Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19

Abstract

Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The literature on nutrition and COVID-19 mainly focuses on the importance of nutrition to preserve life and prevent clinical deterioration during the acute phase of illness. However, there is a lack of information guiding practice across the whole patient journey (e.g., hospital to home) with a focus on targeting recovery (e.g., long COVID). This review paper is of relevance to doctors and other healthcare professionals in acute care and primary care worldwide, since it addresses early, multi-modal individualised nutrition interventions across the continuum of care to improve COVID-19 patient outcomes. It is of relevance to nutrition experts and non-nutrition experts and can be used to promote inter-professional and inter-organisational knowledge transfer on the topic. The primary goal is to prevent complications and support recovery to enable COVID-19 patients to achieve the best possible nutritional, physical, functional and mental health status and to apply the learning to date from the COVID-19 pandemic to other patient groups experiencing acute severe illness.

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

“…The strong point of such evaluation is to assess muscle function in the long term and to judge the evolution of muscle strength, without knowledge of the level of strength prior to the disease. We evaluated this tool in a small cohort of hospitalized patients [17] and while we were unable to identify the actual threshold of functional impairment, our assessment was nevertheless based on the threshold determined according to the questionnaire of Krznaric et al [14] and on other subjective visual or numeric scales [40]. This threshold must, however, be validated in a large cohort study, notably in comparison with the evolution of muscle strength objectively measured by dynamometry.…”

“…In practice, patients were asked to evaluate their arm and leg strength in comparison with their strength prior to COVID-19. As suggested by Krznaric et al [14], patients were asked about their degree of difficulty in lifting or carrying a weight, walking across the room, rising from a chair or bed, and to evaluate these difficulties using a 10point verbal or visual analogue scale (10 = same strength as before illness and 0 = total loss of strength).…”

“…As a result, studies have mainly focused on the importance of nutritional intervention during the acute phase of COVID-19 in order to prevent clinical deterioration (review in [14]). However, the consequences of unintentional weight loss and resulting sarcopenia can also have major long-term functional impacts [15].…”

The Role of Nutrients in Prevention, Treatment and Post-Coronavirus Disease-2019 (COVID-19)

“…COVID-19 patients, especially hospitalized ones, show strong consequences, such as hypermetabolism and muscle catabolism, due to a marked systemic inflammation, with a reduction in food intake and therefore malnutrition. Some studies show that the outcome of COVID-19 patients is correlated with their nutritional status [ 46 , 47 ].…”

Dietary Recommendations for Post-COVID-19 Syndrome

“…As reported in the previous sections, post-COVID-19 syndrome is characterized by malnutrition, loss of fat-free mass, and low-grade inflammation. In addition, the recovery might be complicated by persistent symptoms such as functional impairment (i.e., fatigue and muscle weakness), dysphagia (particularly in patients who were intubated during hospitalization), appetite loss, and taste/smell alterations (ageusia/dysgeusia and anosmia) [ 62 ]. Therefore, the goal of nutritional therapy in post-COVID-19 syndrome should focus on the correction of nutritional deficiencies to support an adequate recovery in terms of physical and functional conditions, as well as mental health.…”