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 once again been a strong focus on the long-term effects of COVID-19, including recovery from and long-term management of the disease. In the UK, the NHS have created a new hub ‘Your COVID recovery’ to host useful and accessible resources for patients and recovering from the disease and their families (3). Examples of the resources include information on the disease itself, patient's wellbeing and their road to recovery. The Suth African and Indian governments have both released further guidance on the long-term management of patients recovering from COVID-19 (4,5).

The European Respiratory Society has published a statement on the follow up of patients suffering from long covid (6). The ERS taskforce agreed on eight clinical questions which would be used to search the existing literature and identify the optimal strategies for follow-up care that may positively impact the patient's quality-of-life. Overall, they found that the evidence available for follow-up care for patients with long COVID-19 was limited. There have been two more additions to the BMJ COVID-19 journal exploring long-covid. Researchers from King’s College London analysed self-reported data from the UK ZOE covid app and found that the risk of developing long covid was lower among people with the omicron variant of SARS-CoV-2 compared to those with the delta variant (7). Another test negative case control study estimated the change in odds of covid-19 over time following primary series completion of the inactivated whole virus vaccine CoronaVac in São Paulo State, Brazil (8). The authors found a significant increases in the risk of moderate and severe covid-19 outcomes three months after primary vaccination in adults >65 years.

Despite the recent attention, there is still a lot unknown about the recovery from COVID-19 and long-covid should be made a priority research area across the globe.

A final addition this month is an interesting perspective on the difficulties of science communications during the pandemic, emphasising the importance of educating both the public and policymakers about the scientific process and its constant evolution (9).

Nutrition Updates

A number of further papers have been added to the nutrition resources site during the month of June.

In the clinical nutrition space, we have a literature review on the challenges of providing enteral nutrition in the prone position, a commonly used technique in critically ill patients during the pandemic, with a case study from practice also included (10). Further to this, a large US review examines the impact of malnutrition on clinical outcomes from COVID-19, emphasising the importance of a focus on nutrition in primary prevention (11).

We have added an RCT from Pakistan, examining the effectiveness of micronutrient supplementation (Curcumin, Quercetin, and Vitamin D3) as an adjuvant therapy for mild to moderate symptoms of COVID-19 (12). The authors highlight some promising findings and highlight the need for an expansion of this research, particularly in developing countries, in the search for safe, cheap, accessible, and effective treatments for early-stage COVID-19 infection. A further paper from India examines the impact of COVID-19 infection on treatment adherence and outcomes in patients with diabetes mellitus (13).

Lastly, on the subject of Long COVID and COVID recovery, a new paper documents the effectiveness of intensive, multidisciplinary rehabilitation on nutritional and functional outcomes in patients recovering from COVID-19 (14), strengthening the evidence of the importance of multi-modal care in this patient group. In addition, a study from the Netherlands discusses some of the challenges faced by COVID patients receiving dietetic treatment in primary care (15).

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. NHS: Your COVID recovery: https://www.yourcovidrecovery.nhs.uk

4. SA National Institute for Communicable Diseases- Lond covid: https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/long-covid/

5. Ministry of Health and Family Welfare Government of India - NATIONAL COMPREHENSIVE GUIDELINES FOR MANAGEMENT OF POST- COVID SEQUELAE - https://www.mohfw.gov.in/pdf/NationalComprehensiveGuidelinesforManagementofPostCovidSequelae.pdf

6. European Respiratory Society Statement on Long COVID-19 Follow-Up: https://erj.ersjournals.com/content/early/2022/02/03/13993003.02174-2021

7. Covid-19: Long covid risk is lower with omicron than delta, researchers find: https://www.bmj.com/content/377/bmj.o1500

8. Change in covid-19 risk over time following vaccination with CoronaVac: test negative case-control study: https://www.bmj.com/content/377/bmj-2022-070102

9. In Layman's Terms: The Power and Problem of Science Communication https://pubmed.ncbi.nlm.nih.gov/35757894/

10. Challenges to Provision of Adequate Medical Nutrition Therapy in a Critically Ill COVID-19 Patient Fed in the Prone Position https://pubmed.ncbi.nlm.nih.gov/35761886/

11. Impact of malnutrition on clinical outcomes in patients diagnosed with COVID-19 https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/jpen.2418

12. Oral Co-Supplementation of Curcumin, Quercetin, and Vitamin D3 as an Adjuvant Therapy for Mild to Moderate Symptoms of COVID-19 —Results From a Pilot Open-Label, Randomized Controlled Trial https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9211374/pdf/fphar-13-898062.pdf

13. Impact of SARS-CoV-2 Pandemic on Glycaemic Control, Metabolic Status, Treatment Adherence, Quality of Life in Diabetes Mellitus Patients in Tertiary Care Hospital of Eastern India https://pubmed.ncbi.nlm.nih.gov/35733731/

14. The Effects of an Intensive Rehabilitation Program on the Nutritional and Functional Status of Post-COVID-19 Pneumonia Patients https://pubmed.ncbi.nlm.nih.gov/35745230/

15. Nutritional problems of patients with COVID-19 receiving dietetic treatment in primary care https://pubmed.ncbi.nlm.nih.gov/35732588/