Nutritional status, nutritional risk, nutrition impact symptoms, and nutritional treatment in inpatients with COVID-19 during the first outbreak – An observational study

Abstract

Summary: Background/aims: During the first outbreak of COVID-19 knowledge regarding nutritional status and target areas of the nutritional treatment to patients admitted to the hospitals with COVID-19 was limited. Therefore, the aim was 1) to describe baseline characteristics including nutritional status, nutritional risk, energy- and protein intake, nutritional route, and Nutrition Impact Symptoms (NIS) known to have an impact on the nutritional intake; 2) to compare these characteristics in patients who, respectively, survived or died within 30 days after discharge and 3) to describe nutritional aspects in the transition between hospitalisation and a home setting. Methods: This was an observational study. Patients admitted with COVID-19 in 2020 and referred to clinical dietitians were enrolled. Data on nutritional status, nutritional risk, NIS, nutritional treatment, grade of inflammation, 30-days mortality and readmissions rate and nutritional aspects after discharge were collected from the patient journal. Results: We included 81 patients, 41 (51%) male, median age 75 (IQR: 63–83). Patients were referred to the clinical dietitians at median day 4 (IQR: 3–8) of the hospital stay. The median BMI was 25 (IQR: 21–28) and 58 (83%) were at nutritional risk. Nutrition route was primarily oral (89%). The three most common NIS were; decreased appetite (88%), shortness of breath (55%), and early satiety (47%).At the 30 days follow-up 23 (28%) patients were deceased, of these 16 (70%) before discharge. The patients who died were older (median 82 vs. 72 y, P=0.002), and more were admitted from a care facility (48 vs. 17%, P=0.005). Further, among those who died fewer covered their energy requirement (25 vs. 43%, P=0.001), and protein requirement (23 vs. 34%, P=0.032). Also chewing- and swallowing problems were more prevalent in those who died (45 vs. 17%, P=0.048). There were no differences in nutritional status, nutritional risk, or nutritional route among the two groups. A total of 21 (26%) patients were readmitted within 30 days.At discharge only 11 (14%) patients had a nutritional discharge plan made by the clinical dietician. Up to one fifth still experienced NIS with early satiety (20%), chewing or swallowing problems (15%) and respiratory problems (15%) being the most frequent. Conclusions: Hospitalized patients with COVID-19 had several NIS, a high prevalence of nutritional risk and the majority had a nutritional intake below requirement. The mortality was high, especially during hospitalisation, and those patients that died had a lower intake of energy and protein and hence also coverage of requirement. Most patients were fed orally during hospitalisation. More than one fourth of the patients were readmitted within 30 days. Few patients had a nutritional discharge plan made by the dietitian and up till one fifth of the patients still suffered from NIS.Therefore, nutritional treatment is relevant in this group of patients.

Keywords

• Nutritional treatment
• Clinical dietitian
• Re-admission
• Mortality