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Karim ZA, Reese RA, Smith AN, Blackadar ME, Arora V, Moore NM, Johnson EA. Positive impact of nutrition in the prevention of peripheral vascular disease and severe acute respiratory syndrome coronavirus 2: review. Front Nutr 2024; 11:1418028. [PMID: 39364158 PMCID: PMC11448360 DOI: 10.3389/fnut.2024.1418028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/27/2024] [Indexed: 10/05/2024] Open
Abstract
Recent research has shown that there is a link between the trend of cardiovascular disease (CVD), chronic symptoms of SARS-CoV-2 (COVID-19), and medical nutrition therapy. Making positive changes to an individual's lifestyle can help to reduce the symptoms that follow exposure to CVD and COVID-19. Sustainable nutrition and lifestyle changes can positively impact an individual's health. Studies have considered the risk factors associated with the disease, medical history, the link between nutrition and peripheral vascular disease (PVD), symptom management, and the interrelationship between nutrition, COVID-19, and PVD. One study has demonstrated that Western Dietary intake can boost the innate immune system while suppressing humoral response, causing chronic inflammation and poor host defense against viruses. However, further investigation is needed to confirm. Patients with PVD and COVID-19 have experienced a reduction in side effects when prescribed a regimen of medical nutrition therapy, heart-healthy diets, and adequate physical activity before and after symptoms of both diseases appear. This approach has proven to be a protective factor during the combination of both illnesses. Our findings indicate that balanced diet and lifestyle are essential in supporting an optimal immune system that can reduce the risk of virus load in individuals at risk of infection and symptoms from COVID-19 and PVD.
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Affiliation(s)
- Zubair A Karim
- Department of Nutrition and Dietetics, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Rebecca A Reese
- Department of Nutrition and Dietetics, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Adrianne N Smith
- Department of Nutrition and Dietetics, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Madeline E Blackadar
- Department of Nutrition and Dietetics, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Vishal Arora
- Department of Medicine: Cardiology, Wellstar MCG Health, Augusta University, Augusta, GA, United States
| | - Nicole M Moore
- Department of Nutrition and Dietetics, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
| | - Emily A Johnson
- Department of Nutrition and Dietetics, College of Allied Health Sciences, Augusta University, Augusta, GA, United States
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Ferreira-da-Silva R, Maranhão P, Dias CC, Alves JM, Pires L, Morato M, Polónia JJ, Ribeiro-Vaz I. Assessing medication use patterns by clinical outcomes severity among inpatients with COVID-19: A retrospective drug utilization study. Biomed Pharmacother 2024; 172:116242. [PMID: 38340395 DOI: 10.1016/j.biopha.2024.116242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
PURPOSE This study assessed medication patterns for inpatients at a central hospital in Portugal and explored their relationships with clinical outcomes in COVID-19 cases. METHODS A retrospective study analyzed inpatient medication data, coded using the Anatomical Therapeutic Chemical classification system, from electronic patient records. It investigated the association between medications and clinical severity outcomes such as ICU admissions, respiratory/circulatory support needs, and hospital discharge status, including mortality (identified by ICD-10-CM/PCS codes). Multivariate analyses incorporating demographic data and comorbidities were used to adjust for potential confounders and understand the impact of medication patterns on disease progression and outcomes. RESULTS The analysis of 2688 hospitalized COVID-19 patients (55.3% male, average age 62.8 years) revealed a significant correlation between medication types and intensity and disease severity. Cases requiring ICU admission or ECMO support often involved blood and blood-forming organ drugs. Increased use of nervous system and genitourinary hormones was observed in nonsurvivors. Corticosteroids, like dexamethasone, were common in critically ill patients, while tocilizumab was used in ECMO cases. Medications for the alimentary tract, metabolism, and cardiovascular system, although widely prescribed, were linked to more severe cases. Invasive mechanical ventilation correlated with higher usage of systemic anti-infectives and musculoskeletal medications. Trends in co-prescribing blood-forming drugs with those for acid-related disorders, analgesics, and antibacterials were associated with intensive interventions and worse outcomes. CONCLUSIONS The study highlights complex medication regimens in managing severe COVID-19, underscoring specific drug patterns associated with critical health outcomes. Further research is needed to explore these patterns.
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Affiliation(s)
- Renato Ferreira-da-Silva
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal.
| | - Priscila Maranhão
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Cláudia Camila Dias
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Knowledge Management Unit, Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - João Miguel Alves
- CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
| | - Lígia Pires
- Pulmonology Service, Algarve University Hospital Center, Faro, Portugal; Intensive Care Unit, Algarve Private Hospital, Faro, Portugal
| | - Manuela Morato
- Laboratory of Pharmacology, Department of Drug Sciences, Faculty of Pharmacy of the University of Porto, Porto, Portugal; LAQV@REQUIMTE, Faculty of Pharmacy of the University of Porto, Porto, Portugal
| | - Jorge Junqueira Polónia
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS@RISE, Department of Medicine, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Ribeiro-Vaz
- Porto Pharmacovigilance Centre, Faculty of Medicine of the University of Porto, Porto, Portugal; CINTESIS@RISE, Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal
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Yousefi M, Sadriirani M, Mahmoodi S, Samimi B, Pourmahmoudi A, Hosseinikia M, Sadeghi O, Roustaei N, Saeedinezhad Z, Espín JC, Ansari S, Panahande SB. Adjuvant Pomegranate Juice Intake Improves the Inflammatory Status of Hospitalized COVID-19 Patients: A Randomized and Placebo-Controlled Trial. Complement Ther Med 2023:102958. [PMID: 37271189 DOI: 10.1016/j.ctim.2023.102958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/27/2023] [Accepted: 06/02/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the effect of pomegranate juice intake on the inflammatory status and complete blood count in hospitalized Covid-19 patients. METHODS This randomized, double-blinded placebo-controlled trial included 48 patients with two parallel arms. In addition to the standard care provided at the hospital, the patients consumed 500mL of whole pomegranate juice (PJ) daily or a placebo for 14 days. Inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), erythrocyte sedimentation rate (ESR)) and complete blood count were determined at baseline and after the 14 days of intervention. RESULTS At the end of the intervention, a significant decreased was observed in primary outcomes [mean difference (95%CI)] including IL-6 [5.24(0.87 to 9.61)], CRP [23.19(11.93 to 34.44)] and ESR [10.52(1.54 to 19.50)] in the PJ group vs. before the intervention. In addition, significant changes were also observed in the some of the secondary outcomes, including neutrophils, lymphocytes, platelets, platelets-to-lymphocyte(PLR) and neutrophils-to-lymphocyte (NLR) ratios (p<0.05) in the PJ group compared to before the intervention. At the end of the intervention period, the mean change of IL-6 [-7.09(-12.21 to -1.96)], white blood cells [-3.09(-6.14 to -0.05)], neutrophils [-9.12(-18.08 to -0.15)], lymphocyte [7.05(0.17 to 13.92)], platelets [-94.54(-139.33 to -49.75)], PLR [-15.99(-29.31 to -2.67)], blood oxygen saturation [1.75(0.13 to 3.37)] and MCV [0.31(-0.25 to 0.88)] levels were significantly different between groups while no difference was observed between the two groups in other blood indices. CONCLUSION Our results suggest that pomegranate juice intake might slightly improve the inflammatory status and CBC outcomes of COVID-19 patients and it may be beneficial. AVAILABILITY OF DATA AND MATERIALS The final dataset of trial will be available upon request from the primary investigator via e-mail at panahande.b@gmail.com, after obtaining permission from Regional Ethics Committee.
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Affiliation(s)
- Mojtaba Yousefi
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mohammadreza Sadriirani
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sara Mahmoodi
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Bahar Samimi
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Azizollah Pourmahmoudi
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Mahboobe Hosseinikia
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Omid Sadeghi
- Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Roustaei
- Department of Biostatistics and Epidmiology, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zaker Saeedinezhad
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Juan Carlos Espín
- Food & Health Lab; Quality, Safety, and Bioactivity of Plant Foods; CEBAS-CSIC, 30100 Campus de Espinardo, Murcia, Spain
| | - Somaye Ansari
- Department of nursing, School of nursing, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Bahman Panahande
- Department of Nutrition, School of Health and nutrition, Yasuj University of Medical Sciences, Yasuj, Iran.
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Bell MG, Ganesh R, Bonnes SL. COVID-19, the Gut, and Nutritional Implications. Curr Nutr Rep 2023:10.1007/s13668-023-00465-0. [PMID: 36894741 PMCID: PMC9998140 DOI: 10.1007/s13668-023-00465-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/11/2023]
Abstract
PURPOSE OF REVIEW Our goal is to provide the most recent and accurate scientific evidence available regarding COVID-19's interaction with the human gut and the role of nutrition/nutritional supplementation in the prevention and treatment of the disease. RECENT FINDINGS Gastrointestinal symptoms of COVID-19 are common and often persist even after classically defined illness resolution. Nutritional status and content have been shown to impact infection risk and severity. Well-balanced diets are associated with decreased infection risk/severity, and early nutrition is associated with better outcomes in the critically ill. No specific vitamin supplementation regimen has shown consistent benefit for infection treatment or prevention. The impact of COVID-19 extends far past the pulmonary system, and its impact on the gut should not be ignored. For those interested in adopting lifestyle modifications to prevent severe COVID-19 infection/side effects, consideration should be made for adoption of a well-balanced diet (e.g., Mediterranean style), utilization of probiotics, and addressing nutritional/vitamin deficiencies. Future, high-quality research is needed in this arena.
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Affiliation(s)
- Matthew G Bell
- Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
| | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
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Miguélez M, Velasco C, Camblor M, Cedeño J, Serrano C, Bretón I, Arhip L, Motilla M, Carrascal M, Olivares P, Morales A, Brox N, Cuerda C. Nutritional management and clinical outcome of critically ill patients with COVID-19: A retrospective study in a tertiary hospital. Clin Nutr 2022; 41:2940-2946. [PMID: 34782169 PMCID: PMC8559438 DOI: 10.1016/j.clnu.2021.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Severe COVID-19 infection is characterized by an inflammatory response and lung injury that can evolve into an acute respiratory distress syndrome that needs support treatment in intensive care unit. Nutritional treatment is an important component of the management of critically ill patients and should be started in the first 48 h of ICU admission to avoid malnutrition. This study describes the characteristics of the patients treated in a tertiary hospital in Madrid during the months of March-May 2020 (first wave), the medical nutrition treatment employed and its influence in the clinical outcome of these patients. METHODS This is a retrospective study including COVID-19 patients admitted in ICU that needed medical nutrition treatment (MNT). Collected variables included sex, age, BMI, underlying diseases, time from hospitalisation to ICU admission, type of respiratory support (invasive mechanical ventilation (IMV) or high flow nasal cannula (HFNC) or non-invasive ventilation (non-IMV)), caloric and protein requirements (25 kcal/kg adjusted body weight (ABW), 1.3 g/kg ABW/day), MNT type (enteral nutrition (EN), parenteral nutrition (PN), mixed EN + PN), total calories (including propofol) and proteins administered, percentage of caloric and protein goal in ICU day 4th and 7th, metabolic complications, acute kidney failure (AKF), length of stay (LOS) and mortality. Data are expressed as mean ± SD, median (IQR) or frequencies. Statistical analysis was performed with the IBM SPSS Statistics for Windows, Version 25.0. p < 0.05 were considered statistically significant. RESULTS A total of 176 patients were included (72.7% male), 60.1 ± 13.5 years, BMI 29.9 ± 5.4 kg/m2. Underlying diseases included 47.4% overweight, 39.8% obesity, 49.1% hypertension, 41.4% dyslipidaemia. 88.6% of patients needed IMV, 89.1% prone position, 2.9% ECMO. Time to ICU admission: 2 (4.75) days. Estimated caloric and protein requirements were 1775 ± 202 kcal and 92.4 ± 10.3 g. Calories and proteins administered at days 4th and 7th were 1425 ± 577 kcal and 66 ± 26 g and 1574 ± 555 and 74 ± 37, respectively. Most of the patients received PN (alone or complementary to EN) to cover nutritional requirements (82.4% at day 4th and 77.9% at day 7th). IVM patients received more calories and proteins during the first week of ICU admission. Complications included 77.8% hyperglycaemia, 13.2% hypoglycaemia, 83.8% hypertriglyceridemia, and 35.1% AKF. ICU LOS was 20.5 (26) days. The mortality rate was 36.4%. CONCLUSIONS In our series, the majority of patients reached energy and protein requirements in the first week of ICU admission due to the use of PN (total or complementary to EN). Patients with HFNC or non-IMV may be at risk of malnutrition if total or complementary PN to oral diet/ONS/tube feeding is not used to cover nutritional requirements. Therefore, if EN is not possible or insufficient, PN can be safely used in critically ill patients with COVID-19 with a close monitoring of metabolic complications.
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Affiliation(s)
- M. Miguélez
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C. Velasco
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain,Corresponding author. Nutrition Unit, Hospital General Universitario Gregorio Marañón, c/ Doctor Esquerdo 46, 28007, Madrid, Spain
| | - M. Camblor
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - J. Cedeño
- Intensive Care Service. Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C. Serrano
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - I. Bretón
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - L. Arhip
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M. Motilla
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - M.L. Carrascal
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - P. Olivares
- Intensive Care Service. Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - A. Morales
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - N. Brox
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - C. Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Luque Calvo C, Mataix Sanjuan ÁL, Candela Toha Á, Martínez Castro N, Pintor Recuenco MR, Calleja López JL, Botella-Carretero JI, Arrieta Blanco F. Impact of COVID-19 on Short- and Medium-Term Prescription of Enteral Nutrition in the General Population vs. Older People in the Community of Madrid, Spain. Nutrients 2022; 14:3892. [PMID: 36235545 PMCID: PMC9570917 DOI: 10.3390/nu14193892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
We aimed to analyse the impact of COVID-19 during 2020 and 2021 on the prescription of enteral nutritional support and its expenditure in the Community of Madrid, Spain, compared to pre-pandemic data from 2016 in the general population vs. elderly. We analysed official electronic prescriptions of all public hospitals of the Community of Madrid. The population over 75 years of age have the higher prescription of nutritional supplements (p < 0.001 vs. other age groups), with no differences between the 45−64 age group compared to the 65−74 age group (χ2 = 3.259, p = 0.196). The first wave of COVID-19 or the first time there was a real awareness of the virus in Spain is similar in a way to the first peak of prescription of enteral nutrition in March 2020. The second peak of prescription was observed in the over 75 age group in July 2020, being more pronounced in December 2020 and March−April of the following year (F = 7.863, p = 0.041). The last peaks correspond to summer 2021 and autumn of the same year (p = 0.031—year 2021 vs. 2020, p = 0.011—year 2021 vs. 2019), where a relationship between increased prescription of enteral nutrition and COVID-19 cases is observed. High-protein and high-calorie dietary therapies were the most prescribed in patients with or without diabetes. All of this entailed higher cost for the Community of Madrid. In conclusion, COVID-19 significantly affected the prescription of nutritional support, especially in the population over 75 years of age.
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Affiliation(s)
- Carolina Luque Calvo
- Farmacia, Investigación Ramón y Cajal, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
| | - Ángel Luis Mataix Sanjuan
- Responsable Sistemas Información Farmacia, Subdirección General de Farmacia y Productos Sanitarios Comunidad Autónoma de Madrid, Paseo de la Castellana, 280, 28046 Madrid, Spain
| | - Ángel Candela Toha
- Department of Anesthesia & Reanimation, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
| | - Nilda Martínez Castro
- Department of Anesthesia & Reanimation, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
| | | | | | | | - Francisco Arrieta Blanco
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
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Santos OVD, Pinaffi Langley ACDC, Mota de Lima AJ, Vale Moraes VS, Dias Soares S, Teixeira-Costa BE. Nutraceutical potential of Amazonian oilseeds in modulating the immune system against COVID-19 - A narrative review. J Funct Foods 2022; 94:105123. [PMID: 35634457 PMCID: PMC9127052 DOI: 10.1016/j.jff.2022.105123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 01/31/2023] Open
Abstract
Since the outbreak of COVID-19 disease, medical and scientific communities are facing a challenge to contain its spread, develop effective treatments, and reduce its sequelae. Together with the therapeutical treatments, the use of dietary bioactive compounds represents a promising and cost-effective strategy to modulate immunological responses. Amazonian oilseeds are great sources of bioactive compounds, thus representing not only a dietary source of nutrients but also of substances with great interest for human health. This narrative review compiled the available evidence regarding the biochemical properties of some Amazonian oilseeds, especially Brazil nut, Açaí berry, Bacaba, Peach palm, Sapucaya and Tucuma fruits, on human health and its immune system. These effects were discussed from an etiological and pathophysiological perspective, emphasizing their potential role as a co-adjuvant strategy against COVID-19. Besides this, the cost associated with these strategies hinders their applicability in many nations, especially low-income countries and communities living in social insecurity.
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Affiliation(s)
| | | | - Ana Júlia Mota de Lima
- Graduate Program in Food Science and Technology, Technology Institute, Federal University of Pará, Belém 66075-900, Pará, Brazil
| | - Vinícius Sidonio Vale Moraes
- Graduate Program in Food Science and Technology, Technology Institute, Federal University of Pará, Belém 66075-900, Pará, Brazil
| | - Stephanie Dias Soares
- Graduate Program in Food Science and Technology, Technology Institute, Federal University of Pará, Belém 66075-900, Pará, Brazil
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Grecco BH, Araújo-Rossi PA, Nicoletti CF. Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review. JOURNAL OF INTENSIVE MEDICINE 2022; 2:249-256. [PMID: 36785649 PMCID: PMC9110372 DOI: 10.1016/j.jointm.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/07/2022]
Abstract
Hospitalized patients affected by coronavirus disease 19 (COVID-19) have a sustained pro-inflammatory state and recurrent gastrointestinal symptoms that correlate with a decline in the nutritional status, which is directly related to poor immune response and clinical evolution. Nutritional therapy has proven crucial in COVID-19 treatment through the provision of adequate amounts of nutrients. Since the beginning of the pandemic, medical societies have mobilized to provide practical nutritional guidelines to support decision-making; despite this, there are only a few studies dedicated to compiling the most relevant recommendations. In this narrative review, we aimed to summarize and stratify the current scientific literature on nutritional support for hospitalized COVID-19 patients. We carried out a literature review from three databases between January 2020 and July 2021, using nutrition therapy (or medical nutrition or enteral nutrition or parental nutrition or nutritional support) and COVID-19 (SARS-CoV-2 infection) as the search terms. Only those studies that evaluated adult hospitalized patients with admissions to wards, specific clinics, or intensive care units were included. The nutritional intervention considered was that of specific nutritional support via oral, enteral, or parenteral modes. A total of 37 articles were included. In general, the nutritional care provided to COVID-19 patients follows the same premises as for other patients, i.e., it opts for the most physiological route and meets nutritional demands based on the clinical condition. However, some protocols that minimize the risk of contamination exposure for the health team have to be considered. Energy requirements varied from 15 kcal/kg/day to 30 kcal/kg/day and protein goals from 1.2 g/kg/day to 2 g/kg/day. In both cases, the ramp protocol for increased supply should be considered. In cases of enteral therapy, ready-to-use diet and continuous mode are recommended. Attention to refeeding syndrome is essential when parenteral nutrition is used.
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Affiliation(s)
- Beatriz H. Grecco
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Paula A.O. Araújo-Rossi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Carolina F. Nicoletti
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, University of São Paulo, Av Dr Arnaldo 455, São Paulo, SP 01246-903, Brazil,Corresponding author: Carolina F. Nicoletti, Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, University of São Paulo, Av Dr Arnaldo 455, São Paulo, SP 01246-903, Brazil.
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Ojo O, Ojo OO, Feng Q, Boateng J, Wang X, Brooke J, Adegboye ARA. The Effects of Enteral Nutrition in Critically Ill Patients with COVID-19: A Systematic Review and Meta-Analysis. Nutrients 2022; 14:nu14051120. [PMID: 35268095 PMCID: PMC8912272 DOI: 10.3390/nu14051120] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Patients who are critically ill with COVID-19 could have impaired nutrient absorption due to disruption of the normal intestinal mucosa. They are often in a state of high inflammation, increased stress and catabolism as well as a significant increase in energy and protein requirements. Therefore, timely enteral nutrition support and the provision of optimal nutrients are essential in preventing malnutrition in these patients. Aim: This review aims to evaluate the effects of enteral nutrition in critically ill patients with COVID-19. Method: This systematic review and meta-analysis was conducted based on the preferred reporting items for systematic review and meta-Analysis framework and PICO. Searches were conducted in databases, including EMBASE, Health Research databases and Google Scholar. Searches were conducted from database inception until 3 February 2022. The reference lists of articles were also searched for relevant articles. Results: Seven articles were included in the systematic review, and four articles were included in the meta-analysis. Two distinct areas were identified from the results of the systematic review and meta-analysis: the impact of enteral nutrition and gastrointestinal intolerance associated with enteral nutrition. The impact of enteral nutrition was further sub-divided into early enteral nutrition versus delayed enteral nutrition and enteral nutrition versus parenteral nutrition. The results of the meta-analysis of the effects of enteral nutrition in critically ill patients with COVID-19 showed that, overall, enteral nutrition was effective in significantly reducing the risk of mortality in these patients compared with the control with a risk ratio of 0.89 (95% CI, 0.79, 0.99, p = 0.04). Following sub-group analysis, the early enteral nutrition group also showed a significant reduction in the risk of mortality with a risk ratio of 0.89 (95% CI, 0.79, 1.00, p = 0.05). The Relative Risk Reduction (RRR) of mortality in patients with COVID-19 by early enteral nutrition was 11%. There was a significant reduction in the Sequential Organ Failure Assessment (SOFA) score in the early enteral nutrition group compared with the delayed enteral nutrition group. There was no significant difference between enteral nutrition and parenteral nutrition in relation to mortality (RR = 0.87; 95% CI, 0.59, 1.28, p = 0.48). Concerning the length of hospital stay, length of ICU stay and days on mechanical ventilation, while there were reductions in the number of days in the enteral nutrition group compared to the control (delayed enteral nutrition or parenteral nutrition), the differences were not significant (p > 0.05). Conclusion: The results showed that early enteral nutrition significantly (p < 0.05) reduced the risk of mortality among critically ill patients with COVID-19. However, early enteral nutrition or enteral nutrition did not significantly (p > 0.05) reduce the length of hospital stay, length of ICU stay and days on mechanical ventilation compared to delayed enteral nutrition or parenteral nutrition. More studies are needed to examine the effect of early enteral nutrition in patients with COVID-19.
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Affiliation(s)
- Omorogieva Ojo
- Faculty of Education, School of Health Sciences, Health and Human Sciences, University of Greenwich, Avery Hill Campus, Avery Hill Road, London SE9 2UG, UK
- Correspondence:
| | - Osarhumwese Osaretin Ojo
- Smoking Cessation Department, University Hospital, South London and Maudsley NHS Foundation Trust, Lewisham High Street, London SE13 6LH, UK;
| | - Qianqian Feng
- The School of Nursing, Soochow University, Suzhou 215006, China; (Q.F.); (X.W.)
| | - Joshua Boateng
- School of Science, University of Greenwich, Medway Campus, Central Ave, Gillingham, Chatham Maritime, Kent ME4 4TB, UK;
| | - Xiaohua Wang
- The School of Nursing, Soochow University, Suzhou 215006, China; (Q.F.); (X.W.)
| | - Joanne Brooke
- Faculty of Health, Education and Life Sciences, Ravensbury House, Birmingham City University, City South Campus, Birmingham B15 3TN, UK;
| | - Amanda Rodrigues Amorim Adegboye
- Centre for Healthcare Research, Faculty of Health and Life Sciences, School of Nursing, Midwifery and Health, Coventry University, Priory Street, Coventry CV1 5FB, UK;
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10
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Deane AM, Casaer MP. Editorial: Recent challenges in providing clinical nutrition and metabolic care. Curr Opin Clin Nutr Metab Care 2022; 25:86-87. [PMID: 35115448 DOI: 10.1097/mco.0000000000000811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Adam M Deane
- University of Melbourne, Melbourne Medical School, Department of Critical Care
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael P Casaer
- Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
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11
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Lewis SL, Chizmar LR, Liotta S. COVID-19 and Micronutrient Deficiency symptoms – is there some overlap? Clin Nutr ESPEN 2022; 48:275-281. [PMID: 35331502 PMCID: PMC8809666 DOI: 10.1016/j.clnesp.2022.01.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 11/30/2022]
Abstract
Background & aims COVID-19 is highly inflammatory and when it affects the elderly who have multiple comorbidities, the risk of malnutrition is high. The aim of this review is to highlight the evidence for COVID-19 and risk for malnutrition (macro- and micro-nutrient deficiency) sharing two case reports. Methods We report two cases of patients with COVID-19. The first case includes a 75-year-old male with increasing confusion, delirium and malnutrition once he had clinically resolved from his COVID-19 diagnosis. The patient had a number of comorbidities and was treated with diuretics before and after his hospital admission. He was treated with intravenous thiamine and enteral nutrition. The second case includes a 77-year-old male with diabetes who presented with suspected vitamin C deficiency likely due to chronic aspirin use nearly two weeks prior to being diagnosed with pneumonia and COVID-19. The patient recovered from his COVID-19 diagnosis but continued to decline nutritionally and was readmitted sixty days later with failure to thrive. Results The first case had significant improvements in his appetite and neurological conditions following thiamine infusion and enteral nutrition and was discharged to home after a 19-day hospital stay. The second case presented with a vitamin C deficiency before testing positive for COVID-19. Although he did recover from COVID-19 he struggled to meet nutritional needs post-COVID and passed away 60 days after his COVID-19 diagnosis with pneumonia and failure to thrive. Conclusion Elderly patients with chronic diseases who use nutrient depleting medications are particularly high risk for micronutrient deficiency when they also experience the inflammatory insult of COVID-19. Patients who continue to have poor nutrition intake even after they appear to be clinically resolved from the virus should be closely monitored.
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12
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de Jesus RP, de Carvalho JF, de Oliveira LPM, Cunha CDM, Alves TCHS, Vieira STB, Figueiredo VM, Bueno AA. Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2. World J Hepatol 2022; 14:80-97. [PMID: 35126841 PMCID: PMC8790394 DOI: 10.4254/wjh.v14.i1.80] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/28/2021] [Accepted: 12/22/2022] [Indexed: 02/06/2023] Open
Abstract
Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.
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Affiliation(s)
- Rosangela Passos de Jesus
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | | | | | - Carla de Magalhães Cunha
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | - Thaisy Cristina Honorato Santos Alves
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | - Sandra Tavares Brito Vieira
- Postgraduate Program in Food, Nutrition and Health at the School of Nutrition of the Federal University of Bahia, Salvador 40.110-150, Bahia, Brazil
| | - Virginia Maria Figueiredo
- Department of Gastroenterology, IPEMED, Ipemed Faculty of Medical Sciences, Salvador 40170-110, Bahia, Brazil
| | - Allain Amador Bueno
- College of Health, Life and Environmental Sciences, University of Worcester, Worcester WR2 6AJ, United Kingdom
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13
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Subramanian K, Solomon N, Faillace R, Menon V, Raiszadeh F, Brandeis G. Effect of parenteral nutrition in oxygen escalation/de-escalation in SARS-CoV-2 infected patients who are pre-intubation: A multicenter, observational study. Clin Nutr ESPEN 2021; 46:206-209. [PMID: 34857197 PMCID: PMC8526114 DOI: 10.1016/j.clnesp.2021.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/05/2023]
Abstract
Background & aims SARS-CoV-2 infection includes a variety of gastrointestinal manifestations along with the usual viral symptoms of malaise and myalgias. The objective of this study was to determine if intravenous parenteral nutrition (PN) affected the risk of intubation in SARS-CoV-2 patients who were dependent on non-invasive ventilation. Methods Retrospective, multicenter case-control study which analyzed oxygen requirements for 1974 adults with SARS-CoV-2, who were admitted to the local public hospital system between March 1 and May 17, 2020. Relevant baseline biomarkers were studied over 5 days. The main outcome was an escalation or de-escalation of oxygen requirements relative to the exposure of PN. Results 111 patients received PN while on non-invasive ventilation. Patients who received PN had a significantly lower odds (p < 0.001) of oxygen escalation in comparison to their control group counterparts (OR = 0.804, 95% CI 0.720, 0.899) when matched for age, body mass index, Charlson comorbidity index, and gender. Conclusion Initiating PN in the setting of non-invasive ventilation of SARS-CoV-2 infected patients was significantly associated with a lower odds of oxygen escalation. PN does not independently exacerbate oxygen requirements in SARS-CoV-2 infected pre-intubated patients.
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Affiliation(s)
- Kritika Subramanian
- Department of Molecular Imaging and Therapeutics, Weill Cornell Medicine, New York, NY, USA; Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical and Epidemiological Virology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Nadia Solomon
- Department of Radiology, Yale University, New Haven, CT, USA
| | - Robert Faillace
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vidya Menon
- Department of Medicine, Lincoln Hospital Center, Weill Cornell Medicine, Bronx, NY, USA
| | - Farbod Raiszadeh
- Division of Cardiology, Department of Medicine, Harlem Hospital Center, Columbia University, New York, NY, USA
| | - Gary Brandeis
- Division of Geriatrics, Department of Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, Elmhurst, NY, USA; Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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14
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Vargas-Mendoza N, García-Machorro J, Angeles-Valencia M, Martínez-Archundia M, Madrigal-Santillán EO, Morales-González Á, Anguiano-Robledo L, Morales-González JA. Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals. World J Gastroenterol 2021; 27:5630-5665. [PMID: 34629792 PMCID: PMC8473593 DOI: 10.3748/wjg.v27.i34.5630] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/19/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has affected millions of people globally. It was declared a pandemic by the World Health Organization in March 2020. The hyperinflammatory response to the entry of SARS-CoV-2 into the host through angiotensin-converting enzyme 2 is the result of a "cytokine storm" and the high oxidative stress responsible for the associated symptomatology. Not only respiratory symptoms are reported, but gastrointestinal symptoms (diarrhea, vomiting, and nausea) and liver abnormalities (high levels of aspartate aminotransferase, alanine aminotransferase transaminases, and bilirubin) are observed in at least 30% of patients. Reduced food intake and a delay in medical services may lead to malnutrition, which increases mortality and poor outcomes. This review provides some strategies to identify malnutrition and establishes nutritional approaches for the management of COVID-19 and liver injury, taking energy and nutrient requirements and their impact on the immune response into account. The roles of certain phytochemicals in the prevention of the disease or as promising target drugs in the treatment of this disease are also considered.
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Affiliation(s)
- Nancy Vargas-Mendoza
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | - Jazmín García-Machorro
- Laboratorio de Medicina de Conservacion, Instituto Politécnico Nacional, México 11340, Mexico
| | | | - Marlet Martínez-Archundia
- Laboratorio de Diseño y Desarrollo de Nuevos Fármacos e Innovación Biotécnológica, Instituto Politécnico Nacional, México 11340, Mexico
| | | | | | | | - José A Morales-González
- Laboratorio Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, México 11340, Mexico
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15
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Herrera-Quintana L, Gamarra-Morales Y, Vázquez-Lorente H, Molina-López J, Castaño-Pérez J, Machado-Casas JF, Coca-Zúñiga R, Pérez-Villares JM, Planells E. Bad Prognosis in Critical Ill Patients with COVID-19 during Short-Term ICU Stay regarding Vitamin D Levels. Nutrients 2021; 13:nu13061988. [PMID: 34207873 PMCID: PMC8229686 DOI: 10.3390/nu13061988] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND AIMS Vitamin D inadequacy may be involved in the mechanisms of SARS-CoV-2 infection and in potential risk factors for disease propagation or control of coronavirus disease 2019 (COVID-19). This study assessed a short-term evolution of vitamin D status and its influence upon different clinical parameters in critically ill patients with COVID-19. METHODS A prospective analytical study in which 37 critically ill volunteers between 41 and 71 years of age with COVID-19 were evaluated at baseline and three days of intensive care unit (ICU) stay. 25-OH-D3 and 25-OH-D2 were analyzed by liquid chromatography-tandem mass spectrometry and total 25-OH-D levels were calculated as the sum of both. RESULTS All patients presented low 25-OH-D levels at baseline, decreasing total 25-OH-D (p = 0.011) mainly through 25-OH-D2 (p = 0.006) levels during ICU stay. 25-OH-D2 levels decreased a mean of 41.6% ± 89.6% versus 7.0% ± 23.4% for the 25-OH-D3 form during the ICU stay. Patients who did not need invasive mechanical ventilation presented higher levels of 25-OH-D2 at baseline and follow-up. Lower 25-OH-D and 25-OH-D3 levels were associated with higher D-dimer at baseline (p = 0.003; p = 0.001) and at follow up (p = 0.029), higher procalcitonin levels (p = 0.002; p = 0.018) at follow up, and lower percentage lymphocyte counts (p = 0.044; p = 0.040) during ICU stay. CONCLUSIONS Deficient vitamin D status in critical patients was established at the admission and further worsened after three days of stay. Lower vitamin D levels were related to key altered clinical and biochemical parameters on patients with SARS-CoV-2 infection. Given the different response of the 25-OH-D3 and 25-OH-D2 forms, it would be useful to monitor them on the evolution of the critically ill patient.
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Affiliation(s)
- Lourdes Herrera-Quintana
- Department of Physiology, Institute of Nutrition and Food Technology “Jose Mataix”, School of Pharmacy, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (Y.G.-M.); (H.V.-L.)
| | - Yenifer Gamarra-Morales
- Department of Physiology, Institute of Nutrition and Food Technology “Jose Mataix”, School of Pharmacy, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (Y.G.-M.); (H.V.-L.)
| | - Héctor Vázquez-Lorente
- Department of Physiology, Institute of Nutrition and Food Technology “Jose Mataix”, School of Pharmacy, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (Y.G.-M.); (H.V.-L.)
| | - Jorge Molina-López
- Faculty of Education, Psychology and Sports Sciences, University of Huelva, 21007 Huelva, Spain
- Correspondence: (J.M.-L.); (E.P.)
| | - José Castaño-Pérez
- Intensive Care Unit, Virgen de las Nieves Hospital, Fuerzas Armadas Avenue, 18014 Granada, Spain; (J.C.-P.); (J.F.M.-C.); (R.C.-Z.); (J.M.P.-V.)
| | - Juan Francisco Machado-Casas
- Intensive Care Unit, Virgen de las Nieves Hospital, Fuerzas Armadas Avenue, 18014 Granada, Spain; (J.C.-P.); (J.F.M.-C.); (R.C.-Z.); (J.M.P.-V.)
| | - Ramón Coca-Zúñiga
- Intensive Care Unit, Virgen de las Nieves Hospital, Fuerzas Armadas Avenue, 18014 Granada, Spain; (J.C.-P.); (J.F.M.-C.); (R.C.-Z.); (J.M.P.-V.)
| | - José Miguel Pérez-Villares
- Intensive Care Unit, Virgen de las Nieves Hospital, Fuerzas Armadas Avenue, 18014 Granada, Spain; (J.C.-P.); (J.F.M.-C.); (R.C.-Z.); (J.M.P.-V.)
| | - Elena Planells
- Department of Physiology, Institute of Nutrition and Food Technology “Jose Mataix”, School of Pharmacy, University of Granada, 18071 Granada, Spain; (L.H.-Q.); (Y.G.-M.); (H.V.-L.)
- Correspondence: (J.M.-L.); (E.P.)
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Mahluji S, Jalili M, Ostadrahimi A, Hallajzadeh J, Ebrahimzadeh-Attari V, Saghafi-Asl M. Nutritional management of diabetes mellitus during the pandemic of COVID-19: a comprehensive narrative review. J Diabetes Metab Disord 2021; 20:963-972. [PMID: 33842400 PMCID: PMC8021300 DOI: 10.1007/s40200-021-00784-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/20/2021] [Indexed: 01/08/2023]
Abstract
Objectives According to the recent epidemiological studies, patients with diabetes mellitus (DM) may be at higher risk of hospitalization due to COVID-19. Regarding the important role of nutrition on the immunity, the present review article aimed to outline nutritional support of DM during the outbreak of COVID-19 with a mechanistic insight. Methods Searches were performed in PubMed/MEDLINE, ScienceDirect, Scopus, and Google Scholar databases from 2000 until December 2020 using the following keywords. All relevant clinical and experimental studies published in English were included. Results Evidences revealed that hyperglycemia is a significant predictor of some viral infections including COVID-19 which can exacerbate the complications of DM. According to the literature review, adequate intake of dietary protein, fiber, essential fatty acids and some micronutrients especially vitamins D, C, B12, folate, zinc and selenium has beneficial effects on the prevention and treatment of COVID-19 in diabetic patients through modulation of innate and adaptive immune responses or direct effects on virus enzymes or the rate of cell entrance. Conclusions It is well understood that malnutrition may increase susceptibility to viral infections and disease progression. Therefore, considering nutritional status of diabetic patients and reasonable supplementation of the above mentioned nutrients can ameliorate the symptoms of COVID-19 in DM. However, further well-designed clinical trials are needed to determine their therapeutic dose.
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Affiliation(s)
- Sepideh Mahluji
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Jalili
- Department of Biology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jamal Hallajzadeh
- Department of Biochemistry, Maragheh University of Medical Sciences, Maragheh, Iran
| | | | - Maryam Saghafi-Asl
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
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Alves TCHS, Guimarães RS, Souza SFD, Brandão NA, Daltro CHDC, Conceição-Machado MEP, Oliveira LPMD, Cunha CDM. Influence of nutritional assistance on mortality by COVID-19 in critically ill patients. Clin Nutr ESPEN 2021; 44:469-471. [PMID: 34330508 PMCID: PMC8164511 DOI: 10.1016/j.clnesp.2021.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/09/2022]
Abstract
Background & aims Evidence suggests the existence of an association between the institution of nutritional therapy and clinical outcomes in patients with critical COVID-19. Thus, the aim of this study was to evaluate the influence of nutritional assistance on COVID-19 mortality in patients admitted to intensive care units (ICU). Methods This is a subset of the cohort “Influence of nutritional therapy on clinical prognosis in patients with COVID-19: a multicenter retrospective cohort study”. Clinical and nutrition assistance information (type of assistance, evaluation of anthropometric status, and time of introduction of nutritional therapy) and presence of diabetes, hypertension and previous respiratory disease were collected from electronic medical records. To evaluate the association between the variables of interest and mortality, the hazard ratio was estimated. Results We evaluated 153 critically ill patients ≥18 years old, affected by COVID-19, with a rate of mortality of 77.8%. Among non survivors 58.8% were female, 52.9% aged <65 years, 66.4% had arterial hypertension, 46.2% diabetes mellitus and 81.5% had an early onset of nutritional support. Initiation of nutritional therapy after 48 h (HR: 2.57; 95% CI: 1.57–4.20) and the presence of obesity (HR: 1.55; 95% CI: 1.04–2.31) were associated with higher mortality, even after adjustment for potential confounders. Conclusions Our data suggests that the provision of early nutritional therapy should be prioritized, with greater attention directed to obese patients, and the nutritional assistance can contribute favorably to the clinical evolution and prognosis of critically ill patients with COVID-19.
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Affiliation(s)
- Thaisy Cristina Honorato Santos Alves
- Federal University of Bahia, Nutrition School, Food, Health and Nutrition Postgraduate, Basilio da Gama Street, 40.110-040, Bahia, Brazil; State University of Bahia, Science of Life Department, Silveira Martins Street, 2555, 41.150-000, Bahia, Brazil
| | - Renata Santos Guimarães
- Federal University of Bahia, Nutrition School, Food, Health and Nutrition Postgraduate, Basilio da Gama Street, 40.110-040, Bahia, Brazil; Couto Maia Institute, Coronel Azevedo Street, 41.332-010, Bahia, Brazil
| | - Sineide Freitas de Souza
- Federal University of Bahia, Nutrition School, Food, Health and Nutrition Postgraduate, Basilio da Gama Street, 40.110-040, Bahia, Brazil
| | - Najara Amaral Brandão
- Federal University of Bahia, Science Health Institute, Interactive Organ and System Processes Postgraduate, Reitor Miguel Calmon Avenue, 40.110-902, Bahia, Brazil; Couto Maia Institute, Coronel Azevedo Street, 41.332-010, Bahia, Brazil
| | | | | | | | - Carla de Magalhães Cunha
- Federal University of Bahia, Nutrition School, Basilio da Gama Street, 40.110-040, Bahia, Brazil.
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Ebrahimzadeh-Attari V, Panahi G, Hebert JR, Ostadrahimi A, Saghafi-Asl M, Lotfi-Yaghin N, Baradaran B. Nutritional approach for increasing public health during pandemic of COVID-19: A comprehensive review of antiviral nutrients and nutraceuticals. Health Promot Perspect 2021; 11:119-136. [PMID: 34195036 PMCID: PMC8233676 DOI: 10.34172/hpp.2021.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The novel coronavirus (COVID-19) is considered as the most life-threatening pandemic disease during the last decade. The individual nutritional status, though usually ignored in the management of COVID-19, plays a critical role in the immune function and pathogenesis of infection. Accordingly, the present review article aimed to report the effects of nutrients and nutraceuticals on respiratory viral infections including COVID-19, with a focus on their mechanisms of action. Methods: Studies were identified via systematic searches of the databases including PubMed/ MEDLINE, ScienceDirect, Scopus, and Google Scholar from 2000 until April 2020, using keywords. All relevant clinical and experimental studies published in English were included. Results: Protein-energy malnutrition (PEM) is common in severe respiratory infections and should be considered in the management of COVID-19 patients. On the other hand, obesity can be accompanied by decreasing the host immunity. Therefore, increasing physical activity at home and a slight caloric restriction with adequate intake of micronutrients and nutraceuticals are simple aids to boost host immunity and decrease the clinical manifestations of COVID-19. Conclusion: The most important nutrients which can be considered for COVID-19 management are vitamin D, vitamin C, vitamin A, folate, zinc, and probiotics. Their adequacy should be provided through dietary intake or appropriate supplementation. Moreover, adequate intake of some other dietary agents including vitamin E, magnesium, selenium, alpha linolenic acid and phytochemicals are required to maintain the host immunity.
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Affiliation(s)
| | - Ghodratollah Panahi
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - James R. Hebert
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Alireza Ostadrahimi
- Nutrition Research Center, Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Saghafi-Asl
- Nutrition Research Center, Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Lotfi-Yaghin
- Student Research Committee, Department of Clinical Nutrition, Faculty of Nutrition & Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Moscatelli F, Sessa F, Valenzano A, Polito R, Monda V, Cibelli G, Villano I, Pisanelli D, Perrella M, Daniele A, Monda M, Messina G, Messina A. COVID-19: Role of Nutrition and Supplementation. Nutrients 2021; 13:976. [PMID: 33803015 PMCID: PMC8002713 DOI: 10.3390/nu13030976] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 12/13/2022] Open
Abstract
At the end of 2019, a new coronavirus (COVID-19) appeared on the world scene, which mainly affects the respiratory system, causing pneumonia and multi-organ failure, and, although it starts with common symptoms such as shortness of breath and fever, in about 2-3% of cases it leads to death. Unfortunately, to date, no specific treatments have been found for the cure of this virus and, therefore, it is advisable to implement all possible strategies in order to prevent infection. In this context, it is important to better define the role of all behaviors, in particular nutrition, in order to establish whether these can both prevent infection and improve the outcome of the disease in patients with COVID-19. In the literature, it is widely shown that states of malnutrition, overweight, and obesity negatively affect the immune system, leading to viral infections, and several studies have shown that nutritional interventions can act as immunostimulators, helping to prevent viral infections. Even if several measures, such as the assumption of a specific diet regimen, the use of dietary supplements, and other similar interventions, are promising for the prevention, management, and recovery of COVID-19 patients, it is important to highlight that strong data from randomized clinical trials are needed to support any such assumption. Considering this particular scenario, we present a literature review addressing several important aspects related to diet and SARS-CoV-2 infection, in order to highlight the importance of diet and supplementation in prevention and management of, as well as recovery from COVID-19.
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Affiliation(s)
- Fiorenzo Moscatelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
- Department of Medical Sciences and Advanced Surgery, Università degli Studi della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (V.M.); (I.V.); (A.M.)
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Ines Villano
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (V.M.); (I.V.); (A.M.)
| | - Daniela Pisanelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Michela Perrella
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Aurora Daniele
- CEINGE Biotecnologie Avanzate S.C. a r.l., 80131 Napoli, Italy;
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (V.M.); (I.V.); (A.M.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy; (F.M.); (F.S.); (A.V.); (R.P.) (G.C.); (D.P.); (M.P.)
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (V.M.); (I.V.); (A.M.)
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Lotfi F, Akbarzadeh-Khiavi M, Lotfi Z, Rahbarnia L, Safary A, Zarredar H, Baghbanzadeh A, Naghili B, Baradaran B. Micronutrient therapy and effective immune response: a promising approach for management of COVID-19. Infection 2021; 49:1133-1147. [PMID: 34160789 PMCID: PMC8220424 DOI: 10.1007/s15010-021-01644-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023]
Abstract
The escalating prevalence of coronavirus disease 2019 (COVID-19) worldwide, with an increased rate of morbidity and mortality, highlights an urgent need to develop more effective therapeutic interventions. Despite the authorized treatment against COVID-19 by the European Union (EU), the safety and effectiveness of this therapeutic strategy for a wide variety of patients have remained a significant challenge. In this respect, micronutrients such as vitamins and minerals, as essential factors, can be considered for improving the function of the immune system and accelerating the treatment procedure. Dietary supplements can attenuate vascular and inflammatory manifestations related to infectious diseases in large part due to their anti-inflammatory and antioxidant properties. Recently, it has been revealed that poor nutritional status may be one of the notable risk factors in severe COVID-19 infections. In the current review, we focus on the micronutrient therapy of COVID-19 patients and provide a comprehensive insight into the essential vitamins/minerals and their role in controlling the severity of the COVID-19 infection. We also discuss the recent advancements, challenges, negative and positive outcomes in relevance to this approach.
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Affiliation(s)
- Fariba Lotfi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5163639888, Tabriz, Iran
| | - Mostafa Akbarzadeh-Khiavi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, P.O. Box 5165665811, Tabriz, Iran
| | - Ziba Lotfi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Rahbarnia
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5163639888, Tabriz, Iran
| | - Azam Safary
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Habib Zarredar
- Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Amir Baghbanzadeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5163639888, Tabriz, Iran
| | - Behzad Baradaran
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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21
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Davis RC, Durham LA, Kiraly L, Patel JJ. Safety, Tolerability, and Outcomes of Enteral Nutrition in Extracorporeal Membrane Oxygenation. Nutr Clin Pract 2020; 36:98-104. [PMID: 33078433 DOI: 10.1002/ncp.10591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/31/2020] [Accepted: 09/20/2020] [Indexed: 02/06/2023] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) is a supportive care system for patients with respiratory or cardiac failure. Patients requiring ECMO are at risk for significant inflammation, prolonged hospitalization, and acquired malnutrition and sarcopenia. Societal guidelines recommend early enteral nutrition in critically ill patients; however, in this population, optimal timing and dose of nutrition remains unknown and fear of reduced splanchnic perfusion, delayed gastric emptying, and bowel ischemia poses a barrier to appropriate energy and protein intake. This narrative review intends to provide an overview of ECMO, highlight the rationale for nutrition support in this population, and review the safety, tolerability, and outcomes associated with enteral nutrition during ECMO.
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Affiliation(s)
- Robert C Davis
- Clinical Nutrition Services, Froedtert Hospital, Milwaukee, Wisconsin, USA
| | - Lucian A Durham
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Laszlo Kiraly
- Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Jayshil J Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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