Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Abstract

The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

Nutritional management and clinical outcome of critically ill patients with COVID-19: A retrospective study in a tertiary hospital

“…Obesity (mainly sarcopenic) and its comorbidities are important risk factors for severe COVID-19. As the ESPEN guidance paper on COVID-19 and obesity stand out, a correct diagnosis and nutritional management is essential in patients with obesity [42]. In our study energy and proteins requirements were calculated using adjusted weight if BMI 25kg/m2.…”

“…The median time from hospitalization to ICU admission was 2 (4.75) days. Patients were admitted with a median PaFi 90 [42]. According to Berlin criteria for ARDS, 66.5% were severe (PaFi <100), 31.2% moderate (PaFi 100e200) and 2.3% mild (PaFi 200e300).…”

Prognostic Role of Subcutaneous and Visceral Adiposity in Hospitalized Octogenarians with COVID-19

“…Obesity is associated with a higher prevalence of other risk factors that are related to the COVID-19 severity, such as hypertension and diabetes, but is also recognized as a source of chronic inflammation and as a modulator of the immune response [ 8 , 9 ]. Consequently, obesity and the balance between subcutaneous and visceral adiposity may not only increase the susceptibility of acquiring the infection but also the disease severity, including the risk of a cytokine storm.…”

Protein requirements for critically ill ventilator‐dependent patients with COVID‐19

“…Adjusted body weight was calculated in the ESPEN guidelines by: ideal body weight + ([actual weight -ideal body weight] × 0.25) 26 Recent indirect calorimetry studies demonstrate many critically ill patients with COVID-19 exhibit hypermetabolism. [3][4][5] One study indicated that hypermetabolism (measured energy expenditure > 110% of predicted) occurred in two-thirds of their patients.…”