Discussions

Since its inception, NNEdPro’s COVID-19 Taskforce has worked to improve health during the COVID-19 pandemic, by focusing on nutrition research, clinical practice and public health. As a global organisation, our dedicated microsites contain a repository of generic and region specific public health resources to highlight up-to-date policy and practice across our regional networks(1). Additionally, the taskforce has identified areas for research and evidence synthesis relating to the nutritional aspects of COVID-19 prevention and treatment, including issues of food and nutrition security (2). Our aim has been to coordinate and share resources with NNEdPro’s global and regional networks, and the public, to highlight key challenges, policy updates and best guidance on good nutrition and health practices in the context of COVID-19.

Each month the NNEdPro COVID-19 microsites are updated with new resources related to both public health and nutrition in the context of the COVID-19 pandemic. These evidence collections are linked closely with our research focussed ‘Evidence Tracker’ as well as the International Knowledge Application Network Hub in Nutrition (iKANN).

Alongside this, we will endeavour to produce a monthly statement reflecting on these updates to the evidence base as well as inviting thoughts from taskforce members involved in these areas of work.

Public Health Updates

There has been a focus on COVID-19 vaccines during July and August, with a particular focus on three population groups.

Two studies have investigated COVID-19 vaccination in pregnancy (3,4). Pregnancy is an independent risk factor for severe COVID- 19, and vaccination is the best way to reduce the risk of infection. However, there have been some opposing opinions from professionals and the public regarding the safety of using vaccines before, during and post pregnancy. The World Health Organisation (WHO) and Centers for Disease Control (CDC) considered the potential effects of vaccination on foetal development, placental transfer of antibodies and maternal safety and have decided to recommend pregnant, postpartum and lactating women to receive the COVID-19 vaccine. In this review, the authors examined the evidence supporting the effectiveness, immunogenicity, placental transfer, side effects, and perinatal outcomes of maternal covid-19 vaccination, as well as describing the vaccine hesitancy in pregnancy (3). A Canadian population based retrospective cohort study assessed the risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy (4). The authors concluded that COVID-19 vaccination during pregnancy was not associated with a higher risk of preterm birth, small for gestational age at birth, or stillbirth. There is still little evidence into the pregnancy specific effects of COVID-19 vaccines. Therefore, vaccination during pregnancy must be prioritized in vaccine research.

A BMJ feature looked into what is known about COVID-19 vaccines in children under 5 years (5). The US authorised the vaccination of under 5s in June 2022, joining Argentina, Bahrain, Chile, China, Cuba, Hong Kong, the United Arab Emirates, and Venezuela in offering covid-19 vaccines to the youngest age category. The UK is currently only offering vaccines to those over the age of 5. This feature reported on the evidence of the vaccines’ effectiveness in this age group.

A multicentre prospective cohort study described the incidence of, risk factors for, and impact of vaccines on primary SARS-CoV-2 infection during the second wave of the covid-19 pandemic in susceptible hospital healthcare workers in England (6). The study investigated NHS clinical, support and administrative staff between September 2020 – April 2021 and recorded their COVID-19 infection and vaccination status. Being under 25 years, living in large household, having frequent exposure to COVID-19 patients, working in an emergency department and being a healthcare assistant were the factors increasing the likelihood of infection in the second wave. Time to first vaccination was strongly associated with infection (P<0.001), with each additional day multiplying a participant’s adjusted odds ratio by 1.02. The authors concluded that without the rapid COVID-19 vaccine rollout to healthcare workers in England from December 2020, the second wave infections could have been 69% higher. Equitable delivery of booster vaccines to healthcare workers is therefore essential.

Nutrition Updates

Additional factors considered in new papers added include the impact of ultra-processed food intake on the risk of COVID-19, with data taken from the UK Biobank suggesting a higher risk associated with higher UPF consumption (11). Further to this, a Finnish epidemiological study examines the effects of the pandemic on incident cases of chronic disease, suggesting reduced access to healthcare services as an important factor in their findings (12). On the subject of food security, two studies examine the implications for food access during pandemic times. One study from the Academy of Nutrition and Dietetics in the USA describes changes in practice, challenges and areas of need for registered dietitians working in the area (13). A further systematic review examines global trends in food security and dietary habits of University students (14), noting some concerning trends posing a high risk of weight gain and food insecurity.

The final additions to the microsite collections consider the role of micronutrients in cardiovascular disease and potential implications for COVID-19 infection (15), a clinical case report on the complexities of long-term care With Gastro-Jejunal (GJ) feeding tubes and enteral migration (16) and lastly, qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people (17).

References

1. COVID-19: Useful Resources: https://www.nnedpro.org.uk/coronavirus

2. COVID-19: Nutrition Resources: https://www.nnedpro.org.uk/covid-19nutrition-resources

3. Covid-19 vaccination in pregnancy: https://www.bmj.com/content/378/bmj-2021-069741

4. Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study: https://www.bmj.com/content/378/bmj-2022-071416

5. What do we know about covid-19 vaccines in under 5s? https://www.bmj.com/content/378/bmj.o1892

6. Burden of SARS-CoV-2 infection in healthcare workers during second wave in England and impact of vaccines: prospective multicentre cohort study (SIREN) and mathematical model: https://www.bmj.com/content/378/bmj-2022-070379

7. BMJ NPH Nutrition Interactions with COVID-19: https://nutrition.bmj.com/pages/collections/nph_nutrition_interactions_with_covid-19/

8. Association of periodic fasting with lower severity of COVID-19 outcomes in the SARS-CoV-2 prevaccine era: an observational cohort from the INSPIRE registry https://nutrition.bmj.com/content/early/2022/06/30/bmjnph-2022-000462 

9. Reduced COVID-19 severity elicited by weight loss from a medically supervised ketogenic diet in a geographically diverse ambulatory population with type 2 diabetes and obesity https://nutrition.bmj.com/content/early/2022/07/01/bmjnph-2022-000444  

10. A web-based survey assessing perceived changes in diet, physical activity and sleeping behaviours in adults with type 1 and type 2 diabetes during the COVID-19 pandemic in the UK https://nutrition.bmj.com/content/early/2022/07/19/bmjnph-2021-000391

11. Impact of ultra-processed food intake on the risk of COVID-19: a prospective cohort study - https://pubmed.ncbi.nlm.nih.gov/35972529/

12. The impact of the COVID-19 pandemic on incident cases of chronic diseases in Finland https://pubmed.ncbi.nlm.nih.gov/35972418/

13. Repeated Cross-Sectional Surveys of Registered Dietitian Nutritionists Demonstrate Rapid Practice Changes to Address Food Insecurity During the COVID-19 Pandemic https://pubmed.ncbi.nlm.nih.gov/35963532/  

14. Effect of COVID-19 Outbreak on the Diet, Body Weight, and Food Security Status of Students of Higher Education; A Systematic Review https://pubmed.ncbi.nlm.nih.gov/35946073/  https://pubmed.ncbi.nlm.nih.gov/35946073/  

15. The Mutual Relationship among Cardiovascular Diseases and COVID-19: Focus on Micronutrients Imbalance https://www.mdpi.com/2072-6643/14/16/3439

16. Complexities of Long-Term Care With Gastro-Jejunal (GJ) Feeding Tubes and Enteral Migration During COVID-19 Pandemic Times: A Case Report https://pubmed.ncbi.nlm.nih.gov/35968246/

17. A qualitative exploration of the clinical presentation, trajectory, management and recovery of COVID-19 in older people: Learning from frontline staff experiences https://pubmed.ncbi.nlm.nih.gov/35962626/

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