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Nutritional Management of Patients with COVID-19 Disease

A position paper of the Italian association of medical specialists in dietetics and clinical nutrition (ANSISA)

May 1, 2020
Ancona, Italy – COVID-19 disease is characterized by serious clinical manifestations which could require urgent hospitalization. Prolonged hospitalization, with catabolism and immobilization, induces a decrease in weight and muscle mass which can result in sarcopenia, a condition that impairs respiratory and cardiac function, worsening the prognosis.

The following nutritional indications aim to prevent or contrast hospital malnutrition by improving the patient’s response to therapy and to facilitate healthcare professionals in managing nutritional interventions on patients, reducing their already high workload due to the state of emergency. The full paper is published in Mediterranean Journal of Nutrition and Metabolism.

COVID-19 disease, caused by SARS-CoV-2 virus infection, is characterized by serious clinical manifestations such as pneumonia with respiratory failure, acute respiratory distress syndrome (ARDS), sepsis and septic shock, which require urgent hospitalization, in the most severe cases in intensive care units (ICU). ARDS in particular is characterized by severe hypoxic respiratory failure with inflammation, pulmonary edema and risk of multi-organ dysfunction and often requires invasive mechanical ventilation due to poor lung compliance. First analysis of the data by the Italian national Health Institute (ISS) on deaths from SARS-CoV-2 showed an average age of 78 years and the presence of 3 or more comorbidities including chronic non-communicable diseases (NCDs) such as ischemic heart disease, hypertension, diabetes and chronic obstructive pulmonary disease (COPD). Old age and comorbidities are related to frailty, a syndrome characterized by the reduction in functional reserves and decreased resistance to stressful events, which affects 12% of the Italian population aged 65–74 years old and 29% of those over 85. Frailty is related to weight loss and malnutrition and an acute hospitalization without adequate nutritional support can worsen an already compromised situation. However, among the deceased there are also people affected by obesity, a condition associated with low-grade chronic inflammation, NCDs and sarcopenia. Given the high prevalence in the Italian adult population, it cannot be excluded that obesity and overweight are frequent among hospitalized patients.

It is necessary to remember that all the patients hospitalized for more than 48 hours are at risk of malnutrition and need prompt and appropriate nutritional intervention, regardless of initial body mass index (BMI) and age. Prolonged hospitalization, with catabolism and immobilization, induces a decrease in weight and muscle mass which can result in sarcopenia, a condition that impairs respiratory and cardiac function, prolonging patient’s hospitalization and worsening the prognosis.

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NOTES FOR EDITORS
Full open access paper: “Position paper of the Italian association of medical specialists in dietetics and clinical nutrition (ANSISA) on nutritional management of patients with COVID-19 disease” by Cena, Hella, Maffoni, Silvia, Braschi, Valentina, Brazzo, Silvia, Pallavicini, Cristina, Vietti, Ilaria, Portale, Sandra, Corradi, Ettore (DOI: 10.3233/MNM-200425), published in the Mediterranean Journal of Nutrition and Metabolism. 

Contact 
Maurizio Battino, PhD, DSc, MD (Hon), Editor in Chief, Università Politecnica delle Marche (m.a.battino@univpm.it).

About the Mediterranean Journal of Nutrition and Metabolism
The Mediterranean Journal of Nutrition and Metabolism (MNM) publishes original scientific papers on metabolism, including diabesity and eating disorders; nutrition (epidemiological, basic, clinical and artificial); dietary and nutritional practices and management and their impact on health from prevention to treatment. This journal is intended as a platform for scientific debate and knowledge-sharing among students and clinical practitioners, and between them and the broader scientific community, and finally as a tool for promoting and enhancing scientific cooperation. MNM is published by IOS Press. 

About IOS Press
IOS Press is headquartered in Amsterdam with satellite offices in the USA, Germany, India and China and serves the information needs of scientific and medical communities worldwide. IOS Press now publishes more than 80 international peer-reviewed journals and about 75 book titles each year on subjects ranging from computer science, artificial intelligence, and engineering to medicine, neuroscience, and cancer research. iospress.com