.ConclusionFFM decreased significantly during acute and late phase of illness, but we observed no association with ICU survival. Only low PA was associated with prolonged LOS. FFM wasting likely occurred because of disease severity and immobility.

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Section: Methodsmentioning

confidence: 99%

Section: Tailored Nutrition Supportmentioning

confidence: 99%