Assessment of risk and nutritional status in hospitalized Covid-19 patients
DOI:
https://doi.org/10.12957/demetra.2022.65441Keywords:
Coronavirus Infections. SARS virus. Nutritional status. Malnutrition Obesity.Abstract
Introduction: Initial data connect infection by the novel coronavirus with nutritional status . Malnutrition seems to be a risk factor for Covid-19, and once the infection is installed, both malnutrition, overweight or obesity are an important predictor of unfavorable evolution. Aim: To evaluate the risk and nutritional status in hospitalized patients with Covid-19. Methods: Cross-sectional study involving patients with Covid-19 infection admitted to a university hospital in Recife-PE. The sample consisted of individuals aged ≥20 years who tested positive for Covid-19, through the RT-PCR molecular test, through nasopharyngeal secretion swab. Nutritional risk was assessed through recommended screening for this group of patients, and nutritional status, through the Body Mass Index (BMI) and biochemical tests. Demographic variables, length of hospital stay and clinical outcome (discharge, transfer to ICU and death) were also considered. Results: 71 patients were evaluated, with a mean age of 52.3 ±13.4 years. Nutritional risk was observed in 95.8% of patients, low weight and overweight were found in 12.7% and 56.3% of the sample, respectively. Low hemoglobin levels were found in 70% of patients and about 75% of patients had depletion according to the total lymphocyte count (TLC) parameter. There was no association of nutritional status with worse outcome. Conclusion: A high percentage of nutritional risk, overweight, low levels of TLC and anemia were observed in patients with Covid-19. Nutritional extremes (malnutrition and obesity) were not associated with a worse clinical outcome and longer hospital stay.
Downloads
References
Organization, World Health. Folha informativa – COVID-19 (doença causada pelo novo coronavírus). Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=6101:covid19&Itemid=875. Acesso em: 20 maio 2020.
Lidoriki I, Frountzas M, Schizas, D. Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly? Med Hypotheses, 2020; 144, 109946.
Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K., Krznaric Z, Nitzan D, Singer P. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 Infection. Clin Nutr 2020; 39(6)1631-38.
Bedock D, Lassen PB, Mathian A, Moreau P, Couffignal J, Ciangura C, Amoura, Z. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN, 2020; 40, 214-19.
Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, Duan J. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr, 2020; 74 (6) 871 -75.
Pomar MDB, Lesmes IB. Nutricion Clínica en tiempos de COVID 19. End, Diabetes Y Nutr, 2020; 67 (7) 427-30.
Liu G, Zhang S, Mao Z, Wang W, Hu H. Clinical significance of nutritional risk screening for older adult patients with COVID-19. Eur J Clin Nutr, 2020; 74, 876-83.
Laviano A, Koverech A, Zanetti M. Nutrition support in the time of SARS-CoV-2 (COVID-19). J Nutr, 2020; 74, 110834.
Watanabe M, Caruso D, Tuccinardi D, Risi R, Zerunian M, Polici M, Mariani S. Visceral fat shows the strongest association with the need of intensive care in patients with COVID-19. J Metabol, 2020; 111, 154319.
Piovacari SMF, Santos GFCG, SantanaGA, Scacchetti T, Castro MG. Fluxo de assistência nutricional para pacientes admitidos com COVID-19 e SCOVID-19 em unidade hospitalar. BRASPEN J [Internet], 2020; 35(1), 6-8.
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Gao YD. Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy, 2020; 75 (7) 1730-41.
WORLD HEALTH ORGANIZATION. Physical Status: the use and interpretation of anthropometry. Geneva, Switzerland: WHO, 1995. (WHO Technical Report Series, n. 854)
Lipschitz, DA. Screening for nutritional status in the elderly. Primary care, 1994. 21(1), 55-67.
Brasil. Ministério da Saúde. Unicef. Cadernos de Atenção Básica: Carências de Micronutrientes / Ministério da Saúde, Unicef; Bethsáida de Abreu Soares Schmitz. - Brasília: Ministério da Saúde, 2007. 60 p. - (Série A. Normas e Manuais Técnicos)
Blackburn GL, Thornton PA. Nutritional assessment of the hospitalized patient. Med Clin North Amer, New York, 1979; 63, 1103-15.
Kim T, Roslin, M, Wang JJ, Kane J, Hirsch, JS, Ji Kim E, Kozel Z. Body Mass Index as a Risk Factor for Clinical Outcomes in Patients Hospitalized with COVID‐19 in New York. Obesity, 2020; 28 (2), 279-84.
Campos LF, Barreto PA, Ceniccola GD, Gonçalves RC, Gonçalves RC, Nunes MLB, Castro MG. Parecer BRASPEN/AMIB para o enfrentamento do COVID-19 em pacientes hospitalizados. BRASPEN J, 2020; 35(1), 3-5.
Weber TK, Leandro VA, Bernasconi I, Oliveira MRM. Nutrition Therapy in the Patient with COVID-19 Disease Requiring ICU Care, SCCM and ASPEN. Rev. Nutr. [Internet]. 2020; (33) e200212.
Barazzoni B, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, Pirlich M, Singer P, ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection, Clinical Nutrition, 2020; V 39, 6
Lima MCT; Pinho CPS. Aplicabilidade de métodos de estimativa de peso e altura em pacientes cardiopatas hospitalizados. Rev Soc Cardiol Estado de São Paulo, 2018; 27, (4), 157-62.
Rech CR., Petroski, EL, Böing O, Babel JRJ, Soares MR. Concordância entre as medidas de peso e estatura mensuradas e auto-referidas para o diagnóstico do estado nutricional de idosos residentes no sul do Brasil. Rev Bras Med Esporte [online]. 2008, 14 (2), 126-31.
Berger MM. Nutrition Status Affects COVID‐19 Patient Outcomes. JPEN J Parenter Enteral Nutr, 2020; 44 (7), 1166-67.
Berger MM, Pantet O, Jacquelin-RN, Charrière M, Schmidt S, Becce F. Pichard C. Supplemental parenteral nutrition improves immunity with unchanged carbohydrate and protein metabolism in critically ill patients: the SPN2 randomized tracer study. Clin nutr, 2019; 38(5), 2408-16.
Calder PC, Carr AC, Gombart AF, Eggersdorfer M. O estado nutricional ideal para um sistema imunológico que funcione bem é um fator importante para proteger contra infecções virais. Nutrients 2020; 12, 1181.
Messina G, Polito R, Monda V, Cipolloni L, Di Nunno N, Di Mizio G, Valenzano A. Functional role of dietary intervention to improve the outcome of COVID-19: A hypothesis of work. Int J Mol Sci., 2020; 21 (9), 3104.
Al-Salameh A, Lanoix JP, Bennis Y, Andrejak C, Brochot E, Deschasse G, Maizel J. The association between body mass index class and coronavirus disease 2019 outcomes. Int J Obes, 2020; doi.org/10.1038/s41366-020-00721-1.
Yang J, Tian C, Chen Y, Zhu C, Chi H, Li J. Obesity aggravates COVID‐19: an updated systematic review and meta‐analysis. J med virol, 2020. doi: 10.1002/jmv.26677.
Huh K, Lee R, Ji W, Kang M, Hwang IC, Lee DH, Jung J. Impact of obesity, fasting plasma glucose level, blood pressure, and renal function on the severity of COVID-19: A matter of sexual dimorphism?. Diabetes Res Clinl Pract, 2020; doi:10.1016/j.diabres.2020.108515
Smati S, Tramunt B, Wargny M, Caussy C, Gaborit B, Vatier C, Bourron O. Relationship between obesity and severe COVID‐19 outcomes in patients with type 2 diabetes: results from the CORONADO study. Diabetes, Obesity and Metabolism, 2020; 23 (2), 391-403.
Dixon AE, Peters U. The effect of obesity on lung function. Expert rev resp med, 2018; 12(9), 755-67.
Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, Ou CQ. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J 2020; 55(5) 2000547.
Peters U, Subramanian M., Chapman DG, Kaminsky DA, Irvin CG, Wise RA, Dixon AE. BMI but not central obesity predisposes to airway closure during bronchoconstriction. Respirology, 2019; 24 (6), 543-50.
Al Heialy S, Hachim MY, Senok A, Abou Tayoun, Hamoudi R, Alsheikh-Ali A, Alheialy Q. Regulation of angiotensin converting enzyme 2 (ACE2) in obesity: implications for COVID-19. bioRxiv. 2020; doi.org/10.3389/fphys.2020.555039.
Mo P, Xing Y, Xiao Y, Deng L, Zhao Q, Wang H, Luo M. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clinical Infectious Diseases, 2020; doi.org/10.1093/cid/ciaa270.
Warny M, Helby J, Nordestgaard BG, Birgens H, Bojesen SE. Lymphopenia and risk of infection and infection-related death in 98,344 individuals from a prospective Danish population-based study. PLoS medicine, 2018; 15(11), e1002685.
Bellmann-Weiler R, Lanser L, Barket R, Rangger L, Schapfl A, Schaber M, Weiss G. Prevalence and predictive value of anemia and dysregulated iron homeostasis in patients with COVID-19 infection. J of clin med, 2020; 9 (8), 2429.
Huang Y, Tu M, Wang S, Chen S, Zhou W, Chen D, Huang Q. Clinical characteristics of laboratory confirmed positive cases of SARS-CoV-2 infection in Wuhan, China: A retrospective single center analysis. Travel med infect dis, 2020; doi: 10.1016/j.tmaid.2020.101606
Weiss G, Ganz T, Goodnough LT. Anemia of inflammation. Blood, 2019; 133(1). 40-50.
Roldan EQ, Biasiotto G, Magro P, Zanella I. The possible mechanisms of action of 4-aminoquinolines (chloroquine/hydroxychloroquine) against Sars-Cov-2 infection (COVID-19): A role for iron homeostasis?. Pharmacol Res, 2020; doi: 10.1016/j.phrs.2020.104904.
Tashima VV, Freitas LAG, Guarido EA, Bruniera CAV, Silva SG, Garavelo JJ.
Análisis del perfil sanguíneo de mujeres obesas. Revista Digital. -2014 Año 19 - 192.
Downloads
Published
How to Cite
Issue
Section
License
STATEMENT OF AUTHORSHIP RESPONSIBILITY
Title of the manuscript:
________________________________________________________
1. Statement of responsability
I certify that I have participated in the work above specified and take public responsibility for its content.
I certify that the manuscript represents an original work and that none of the material in the manuscript has been previously published, is included in another manuscript, or is currently under consideration for publication elsewhere, whether in printed form or in electronic media, except that described in the attachment.
In case of acceptance of this text by Demetra: Alimentação, Nutrição & Saude, I declare to be in accordance with the policy of public access and copyright adopted by Demetra, which provides as follows: (a) the authors retain the copyright and grant to the Journal the right of first publication, the work being simultaneously licensed under the Creative Commons Attribution License, which allows the sharing of the work with acknowledgment of authorship and initial publication in this journal; (b) authors are authorized to enter additional contracts separately for non-exclusive distribution of the version of the work published in this journal (eg, publishing in institutional repository or book chapter), with acknowledgment of authorship and initial publication in this journal; and (c) authors are permitted and encouraged to post and distribute their work online (eg, in institutional repositories or on their personal page) at any point before or during the editorial process, as this may lead to productive changes, as well as increase the impact and citation of the published work.
2. Conflict of Interest Statement
I certify that there is no conflict of interest in connection with the submitted article.
Date, signature and full address of all authors.