Clinical Nutrition in times of COVID-19

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

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.

[Effect of COVID-19 on dietotherapeutic prescription during the first half of 2020 in the Community of Madrid]

Introduction

Objectives: the aim of the study was to analyze the impact of COVID-19 on enteral nutrition prescription in the Community of Madrid during the first semester of 2020. Material and Methods: this is a descriptive study of enteral nutrition prescription in the first semester of 2020 and its comparison with the first semester of 2019. We included all the prescriptions in public hospitals of the Community of Madrid as recorded in public electronic databases. Results: there was an 8 % increase in the number of enteral nutrition prescriptions in March 2020 when compared with the previous months (p < 0.001). Then, in April and May 2020 we observed a 9 % decrease in enteral nutrition prescriptions (p < 0.001). Total costs in enteral nutrition showed a similar pattern, with an increase in March 2020 (p < 0.001) and a decrease in April and May 2020 (p < 0.001). When analyzing the data by patient age, those above 75 y.o. showed the highest decrease in enteral nutrition prescriptions (33.1 % higher than for those under 75 y.o.) in April and May 2020 (p < 0.001). Conclusions: the irruption of COVID-19 had a relevant impact on enteral nutrition prescription, especially among the elderly. Follow-up is needed to assess the long-term consequences of this in nutritional therapy.

Medical nutritional therapy for renal transplantation in the COVID-19 pandemic

Nutritional therapy is very important at renal transplantation. Nutrition has become more vital for transplantation patients owing to the coronavirus disease 2019 (COVID-19) pandemic. Inadequate nutrition can negatively affect the immune system. For this reason, adequate protein and energy intake should be provided to the patients. Also, overconsumption of saturated fat, sugar, and refined carbohydrates can both negatively affect the immune system and trigger chronic diseases in transplantation patients. In addition, vitamins and minerals should be monitored and inadequacy should be prevented due to immunomodulatory effects. Applying nutritional therapy suitable for the symptoms of renal transplantation patients and preventing comorbidities may reduce the risk and severity of COVID-19 infection.

COVID-19 and endocrine and metabolic diseases. An updated statement from the European Society of Endocrinology

BACKGROUND

COVID-19 has completely changed our daily clinical practice as well as our social relations. Many organs and biological systems are involved in SARS-Cov-2 infection, either due to direct virus-induced damage or to indirect effects that can have systemic consequences. Endocrine system is not only an exception but its involvement in COVID-19 is so relevant that an "endocrine phenotype" of COVID-19 has progressively acquired clinical relevance.

AIM

We have been appointed by the European Society of Endocrinology (ESE) to update with the current statement ESE members and the whole endocrine community on the emerging endocrine phenotype of COVID-19 and its implication for the prevention and management of the disease.

CONCLUSIONS

Diabetes has a major role in this phenotype since it is one of the most frequent comorbidities associated with severity and mortality of COVID-19. Careful management including treatment modifications may be required for protecting our patients rather with known diabetes from the most dangerous consequences of COVID-19 or hospitalized with COVID-19, but also in patients with SARS-CoV-2 induced newly onset diabetes. Obesity increases susceptibility to SARS-CoV-2 and the risk for COVID-19 adverse outcome. Adequate nutritional management needs to be granted to patients with obesity or undernourishment in order to limit their increased susceptibility and severity of COVID-19 infection. Lack of vitamin D, hypocalcemia and vertebral fractures have also emerged as frequent findings in the hospitalized COVID-19 population and may negatively impact on the outcome of such patients. Also, in patients with adrenal insufficiency prompt adaptation of glucocorticoid doses may be needed. Moreover, in this updated statement role of sex hormones as well as peculiar pituitary and thyroid aspects of COVID-19 have been included. Finally, in view of the mass vaccination, potential implications for endocrine patients should be considered.

[COVID pandemic and clinical nutrition response in Spain: results of a national survey]

Introduction

Introduction: the SARS-CoV-2 pandemic has forced major organizational and care changes in the health system. However, in Spain, the circumstances suffered by the health professionals who have cared for pandemic patients from a clinical nutrition standpoint has remained unknown up to this moment. Objectives: the management and care changes made in clinical nutrition units in Spain, and their impact on clinical practice are described. Material and methods: a cross-sectional study was carried out using a survey directed at SENPE members (June 2020). Responses sent by health professionals in the field of clinical nutrition who had treated patients with COVID-19 in Spanish hospitals were included in the study. Resultados: a total of 116 survey forms were analyzed, mostly filled out by doctors (57.8 %) working at hospitals with more than 500 beds (56 %); 46 % of survey respondents were on telework. There was a nutritional care plan in 68 % of cases, such plan being present mainly in hospitals with more than 500 beds (p < 0.001). In these hospitals more specific diets for COVID-19 were implemented than in those under 500 beds: 18 (35.3 %) vs 44 (67.7 %), (p < 0.001). The use of recommendations issued by scientific societies was reported in 86 % of cases. Never or almost never could a satisfactory nutritional assessment be performed for 38.8 %. The prescription of nutritional supplements was not less than 50 %. Health workers rated their performance as satisfactory or very satisfactory (51.7 %), and this was not related to hospital size but to having implemented a COVID-19 diet (p < 0.05). Conclusions: clinical nutrition in Spain has responded to the COVID-19 pandemic with organizational and managerial changes and, although care has been clearly affected, some quality standards were ultimately maintained. Larger hospitals have had some advantages in making these adjustments.

Ethical and technical aspects of Nutrition teleconsultation in COVID-19 days

ABSTRACT Objective The aim of the present work was to identify, summarize and review the main scientific articles, guiding documents, and legal aspects of Nutrition teleconsultation. Methods The study consisted of a narrative review and documental analyses. The narrative review was performed between March and April, 2021, in the PubMed, Scopus and Lilacs databases. The websites of the Federal Council of Nutritionists, the Regional Councils of Nutritionists and the Brazilian Association of Food and Nutrition were browsed for the documental analysis. Results This article presents the main aspects of Nutrition teleconsultation in Brazil and in the world, both technical (practice, request for laboratory exams, prescription of dietary supplements, service disclosure, fees, service platforms and general conditions) and ethical norms (confidentiality and data protection). Some advantages of the Nutrition teleconsultation were also compiled, such as: cost reduction, improved access to services, increased adherence, reduced geographic barriers, increased involvement of patients and their families and improved self-care; limitations included lack of access to the necessary infrastructure, feeling uncomfortable with the technology, concerns about safety or desire to be assisted in person, among others. Conclusion It is concluded that the Nutritional teleconsultation has promising potential in the pandemic, and may be able to overcome the social isolation challenge, that could impose data collection restrictions. Future studies may elucidate, through professional experiences, nutritional teleconsultation’s advantages and limitations, thus allowing more assertive recommendations and quality adjustments to the nutritional teleconsultation.

Nutrición y pandemia de la COVID-19

La pandemia de la COVID 19 está suponiendo un importante desafío a los sistemas de salud de todo el mundo. La obesidad y la desnutrición, dos pandemias silenciosas preexistentes a la llegada de la infección por SARS-CoV-2, condicionan el riesgo de agravamiento de los pacientes infectados. Los pacientes con esta dolencia presentan un alto riesgo de desnutrición relacionada con la enfermedad (DRE) y sarcopenia por síntomas derivados de la propia infección, la inflamación aguda, el encamamiento prolongado y las terapias de soporte utilizadas. Hoy por hoy, junto al soporte respiratorio, el soporte nutricional resulta imprescindible en la base de toda atención al paciente con infección por este coronavirus a lo largo de su evolución. El abordaje nutricional es un proceso dinámico que incluye el refuerzo en la dieta natural y el tratamiento nutricional especializado (TNE) con la utilización de suplementos orales, nutrición enteral o nutrición parenteral según los requerimientos y necesidades de cada paciente. En esta actualización, repasamos los aspectos relacionados con la estrecha relación entre alimentación, nutrición e inmunidad, su impacto en la evolución de la infección por SARS-Cov-2 y las estrategias terapéuticas propuestas por consenso de expertos de distintas sociedades científicas.