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Shamlan G, Albreiki M, Almasoudi HO, Alshehri LA, Ghaith MM, Alharthi AS, Aleanizy FS. Nutritional status of elderly patients previously ill with COVID-19: Assessment with nutritional risk screening 2002 (NRS-2002) and mini nutritional assessment (MNA-sf). J Infect Public Health 2024; 17:372-377. [PMID: 38217931 DOI: 10.1016/j.jiph.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/19/2023] [Accepted: 11/02/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Long-term effects of COVID-19 showed a wide range of symptoms. Also, it was found that older patients were five times more likely than younger patients to develop long-COVID symptoms (1). This study aimed to investigate the use of Nutrition Risk Screening 2002 (NRS-2002) and the Mini Nutrition Assessment-Short Form (MNA-sf) among COVID-19 in elderly patients in Saudi Arabia. METHODS A total of (n = 159) COVID-19 elderly patients were recruited in the study; the relationship between patients' characteristics, including age, gender, Body Mass Index (BMI), infection history, vaccination and chronic disease were evaluated using NRS-2002 and MNA-sf. Multivariate logistic regression to estimate the Odd Ratio (OR) by comparing the OR of different variables between normal nutritional Status and at-risk and Cohen's kappa (κ) coefficient was assessed to analyse the agreement between both tools. RESULTS MNA-sf showed a positive association between age and malnutrition risk ≥ 66 years old P = 0.035. Both tools showed a negative association between BMI (P < 0.001 and P = 0.046), respectively and vaccination (P = 0.002 and P = 0.01), respectively, with risk for malnutrition. There was no significant association between Diabetes (DM) and malnutrition risk, but elderly Cardiovascular Disease (CVD) were at malnutrition risk using the NRS- 2002 tool P = 0.003. Inversely, people infected six months or more before malnutrition assessment have a lower risk of malnutrition P = 0.05. CONCLUSIONS Both tools were valuable and practical tools for screening elderly people with COVID-19 who are at nutritional risk and those in need of additional nutritional intervention. Further research needed to be applied in the relationship between nutritional status during and post-infectious disease for elderly people using cross-sectional and intervention studies in order to prevent malnutrition complications in Saudi Arabia.
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Affiliation(s)
- Ghalia Shamlan
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed Albreiki
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates; Biosecurity Affairs Division, Innovation and Development Sector, Abu Dhabi Agriculture and Food Safety Authority, Abu Dhabi, United Arab Emirates.
| | - Hadeel O Almasoudi
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Lina A Alshehri
- Department of Human Nutrition, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Mazen M Ghaith
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Umm Al-Qura University, P.O. Box 7607, Al Abdeyah, Makkah, Saudi Arabia
| | - Abdulrahman S Alharthi
- Department of Animal Production, College of food science and agriculture, King Saud University, Riyadh, Saudi Arabia
| | - Fadilah S Aleanizy
- Department of Pharmacutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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Abstract
Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.
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Luque Calvo C, Mataix Sanjuan ÁL, Candela Toha Á, Martínez Castro N, Pintor Recuenco MR, Calleja López JL, Botella-Carretero JI, Arrieta Blanco F. 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. Nutrients 2022; 14:nu14193892. [PMID: 36235545 PMCID: PMC9570917 DOI: 10.3390/nu14193892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/08/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Carolina Luque Calvo
- Farmacia, Investigación Ramón y Cajal, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
- Correspondence: (C.L.C.); (F.A.B.); Tel.: +34-630-788-091 (C.L.C.)
| | - Ángel Luis Mataix Sanjuan
- Responsable Sistemas Información Farmacia, Subdirección General de Farmacia y Productos Sanitarios Comunidad Autónoma de Madrid, Paseo de la Castellana, 280, 28046 Madrid, Spain
| | - Ángel Candela Toha
- Department of Anesthesia & Reanimation, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
| | - Nilda Martínez Castro
- Department of Anesthesia & Reanimation, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
| | | | | | | | - Francisco Arrieta Blanco
- Department of Endocrinology & Nutrition, Hospital Universitario Ramón & Cajal, 28034 Madrid, Spain
- Correspondence: (C.L.C.); (F.A.B.); Tel.: +34-630-788-091 (C.L.C.)
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Obesity and Leptin Resistance in the Regulation of the Type I Interferon Early Response and the Increased Risk for Severe COVID-19. Nutrients 2022; 14:nu14071388. [PMID: 35406000 PMCID: PMC9002648 DOI: 10.3390/nu14071388] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/23/2022] [Accepted: 03/23/2022] [Indexed: 02/06/2023] Open
Abstract
Obesity, and obesity-associated conditions such as hypertension, chronic kidney disease, type 2 diabetes, and cardiovascular disease, are important risk factors for severe Coronavirus disease-2019 (COVID-19). The common denominator is metaflammation, a portmanteau of metabolism and inflammation, which is characterized by chronically elevated levels of leptin and pro-inflammatory cytokines. These induce the “Suppressor Of Cytokine Signaling 1 and 3” (SOCS1/3), which deactivates the leptin receptor and also other SOCS1/3 sensitive cytokine receptors in immune cells, impairing the type I and III interferon early responses. By also upregulating SOCS1/3, Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 adds a significant boost to this. The ensuing consequence is a delayed but over-reactive immune response, characterized by high-grade inflammation (e.g., cytokine storm), endothelial damage, and hypercoagulation, thus leading to severe COVID-19. Superimposing an acute disturbance, such as a SARS-CoV-2 infection, on metaflammation severely tests resilience. In the long run, metaflammation causes the “typical western” conditions associated with metabolic syndrome. Severe COVID-19 and other serious infectious diseases can be added to the list of its short-term consequences. Therefore, preventive measures should include not only vaccination and the well-established actions intended to avoid infection, but also dietary and lifestyle interventions aimed at improving body composition and preventing or reversing metaflammation.
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Esgin Ö, Erten T. Nutrition and a Balanced Diet in the Elderly During the COVID-19 Pandemic. CURRENT NUTRITION & FOOD SCIENCE 2022. [DOI: 10.2174/1573401318666220308154735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Age is an important risk factor in the mortality ratio of the COVID-19 disease and mostly, the hospitalised patients over 60 years with chronic diseases are at high risk of death. With preventive measures, proper nutrient intake might be helpful to maintain a healthy state or reduce the severity of the COVID-19 disease in the elderly.
Methods:
Database searches of PubMed, Scopus, Medline, Google Scholar and Web of Science were performed by the following terms of pandemic; COVID-19; coronavirus; elderly; elderly nutrition.
Results:
The requirement of some macro and micro nutrients increases especially the nutrients that support the immune activity. During the pandemic, the daily energy requirement for the elderly is stated as 27-30 kcal/kg while the protein intake is recommended as at least 1g/kg, and the ratio of fat and carbohydrate is 30:70 or 50:50. The daily intake of Vitamin A, B6, B12, C, D, zinc and selenium can also be increased due to their supporting function in the immune system. Probiotics such as Bifidobacterium longum MM-2, Lactobacillus plantarum 06CC2, Lactobacillus bulgaricus OLL1073R-1 and Lactobacillus rhamnosus M21 and the consumption of prebiotics in diet enhance the immune function. Additionally, flavonoids such as baicalin, epigallocatechin gallate, gallocatechin gallate, kaempferol, luteolin, resveratrol and quercetin improve immunity by reducing oxidative stress in the elderly.
Conclusion:
Adequate and balanced nutrition should be provided during the pandemic; in addition to this, micronutrient deficiencies should also be prevented in this period in the elderly at every stage of life.
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Affiliation(s)
- Özge Esgin
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Ankara University, Ankara, Turkey
| | - Tayyibe Erten
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bayburt University, Bayburt, Turkey
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Affiliation(s)
- Domenico Azzolino
- Department of Clinical and Community Sciences, University of Milan, 20138 Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Matteo Cesari
- Department of Clinical and Community Sciences, University of Milan, 20138 Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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Yılmaz E, Ak R, Doğanay F. Usefulness of the neutrophil-to-lymphocyte ratio in predicting the severity of COVID-19 patients: a retrospective cohort study. SAO PAULO MED J 2022; 140:81-86. [PMID: 34346985 PMCID: PMC9623832 DOI: 10.1590/1516-3180.2021.0298.r1.27052021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Quick and accurate identification of critically ill patients ensures appropriate and correct use of medical resources. In situations that threaten public health, like pandemics, rapid and effective methods are needed for early disease detection among critically ill patients. OBJECTIVE To determine the relationship between the neutrophil-to-lymphocyte ratio (NLR) of coronavirus disease-19 (COVID-19) patients upon admission to the emergency department (ED) and these patients' prognosis. DESIGN AND SETTING Retrospective cohort study among COVID-19 patients in the ED of a tertiary-level hospital. METHODS Data on patients' age, gender, vital signs, chronic diseases, laboratory tests and clinical outcomes were collected from electronic medical records. Receiver operating characteristic (ROC) curve analysis was performed. The area under the curve (AUC) was used to assess the accuracy of NLR for predicting in-hospital mortality risk and intensive care unit (ICU) requirement. The Youden J index (YJI) was used to determine optimal threshold values. RESULTS 1,175 patients were included. Their median age was 63 years (IQR, 48-75). With an NLR cutoff value of 5.14, the sensitivity, specificity, PPV, AUC and YJI for ICU requirement were calculated as 77.87%, 74.08%, 92.4%, 0.811 and 0.5194, respectively. With the same cutoff value, the sensitivity, specificity, AUC and YJI for in-hospital mortality were 77.27%, 75.82%, 0.815 and 0.5309, respectively. In addition, advanced age, leukocytosis, anemia and lymphopenia were found to be associated with poor prognosis. CONCLUSION The NLR, which is a widely available simple parameter, can provide rapid insights regarding early recognition of critical illness and prognosis among COVID-19 patients.
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Affiliation(s)
- Erdal Yılmaz
- MD. Specialist in Emergency Medicine, Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar Şehir Hastanesi, Istanbul, Turkey.
| | - Rohat Ak
- MD. Specialist in Emergency Medicine, Department of Emergency Medicine, Kartal Dr. Lütfi Kırdar Şehir Hastanesi, Istanbul, Turkey.
| | - Fatih Doğanay
- MD. Specialist in Emergency Medicine, Department of Emergency Medicine, Edremit Devlet Hastanesi, Balıkesir, Turkey.
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[Effect of COVID-19 on dietotherapeutic prescription during the first half of 2020 in the Community of Madrid]. NUTR HOSP 2021; 38:1138-1143. [PMID: 34670393 DOI: 10.20960/nh.03758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
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.
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Sebastian IR, Venkitaraman S, Syamala S, Shajan A, Tennyson N, Devi Y. Nutritional Status and COVID-19 among Older Persons in Kerala, India. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059738. [PMID: 34870520 PMCID: PMC8842181 DOI: 10.1177/00469580211059738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background and Aims: The COVID-19 pandemic has posed an unprecedented public health crisis globally irrespective of age. There is no doubt that the older population (above the age of 60) is the most vulnerable age category due to multiple co-morbidities, which often is not in their favour. Age category, types of co-morbidities and nutritional levels indeed play a pivotal role in determining mortality rates. This paper focuses on Kerala, a southern Indian state and how it maintained low mortality levels due to COVID-19 during the first wave despite being the state with the highest proportion of the older population. The present study argues although the state possessed a robust health system and had an active engagement of the public health sector with its citizens through local governments, it was the state's meticulous planning, innovative schemes centred around older persons such as reverse quarantine, the prevailing excellent nutritional status among its population and initiatives to ensure good nutrition through food security schemes like 'essential grocery kits' and 'community kitchens' that helped to develop the body's resistance to infection and thus played a significant role in flattening the curve for Kerala's older adult COVID-19 deaths effectively, thereby achieving a high recovery rate and low rates of fatality during the first wave of COVID-19 in Kerala. Methods: Pre-COVID-19 health conditions of older adults in Kerala were analysed through Kerala Ageing Survey (KAS) panel data and Longitudinal Ageing Survey in India (LASI) data. Percentage analysis, Logistic regression method and Cox hazard regression methods were used to analyse the effect of nutritional levels on health and mortality among older adults in Kerala. Publically available COVID-19 data from the Government of Kerala and the Government of India were used to analyse the COVID-19 death rates. In addition, changes in dietary patterns and other preventive measures taken to fight against COVID-19 were investigated through qualitative response. Result: The study found that nutritional status influences mortality and co-morbidities among older adults in Kerala in the pre-COVID situation. Furthermore, the study found that though nutritional indicators, that is, overweight or obese, significantly increases the risk of comorbid conditions among older adults, good nourishment reduces the risk of all-cause mortality. The study also found that Kerala's COVID-19 fatality was much lower when compared to India and developed nations like the US, UK and Italy. Even if Kerala is one of the highly COVID-19 affected states, the effective nutritional intervention by the Government of Kerala through its various schemes to build up the general immunity of the state's citizens, especially high-risk groups; thereby achieving low COVID fatality in the state.Conclusion: Based on Kerala's experience, nutritional factors influence the population in building up the body's resistance to infection against COVID-19. Even though the fatality rate is very low, obesity coupled with non-communicable diseases affects preventive measures of the state. There is an immediate and persuasive need to find new and more efficient clinical studies apart from socio-epidemiological studies, which could play a pivotal role in determining COVID-19 health outcomes.
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Affiliation(s)
| | - Sriram Venkitaraman
- Department of Health and Family Welfare, 29302Government of Kerala, Kerala, India
| | - Sunitha Syamala
- The International Institute of Migration and Development (IIMAD), Kerala, India
| | - Aneeta Shajan
- 373113Northumbria University Faculty of Arts Design and Social Sciences, Newcastle, UK
| | - Nelgyn Tennyson
- The International Institute of Migration and Development (IIMAD), Kerala, India
| | - Yamuna Devi
- The International Institute of Migration and Development (IIMAD), Kerala, India
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