Are COVID-19 patients more susceptible to undernutrition following discharge from intensive care units?

Posting on behalf on the NNEdPro Nutrition & COVID-19 Taskforce

Much of the existing literature on nutrition in COVID-19 has focused on nutritional risk factors in relation to acute disease severity and outcomes, for which we know there are severe nutrition related consequences. These admissions may last days to weeks and even months, depending upon the severity of disease. During long stays in the ICU, prolonged immobilization and ventilatory support contribute to muscle mass losses, which is exacerbated further by the severe metabolic cost associated with COVID-19, meaning nutritional depletion is a major risk.

The LEEP-COVID study group in the USA has published work on the metabolic changes and energy expenditure observed in critically ill patients with COVID-19. They observed that energy expenditure can be anywhere as high 120%–200% of expected values for prolonged periods, meaning, significant adjustments in the provision of nutrition support during this period is warranted. The consequences of these observations for the deterioration of nutritional status described above are stark.

For example, our group recently published a case study on a patient with COVID-19 in a London intensive care unit (ICU) during the first wave of the pandemic. Severe weight loss occurred during this prolonged ICU admission, which resulting in an estimate of 19kg weight loss across the 52 days on ICU (or 24-28% of initial body weight). Evidence of further deconditioning was noted on physical examination post ICU stepdown, with a visual reduction in subcutaneous fat at the triceps, chest and muscle wasting at the biceps, clavicle and lower limbs.

The patient struggled with continued reduced appetite and poor oral intake following ICU discharge and despite counselling on a modified texture diet and various oral nutritional supplements, he was estimated to be meeting <30% of predicted nutritional requirements in the initial period after his ICU discharge. This shows the consequences of severe COVID-19 illness and the barriers to recovering nutritional status in the recovery period. For these reasons, a focus on nutritional rehabiliation in this patient group is extremely important.

As such, we believe nutrition support should be an integral part of COVID-19 follow up in this patient group.

References:

Whittle J, Molinger J, MacLeod D, et al. Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19. Crit Care 2020;24:581

Eden T, McAuliffe S. Critical care nutrition and COVID-19: a cause of malnutrition not to be underestimated. BMJ Nutrition, Prevention & Health 2021;4:e000271. doi:10.1136/ bmjnph-2021-000271

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Shane McAuliffe November 19, 2021 at 9:53pm

Posting on behalf on the NNEdPro Nutrition & COVID-19 Taskforce

Much of the existing literature on nutrition in COVID-19 has focused on nutritional risk factors in relation to acute disease severity and outcomes, for which we know there are severe nutrition related consequences. These admissions may last days to weeks and even months, depending upon the severity of disease. During long stays in the ICU, prolonged immobilization and ventilatory support contribute to muscle mass losses, which is exacerbated further by the severe metabolic cost associated with COVID-19, meaning nutritional depletion is a major risk.

The LEEP-COVID study group in the USA has published work on the metabolic changes and energy expenditure observed in critically ill patients with COVID-19. They observed that energy expenditure can be anywhere as high 120%–200% of expected values for prolonged periods, meaning, significant adjustments in the provision of nutrition support during this period is warranted. The consequences of these observations for the deterioration of nutritional status described above are stark.

For example, our group recently published a case study on a patient with COVID-19 in a London intensive care unit (ICU) during the first wave of the pandemic. Severe weight loss occurred during this prolonged ICU admission, which resulting in an estimate of 19kg weight loss across the 52 days on ICU (or 24-28% of initial body weight). Evidence of further deconditioning was noted on physical examination post ICU stepdown, with a visual reduction in subcutaneous fat at the triceps, chest and muscle wasting at the biceps, clavicle and lower limbs.

The patient struggled with continued reduced appetite and poor oral intake following ICU discharge and despite counselling on a modified texture diet and various oral nutritional supplements, he was estimated to be meeting <30% of predicted nutritional requirements in the initial period after his ICU discharge. This shows the consequences of severe COVID-19 illness and the barriers to recovering nutritional status in the recovery period. For these reasons, a focus on nutritional rehabiliation in this patient group is extremely important.

As such, we believe nutrition support should be an integral part of COVID-19 follow up in this patient group.

References:

Whittle J, Molinger J, MacLeod D, et al. Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19. Crit Care 2020;24:581

Eden T, McAuliffe S. Critical care nutrition and COVID-19: a cause of malnutrition not to be underestimated. BMJ Nutrition, Prevention & Health 2021;4:e000271. doi:10.1136/ bmjnph-2021-000271

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