Copyright ©The Author(s) 2021.
World J Gastroenterol. Sep 14, 2021; 27(34): 5630-5665
Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5630
Table 1 Tools for malnutrition detection in patients with coronavirus disease 2019 and liver injury
ToolTarget patientsCriteria
MUSTLow weightObjective criteria:
Objective measures: weight and height to obtain BMI
Other measures (optional): ulna length and mid upper arm circumference
Weight loss in las 3-6 mo
Obese patientsSubjective criteria:
Reduced food intake in last 5 d: clinical management, psychological factors
Weight loss appearance (clothes, jewelry)
NRS-2002Hospitalized individualsBMI
Weight loss within 3 mo
Reduced dietary intake in last week
NUTRIC scoreHospitalized patients at ICUAge
Days hospitalized or in the ICU
Number of comorbidities
IL-6 levels (optional)
SOFA score
APACHE II scorePatients at ICU (predicting mortality)Age
Mean arterial pressure
Heart rate/pulse
Respiratory rate
Sodium, potassium levels
Acute renal failure
SOFA scorePatients at ICU (estimation of mortality)PaO2
Medical ventilation
Platelets level
Glasgow Coma Scale
Bilirubin levels
Mean arterial pressure or administration of vasoactive agents required
Creatinine levels
Is a COVID-19 patient?
GLIMIndividuals at risk in generalPhenotypic criteria:
Weight loss
Loss of muscle mass
Etiologic criteria:
Reduced food intake or assimilation
Presence of disease or inflammation
NRF-NPTDetection of malnutrition in liver patients diseaseUnplanned weight loss in las 3-6 mo
Reduced dietary intake and uncompleted meals
Table 2 Energy and nutrient recommendations for patients with coronavirus disease 2019 with or without liver injury
Estimation of REEAll individuals with COVID-19Estimation by indirect calorimetry
Prediction equations
CaloriesNormal oral diets1500-2000 kcals/d
Increase 400-500 kcals in stress or infection crisis
Polymorbid, old patients > 65 yr27 kcals/kg Bw/day
Low weight, older patients30 kcals/kg Bw/day
Malnourish chronic patients and muscle depletion30-35 kcals/kg Bw/day
-Patients with COVID-19 outside ICUONS with low oral intolerance:
150-400 kcals/service
70-100 g protein/service
Carbohydrates, fiber, PUFAs, vitamins, minerals, probiotics
Consuming for a month
ProteinNormal individuals (prevent loss and muscle mass)1 g/kg Bw/day
70-100 g/d
Form animal (milk, yogurt, meat, fish, chicken, cheese) and vegetable sources (beans, soy, nuts, peas)
Patients with liver cirrhosis sarcopenic1.2-1.5 g/kg Bw/day
Obese sarcopenicOral supplementation of BCAA 0.20-0.25 g/kg Bw/day or 30 g/d
Glutamine and arginine supplementation
Carbohydrates/fat Patients with COVID-19 without respiratory impairmentRatio 70:30 carbohydrates/fat
Medium and low glycemic
Fiber 25-30 g/d
Patients with ventilator supportRatio 50:50 carbohydrates/fat
VitaminsAll individuals with COVID-19A, C, D, E, folate, B6 and B12 (monitoring in patients with liver abnormalities)
MineralsAll individuals with COVID-19Zinc, copper, selenium (monitoring in patients with liver abnormalities)
Critically ill patientsEN after 24-36 h. after ICU admission
Initiate with trophic low-dose (10-20 mL/h.)
Polymeric formula: 15-20 kcals/kg Bw and 1.2-2.0 g/kg Bw/day of protein vitamins, minerals, fiber, probiotics
Provide 70%-80% needs in over 1 wk
Sever obese patients BMI > 50Energy 22-25 kcals/kg IBW
Protein 2 g/kg per day (Class I, II) or 2.5 g/kg IBW/day of (Class III)
Vitamins, minerals, fiber, probiotics
Gastric intolerance individualsUse prokinetics
Post-pyloric feeding in persistence intolerance or at high risk of aspiration
Patients with no GI feasiblePN recommended
Poor nutrition statusLimit the use of omega-6 soy-based ILE during first week
Prolonged stay at ICUMixture of lipids such as olive oil based ILE or SMOF (soy, medium chain triglycerides, olive oil, fish oil)
Table 3 Curcumina, silibylin, sulfuraphane evaluation by Autodock 4.2
LigandBinding energy (kcal/mol)kI µmol/LResidue interactions
Curcumine-4.6428.13Phe 23, Val 25, Leu 28, Phe 26, Thr 30, Val 26
Silybin-5.7362.57Phe 23, Phe 26, Val 29
Sulforaphane-3.751.79Val 29, Phe 26, Val 25, Ala 22, Phe 23, Leu 27