Adherence to COVID-19 nutritional guidelines and their impact on the clinical outcomes of hospitalized COVID-19 patients

Abstract

Background & Aims Coronavirus disease 2019 (COVID-19) patients are at high risk of malnutrition, and their doctors are part of a multidisciplinary team, including nutritionists. However, adherence to nutritional guidelines may be difficult in the context of capacity constraints during the COVID-19 pandemic. The aim of this study was to investigate barriers to doctors’ adherence to nutritional guidelines and the impacts of guideline adherence on the outcomes of hospitalized COVID-19 patients. Methods A multinational electronic survey involving 51 doctors was conducted between November 2020 and January 2021 from 17 COVID-19-designated hospitals in countries with high (Indonesia) and low (Vietnam) numbers of confirmed COVID-19 cases. Results In general, doctors reported concerns related to nutritional practices in patients with Covid-19 which included feeling stress when performing medical nutritional therapy (65%), lacking self-efficacy or confidence in performing nutritional care (49%), lacking clear nutritional guidelines (45%), and experiencing budget limitations (33%). A regression analysis adjusted for age, country, and the number of hospitalized COVID-19 cases revealed that guideline knowledge (ß: -1.01 (-1.78, -0.23); p=0.012) and awareness of guidelines (ß: -1.37 (-2.66, -0.09); p=0.037) were negatively correlated with the length of stay of critically ill COVID-19 patients, but non-significant after adjusting for specialization of the doctor. When stratified according to country, a significant relationship between guideline adherence and length of stay of critically ill patients was only found in Vietnam [guideline adherence: ß: -0.55 (-1.08, -0.03); p=0.038; guideline knowledge: ß: -1.01 (-1.9, -0.13); p=0.027] after adjusting for age, specialty, and number of hospitalized COVID-19 cases. In Indonesia, the significant relationship between guideline adherence and mortality of COVID-19 patients remained strong (ß: -14 (-27, -1); p=0.033) after adjusting for age, specialty, and number of hospitalized COVID-19 cases Conclusions Inadequate nutritional knowledge is a key barrier to guideline adherence, and this was international and may be related to doctors’ specialties and the COVID-19 pandemic. Adherence to nutritional guidelines may represent a prognostic factor for survival in COVID-19 patients.

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

“…Even in tertiary care centers, inadequate implementation of nutritional care in patients with COVID-19 has been documented when compared to malnutrition prevalence [28,67]. In surveys from South-East Asia, limitations were confirmed in implementation of nutrition guidelines in COVID-19 patients, with reasons including lack of confidence as well as budget limitations [121]. Similarly, insufficient knowledge of nutrition management was self-reported by ICU personnel in a Swiss survey [122].…”

“…Similarly, insufficient knowledge of nutrition management was self-reported by ICU personnel in a Swiss survey [122]. Importantly, low adherence to nutritional guidelines was associated with negative clinical outcomes including higher length of stay in ICU and mortality [121]. On the other hand, studies reporting adequate implementation of nutritional care in ICU to reach nutritional targets also reported good access to healthcare professionals such as nutritionists and dietitians [123e126].…”

The syndromic triad of COVID-19, type 2 diabetes, and malnutrition

“…Other immunonutrients, including the amino acids glycine, arginine, and glutamine, may mitigate inflammation, protect lung and intestinal integrity during acute illness, and support muscle renewal during recovery (156). Unfortunately, the volatile status of the pandemic continues to limit clinical trials on COVID-19-specific nutrition recommendations, and some reports indicate suboptimal institutional adherence to existing guidelines (157)(158)(159). The completion of well-designed clinical trials and then creation and adoption of subsequent evidence-based guidelines is critically important for lowering mortality and shortening hospital stays (158).…”

“…Unfortunately, the volatile status of the pandemic continues to limit clinical trials on COVID-19-specific nutrition recommendations, and some reports indicate suboptimal institutional adherence to existing guidelines (157)(158)(159). The completion of well-designed clinical trials and then creation and adoption of subsequent evidence-based guidelines is critically important for lowering mortality and shortening hospital stays (158).…”

Knowledge and attitudes towards dietary patterns and lifestyle during COVID-19 pandemic in Bangladesh: an online based cross-sectional study

“…A study based on hospitalized patients indicated that the reason, behind not following doctors' guideline lack of nutritional knowledge, not attitudes or financial factors. 7 Making individuals understand the importance of nutritional practice is vital to make post-COVID situation better in case of regaining immunity. According to a survey done in China, inhabitants had a high awareness rate of most nutrition knowledge during the epidemic time, and a significant number of them adjusted their food safety and nutrition-related practices.…”