A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community

Abstract

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.

Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19)

“…Current guidelines emphasize the importance of referring COVID-19 with high nutritional risk to a dietitian to facilitate adequate nutritional support [ 67 ]. Therefore, it is necessary to identify patients with the highest risk for malnutrition.…”

“…Therefore, detecting and treating malnutrition in community-dwelling non-COVID-19 patients and the general public may be essential to increase immune resilience against SARS-CoV-2 [ 42 , 74 ]. Nutritional screening for vulnerable individuals in the community (e.g., the elderly and diseased conditions) may be conducted through digital channels to lower the occurrence of infection due to unnecessary exposure [ 63 , 67 , 75 ]. Simple remote nutritional screening tools such as Remote-Malnutrition APP (R-MAPP) can be conducted through phone calls.…”

“…Nutritional guidelines for COVID-19 patients emphasize the use of food-based strategies, oral nutritional supplements, referral to a dietitian, and use of efficient algorithms to provide nutrition for the first 5–7 days in lower-nutritional-risk patients and individualized care for high-nutritional-risk patients [ 63 , 67 ]. Clinical trials show that ICU-admitted patients with sepsis or low BMI who also express high nutritional risk demonstrate significant reductions in 28- and 60-day mortality following an early increase of energy (≥25 kcal/kg) and protein intake (≥1.2 g/kg) [ 83 ] or 10% greater protein and energy adequacy [ 84 ].…”

Reply to “Nutritional approach to patients with coronavirus: our experience in 914 COVID-19–bed hospital”

“…Like our Colleagues in Turin, we have implemented a multidisciplinary outpatient clinic, which includes the systematic consultation by registered dietitians, aimed at facilitating the recovery of adequate energy-protein intake, which is crucial in the rehabilitation process [6] , in particular for patients with previous admission in ICU, in whom the occurrence of muscle loss and sarcopenia is more plausible [7] .…”

Editorial: COVID-19 in older persons: the role of nutrition

“…In a review on nutrition support guidelines for recovering COVID-19 patients in the community the authors stressed the importance of screening for malnutrition, the installment of nutritional care plans and the continuity of nutritional care between settings [ 14 ]. In this context, it also has to be considered that nutritional care is also an essential component of rehabilitation in this population.…”