There is emerging evidence that nutrition support is crucial in the treatment of patients with COVID- 19, with different levels of support required based on disease severity. Individuals ‘at risk’ of severe illness with COVID -19 include those over 60 years of age, those with long term medical conditions or individuals who are immunosuppressed. These groups are also at higher risk of malnutrition. Patients with COVID- 19 are at risk of developing acute malnutrition caused by inflammation of acute disease and a reduced food intake/assimilation due to GI symptoms including anorexia, diarrhoea, vomiting and abdominal pain.
Malnutrition due to any cause is associated with a higher hospital admission and re-admission rates as well as increased length of hospital stay. There are many physical effects of malnutrition on the body including reduced muscle strength and fatigue which can lead to reduced respiratory muscle function and in turn poor cough pressure - delaying expectoration and recovery from chest infection. More information in: Nutrition screening and use of oral nutrition support for adults in the acute care setting National Clinical Guideline No. 23, Department of Health (https://bit.ly/3dmAGhY).
Malnutrition is associated with an altered immune system and impaired response to both bacterial and viral illness. Patients in the critical care setting (ICU/HDU) are at high risk of malnutrition and are likely require enteral, parenteral or oral nutrition support (or a combination of these) to meet their nutritional needs. Early evaluation of nutritional status, gastrointestinal function and risk of aspiration along with timely enteral nutritional support are important to the patient’s prognosis. Provision of nutrition to critically ill patients is complex; the dietitian is best placed to provide nutritional advice to the multi-professional team on the optimal way to manage the nutritional needs of all critically ill patients. See https://bit.ly/2L4Kzoh for further information.
As patients with COVID-19 begin to improve it is important that their nutritional status continues to be monitored and that they are provided with appropriate nutrition support to recover from acute malnutrition. This may include counselling the patient to continue to monitor their body weight after discharge.
This document was written by Sharon Kennelly, Clinical Specialist Community Dietitian (Older Persons) and Karen Gaynor, Obesity Programme Manager, with additional comments from the Irish Nutrition and Dietetic Institute (INDI). It has been approved by Margaret O’ Neill, National Dietetic Advisor, Prof Donal O’ Shea, HSE Clinical Lead for the National Obesity Management Clinical Programme and Dr Siobhan Kennelly National Clinical Advisory Group Lead Social Care Division HSE.
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