Nutrition, Malnutrition and Coronavirus
06 May 2020
The Covid-19 pandemic has caused a significant change in peoples’ lives
A novel disease brings many questions and insecurities, and as a response, people are looking for ways to maintain and improve their health and immunity. Alongside the necessary hygiene measures and social distancing, there is an increased demand for nutritional solutions to support immunity, with the hope to reduce the chance or impact of an infection.
Unfortunately in these times, misinformation spreads quickly and it is important to seek scientific guidance and maintain a healthy diet and lifestyle.
In the Medical Nutrition team in NZMP, we want to use our platforms and communication channels to share information from recognised advising bodies that utilise research-backed guidelines for optimal nutrition support.
The World Health Organization (WHO) confirms that a healthy, balanced diet supports good immunity. A website has been created with information on food and nutrition practises for the general public. General food practises include consuming a variety of foods, including plenty of fresh fruit and vegetables, protein including dairy, and healthy fat sources, but also food safety measures whilst cooking at home.
The World Health Organisation confirms that a healthy, balanced, varied diet supports immunity
Jacqueline van Schaik, Lead Nutritionist | Medical and Healthy Ageing
Supporting health care professionals with nutrition management
The European Society for Clinical Nutrition and Metabolism (ESPEN) experts provided nutrition guidelines of Covid-19 patients to increase awareness of nutrition management of their patients. Other regional societies like ASPEN and AuSPEN underline their guidelines on their websites also.
Disease-related malnutrition is an important factor to measure to understand how to best support patient recovery and the first recommendation in the guidance is screening every new patient for the presence of malnutrition. When malnourished, the primary goal is to increase protein and energy intake with food.
Additional supplementation using ready-to-drink beverages or protein powders should follow before resorting to tube feeding or parenteral feeding. Also, there are nutritional considerations for patients in Intensive Care, as well as in recovery post-Intensive Care. All of this guidance will be entirely managed by a trained healthcare professional.
The ESPEN document provides ten nutritional guidelines, summarised here:
- Screening for malnutrition against the global malnutrition assessment criteria (MUST).
- Optimise nutritional status through counselling from experienced professionals.
- Consider supplementation to meet sufficient vitamin and mineral levels in malnourished patients
- Patients in quarantine should continue physical exercise at home to support muscle mass and resilience.
- High protein, high calorie oral nutritional supplements (ONS) should be used whenever possible to meet patient’s needs when dietary counselling and food fortification are not sufficient to meet dietary goals and should continue for at least one month.
- Parenteral nutrition should be considered in patients with reasonable prognosis who cannot meet their requirements using ONS or via tube-feeding.
- Non-intubated patients should receive oral supplements prior to considering tube-feeding or parenteral nutrition.
- Nasogastric tube-feeding can be used in ventilated patients, without limitations by the prone position of the patient, but post-pyloric feeding should be considered in case of gastric intolerance of feeds.
- Tolerability of feeds should always be a primary measure for care and every case should be considered independently to meet nutrition needs with a preference for enteral over parenteral nutrition support.
- Texture-modified food should be considered post-intubation if swallowing is proven unsafe.
Please refer to the document references for detailed information on the implementation of these recommendations.
In recovered patients, there is an important consideration for recovering from extended periods of bed-rest. Even one week of bed rest impacts muscle mass and function substantially. Therefore, ensuring physical exercise, even if it is only walking, as well as quality protein intake in a balanced diet is pivotal to a well-supported recovery.
About the author
Jacqueline van Schaik
Jacqueline has a MSc in Human Nutrition, Marketing and Consumer Science. She is the Lead Nutritionist for the Medical and Healthy Ageing Functional Nutrition Unit.
- Source: Food and nutrition during self-quarantine: what to choose and how to eat healthily
- Source: Barazzoni R, Bischoff SC, Krznaric Z, Pirlich M, Singer P, endorsed by the ESPEN Council, ESPEN expert statements and practical guidance for nutritional management of individuals with sars-cov-2 infection, Clinical Nutrition Espen expert statements and practical guidance for nutritional management of individuals with sars-cov-2 infection
- Source: Marlou L. Dirks (2016), ADA. One Week of Bed Rest Leads to Substantial Muscle Atrophy and Induces Whole-Body Insulin Resistance in the Absence of Skeletal Muscle Lipid Accumulation.