Tailoring nutrition therapy amid the COVID-19 pandemic: Does it work?

Abstract

Background: The COVID-19 pandemic has been a challenge for nutrition monitoring and delivery. This study evaluates clinical and nutritional characteristics of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and investigates the relationship between nutrition delivery and clinical outcomes. Methods: Prospective observational study of adults admitted for >24 hrs to a tertiary-care hospital during a period of 2months. Data was collected on disease severity, energy, protein delivery and adequacy, use of mechanical ventilation (MV), hospital length of stay (LOS). Multivariate logistic regression models were used to determine the associations with mortality as the primary outcome. Results: 1083 patients: 69% male (n ¼ 747), 31% females (n ¼ 336), mean age 58.2 ± 12.8 with 26.6 ± 4.32 BMI were analysed. 1021 patients survived and 62 deaths occurred, with 183 and 900 patients in the ICU and ward, respectively. Inadequate calorie and protein delivery had significantly higher mortality than those with adequate provision (p < 0.001) among the ICU patients. In bivariate logistic regression analysis, inadequacy of energy and protein, disease severity, comorbidities !3, NRS score !3 and prone ventilation correlates with mortality (p < 0.001). In multivariate logistic regression analysis of the ICU patients, energy inadequacy (OR:3.6, 95%CI:1.25e10.2) and prone ventilation (OR:11.0, 95%CI:3.8e31.9) were significantly (p < 0.05) associated with mortality after adjusting for disease severity, comorbidities and MV days. Conclusion: Most patients infected with SARS-CoV-2 are at nutrition risk that can impact outcome. Our data suggest that addressing nutritional adequacy can be one of the measures to reduce hospital LOS, and mortality among nutritionally risk patients.

Association of Different Malnutrition Parameters and Clinical Outcomes among COVID-19 Patients: An Observational Study

“…In one study from China, patients were transferred from other hospitals to the study hospital; thus, the overall severity of COVID-19 was very high and, additionally, only patients over 65 years were included, both contributing to more NRS 2002 points [17]. In our analysis, the nutritional risk expressed by the NRS 2002 was associated with a higher risk of in-hospital mortality, which was already shown in a study with patients hospitalized in a medical ward and ICU with COVID-19 [32] and in a cohort of severely and critically ill patients with COVID-19 [18]. However, these associations are not only COVID-19-specific, but generally true for medical inpatients with and without infections [33,34].…”

COVID-19: Lessons on malnutrition, nutritional care and public health from the ESPEN-WHO Europe call for papers

“…In a Brazilian ICU cohort, protein provision above 0.8 g/Ideal Body Weight/day was also associated with lower mortality [107]. A protective impact was also reported in a mixed cohort of non-ICU and ICU patients [108] for reaching overall adequacy of calorie and protein provision at 25 kcal and 1.2e1.5 g per kg/day, respectively. Conversely, in a study from the United States, intolerance to enteral nutrition in ICU was associated with nutritional complications including higher risk of malnutrition, higher risk of organ failure and overall mortality [109].…”

A retrospective analysis of malnutrition risk, nutritional support and outcomes in COVID-19 patients

“…Another study of 139 COVID-19 inpatients demonstrated that those with malnutrition were more likely to be hospitalised longer compared with those of normal nutritional status, by about 11 days on average [7]. A prospective study of 183 COVID-19 patients admitted to ICU in Italy found that 76% survived when calorie adequacy was >80% compared to 33% survival when it was <80% [8]. Furthermore, another Italian study assessing ward-based COVID-19 patients found that deaths in the patients who were meeting their energy and protein needs were reported less frequently than those who were not, with an overall mortality rate of 7.1% vs. 36.8%, n ¼ 94, although this was not adjusted for potential confounding variables [9].…”