Enteral nutritional support for patients hospitalized with COVID-19: Results from the first wave in a public hospital

Abstract

Background & aims Nutrition has become an important component in treating individuals during the COVID-19 pandemic, which is increasingly affecting the world population, and bringing with it a collapse in health services. Prolonged hospitalization, involving immobilization and catabolism, induces a decrease in body weight and muscle mass that may result in sarcopenia, a condition that impairs respiratory and cardiac function, worsening the prognosis. The present study aimed to analyze enteral nutritional support and the clinical evolution of patients admitted for COVID-19 in Brazil. Methods This was a retrospective study, carried out from March to May 2020, with patients admitted to a referral hospital in cardiology and pulmonology in Fortaleza-Ce/Brazil, 200 patients with COVID-19 were selected. Sociodemographic, clinical, and nutritional data were collected from electronic medical records, and associations between outcomes and use of prone body position with nutritional variables were analyzed by linear regression. The odds ratio and 95% confidence interval estimates for the death outcome were analyzed by logistic regression. Results Of the 112 patients who fed by the enteral route, the majority were male (n = 61, 54.5%), elderly (n = 88, 78.6%), with no current smoking habit (n = 81, 72.3%). The median hospital stay was 14 days, mostly in the intensive care units (median of 9 days). Prone body positioning impacted the nutritional therapy. In general, those patients who maintained a prone body position tested lower for kcal/kg of body weight, proteins/kg of body weight, percentage of diet adequacy, and total caloric value. In addition, patients who died had lower mean maximum kcal/kg body weight, protein/kg body weight, percentage of diet adequacy, and total caloric value compared to surviving patients. Conclusions There was an association between inadequacies in protein and energy supply with mortality was confirmed suggesting that nutritional support optimization be prescribed in such situations.

The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Seven studies were included in the systematic review, and four studies were used for the meta-analysis ( Figure 1 ). Three studies were conducted in the US [ 24 , 25 , 26 ], and there was one study each from Brazil [ 27 ], Greece [ 28 ], Mexico [ 7 ] and China [ 29 ] ( Table 2 ).…”

“…Two studies [ 24 , 27 ] showed an unclear risk of bias in relation to missing data, one study was with respect to the selection of participants [ 7 ], and another study was in relation to confounding variables [ 25 ]. Chawla et al [ 24 ] showed a high risk of bias with respect to the confounding variables (refer to Figure 2 ).…”

“…Alencar et al [ 27 ] found that patients on an enteral nutrition diet of ≥25 kcal/kg of weight/day and ≥1.2 protein/kg of weight had a lower odds ratio in relation to mortality compared to patients who did not achieve these energy and protein levels. Furthermore, there were lower average maximum kcal/kg, protein/kg, percentage of diet adequacy and total caloric values among patients who died compared with patients who survived and were discharged [ 27 ]. According to Liu et al [ 26 ], the median length of intensive care unit (ICU) stay of the 79 patients who did not receive enteral feeding was 2 days vs. 18 days for patients who received enteral tube feeding.…”

“… Represents ( a ) risk of bias graph and ( b ) risk of bias summary [ 7 , 24 , 25 , 26 , 27 , 28 , 29 ]. …”

Role of Diet and Nutrients in SARS-CoV-2 Infection: Incidence on Oxidative Stress, Inflammatory Status and Viral Production

“…In December 2019, novel evolved coronavirus called COVID-19 appeared for the first time [ 1 ]. This local epidemic has converted to a global pandemic, and more than two years later the repercussions stay unclear and dreadful [ 2 ]. At the start of 2022, the COVID-19 pandemic has been accountable for more than 100 million stated contaminations and 5 million deaths with dramatic social consequences [ 2 ].…”