ASOCIACIÓN LATINA PARA EL ANÁLISIS DE LOS SISTEMAS DE SALUD

Maurizio Battino: Position paper of the Italian association ANSIS) on nutritional management of patients with COVID-19 disease

Italia 24 aprile, 2020
Categorie: Destacada | notizie

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. In this scenario there is an urgent need of nutritional indications aimed 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.

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.

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.

 

Sent by:
Prof Maurizio BATTINO,
PhD, DSc, MS, MD (Hon) Dipartimento di Scienze Cliniche Specialistiche ed Odontostomatologiche Sez. Biochimica Facoltà di Medicina Università Politecnica delle Marche Via Ranieri

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