The Effects of Oral Nutritional Support on the Ability of the COVID-19 Patients to Recover: A Prospective, Open, Multicenter, Comparative in Two Groups, Observational Study

Abstract

Background. Nutritional insufficiency and decreased muscle mass of patients diagnosed with COVID-19 leads to prolonged respiratory support, stay in ICU and hospital, as well as reduced muscle strength and quality of life in the recovery period after a viral pneumonia caused by COVID-19. Aims: To study the effects of oral nutritional support on the physical health recovery of COVID-19 patients. Materials and methods. A prospective, open, multicenter, comparative observative study of two groups, observational study was initiated to evaluate the effects of oral nutritional support (ONS) by Nutridrink® 200 ml on the ability of COVID-19 patients to recover. The patients with these criteria were included in the study: aged 18–69; a confirmed COVID-19 infection; requires respiratory support; ability to consume more than 60% of food from the total required; presence of a signed consent form. One group received supplementary oral nutritional support (ONS) everyday for 28 days from the day of inclusion. The other group received standard diet. The primary endpoint was the evaluation of quality of life using the SF-36 questionnaire and the changes in the hand grip strength between the 3rd and 1st visits. Secondary endpoints of the study were length of stay in hospital and duration of respiratory support in the hospital. Results. 205 patients with a COVID-19 infection were included in the study. The final number of patients included in the study was 185 patients. Median age was 55 years old. The majority of patients were male — 57.84% (107 patients). Upon evaluation of the physical component of quality of life using the SF-36 questionnaire, we obtained a statistically significant difference between the control and study groups on the 4th visit — 44.28±5.45 and 46.58±6.76 respectively (p=0.012). Muscle strength was statistically different in the control (Δ4.01±1.15 daN) and study (Δ6.1±2.06 daN) groups (p <0.0001). The duration of respiratory support was significantly lower in the study group, 6.7±1.30 days as opposed to 8.14±1.52 days in the control group (p <0.0001). Also, in the group with oral nutritional support, there was a statistically significant decrease in the length of stay in hospital. In the control group, the average length of stay in hospital was 16.47±2.93 days, whereas in the study group it was 13.16±2.69 days (p <0.0001). Conclusion. Oral nutritional support given to oxygen dependent COVID-19 patients improves rehabilitation potential including preservation of muscle mass and function, reducing oxygen support requirements and length of stay in hospital.

Keywords

nutritional support / coronavirus infection / peroral nutritional support / recovery / hand grip strength

References

[1] Временные методические рекомендации: профилактика, диагностика и лечение новой коронавирусной инфекции COVID-19. Версия 10; 08.02.2021. [Temporary guidelines: prevention, diagnosis and treatment of new coronovirus infection COVID-19. Version 10; 08.02.2021. (In Russ).] Режим доступа: https://base.garant.ru/ 400292418/. Дата обращения: 15.07.2020.

[2] Guan WJ, Ni ZY, Hu Y, et al.; China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720. doi: 10.1056/NEJMoa2002032

[3] Barazzoni R, Bischoff SC, Breda J, et al.; endorsed by the ESPEN Council. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020;39(6):1631–1638. doi: 10.1016/j.clnu.2020.03.022

[4] Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473–483.

[5] Klok FA, Boon JA, Barco S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020; 56(1):2001494. doi: 10.1183/13993003.01494-2020

[6] Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3

[7] Brugliera L, Spina A, Castellazzi P, et al. Rehabilitation of COVID-19 patients. J Rehabil Med. 2020;52(4):jrm00046. doi: 10.2340/16501977-2678

[8] Kondrup J, Allison SP, Elia M, et al.; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–421. doi: 10.1016/s0261-5614(03)00098-0

[9] Wang TJ, Chau B, Lui M, et al.; Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19. Am J Phys Med Rehabil. 2020;99(9):769–774. doi: 10.1097/PHM.0000000000001505

[10] Norman K, Stobäus N, Gonzalez MC, et al. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr. 2011;30(2):135–142. doi: 10.1016/j.clnu.2010.09.010

[11] Brugliera L, Spina A, Castellazzi P, et al. Nutritional management of COVID-19 patients in a rehabilitation unit. Eur J Clin Nutr. 2020;74(6):860–863. doi: 10.1038/s41430-020-0664-x

[12] Mendes A, Serratrice C, Herrmann FR, et al. Predictors of in hospital mortality in older patients with COVID-19: The COVID age study. J Am Med Dir Assoc. 2020;21(11): 1546–1554.e3. doi: 10.1016/j.jamda.2020.09.014.

RIGHTS & PERMISSIONS

Sviridov S.V., Krylov K.Y., Vedenina I.V., Mohan R.