Nutritional status assessment in patients with Covid-19 after discharge from the intensive care unit

Abstract

Introduction The nutritional diagnosis and early nutritional management of COVID-19 patients must be integrated into the overall therapeutic strategy. The aim of our study is to assess the nutritional status of patients with COVID-19 after a stay in intensive care, to describe the prevalence of undernutrition, to determine the factors influencing undernutrition and to describe the nutritional management. Tools and methods This is a descriptive observational study of adult patients admitted to the endocrinology service for additional care after a stay in intensive care during the period from April 17, 2020 to May 26, 2020. The assessment tool used was the Mini Nutritional Assessment (MNA). Results Our study included 41 patients; the average age of the patients was 55 years, 51.2% had a severe or critical form of COVID-19, 75.6% stayed in intensive care, 12.2% had a loss of autonomy. The average BMI was 25.2 kg/m 2 (17–42 kg/m 2 ), 42.5% were overweight, 61% had weight loss, 26.2% had weight loss greater than 10%, 14.6% of our patients were undernourished, 65.9% were at risk of undernutrition, 19.5% had hypoalbuminemia, 17.1% had hypoprotidemia, 19.5% hypocalcemia, 34.1% anemia, 12.2% hypomagnesemia and 51.2% had a deficiency in vitamin D. A positive correlation was found between poor nutritional status and a longer stay in intensive care (>5 days) (p = 0.011) and lymphopenia (p = 0,02). Conclusion Despite a personalized diet, 14.6% of patients presented undernutrition. Particular attention should be paid to patients with a long stay in intensive care.

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

“…Rapid communication of malnutrition risk at discharge between settings is necessary to ensure continuity of nutritional care, which should be an integral aspect of rehabilitation pathways for patients recovering from COVID-19 [67]. Indeed, MNA detected malnutrition and high risk of malnutrition in 14.6% and 65.9% of patients following discharge from ICU [52], in 6.6% and 54.7% of remitting patients attending follow up care [51], and in 5.4% and 57.3% of recovering patients 100 days after discharge from the hospital [50]. Some elements in bioactive foods (e.g., bee products) foster the immune system and interact with SARS-CoV-2 and its related host receptor, resulting in lower viral tropism and decreased viral load [4,86].…”

“…Table 1 shows that the risk for malnutrition in COVID-19 patients can be assessed by a wide range of measures. Seven studies counted primarily on the traditional screening measures [ 28 , 34 , 48 , 50 , 51 , 52 , 53 ]. Some of these studies also included nutritional biomarkers (e.g., total protein and albumin) [ 28 , 48 , 52 , 53 ] or anthropometric parameters such as body weight, body mass index (BMI), and calf circumference [ 34 , 48 , 50 , 51 , 52 ].…”

“…Seven studies counted primarily on the traditional screening measures [ 28 , 34 , 48 , 50 , 51 , 52 , 53 ]. Some of these studies also included nutritional biomarkers (e.g., total protein and albumin) [ 28 , 48 , 52 , 53 ] or anthropometric parameters such as body weight, body mass index (BMI), and calf circumference [ 34 , 48 , 50 , 51 , 52 ]. On the other hand, some studies assessed malnutrition through nutritional indices, which are calculated based on combinations of nutritional biomarkers (e.g., serum albumin and cholesterol), markers of inflammation (e.g., lymphocyte count) [ 41 , 47 , 54 ], age, comorbidities, etc.…”

“…Nutritional markers in severe/critical COVID-19 patients correlated with NRS-2002 [ 28 ] and NRI [ 56 ]. Likewise, among remitting patients, MNA scores correlated with nutritional markers [ 52 ]. In a study involving 2623 COVID-19 patients (median age = 64 years), non-critical, critical, and fatal patients, in order, expressed significant hypoalbuminemia on admission (38.2%, 71.2%, and 82.4%), which increased during hospitalization (45.9%, 77.7%, and 95.6%) [ 24 ].…”

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

“…In a study of hospitalized patients above age 65 with COVID-19 infection in Wuhan, China, using the Mini Nutritional Assessment (MNA), 27.5% were at malnutrition risk and 52.7% had malnutrition [ 10 ]. In another study, that applied the MNA in COVID-19 patients, average age 55 years, after discharge from the ICU 65.9% were at risk and 14.5% of patients were malnourished [ 11 ]. Hypoalbuminemia was present in 19.5%.…”