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Community Healthcare Professional Guide to Aid in the Nutritional Management of Patients During and After COVID-19 Illness

The Malnutrition Pathway team has created and launched guidance and resources to assist healthcare professionals address nutritional issues of patients with COVID-19 who they may be supporting in the community – www.malnutritionpathway.co.uk/covid19-community-hcp

The new guidance, which is endorsed by the British Dietetic Association (BDA), the Royal College of Nursing (RCN) and the British Association for Parenteral and Enteral Nutrition (BAPEN), highlights the importance of providing good nutritional care during this pandemic including suggestions for assessing and identifying nutritional issues when conducting remote consultations. It incorporates the recently updated information from BAPEN regarding subjective criteria that can be used to help form an overall clinical impression of an individual’s malnutrition risk category when weighing may not be feasible.1

The ‘Community Healthcare Professional Guide to the Nutritional Management of Patients During and After COVID-19 Illness’ includes a care pathway which guides professionals to appropriate patient/carer leaflets according to the patient’s nutritional status and symptoms related to the COVID-19 infection – www.malnutritionpathway.co.uk/covid19

With the recognition of a range of symptoms, social distancing and isolation that we know adversely affects dietary intake, the resources have been specifically designed to provide a range of ideas to help patient and carers deal with the array of factors that can affect metabolism and dietary intake during the COVID-19 infection, including advice on eating and drinking in the presence of coughing, breathlessness, loss of taste and smell, loss of appetite, fatigue, and at a time when social restrictions are affecting access to food.

“Professionals are likely to be seeing patients who have experienced serious COVID-19 illness in the community, whether they have been suffering at home or have returned home after a hospital stay,” says Liz Anderson, Nutrition Nurse Specialist, Nurse Representative on the Malnutrition Pathway and BAPEN Executive Officer.  “Those at risk of a severe COVID-19 infection, the elderly and those with multiple morbidities, people with lower socio economic status, are equally those in whom malnutrition is already prevalent.”

“Although COVID-19 is a new pandemic and data on the nutritional status during infection and in recovery is only beginning to emerge, it is evident from knowledge acquired to date, and parallels with conditions that present with similar symptoms and disease trajectory, that patients who have moderate to severe infections of COVID-19, are at risk of malnutrition and diet-related distress. If these issues remain unaddressed they can affect function, rehabilitation and quality of life,” says Anne Holdoway, Consultant Dietitian, Chair of the Malnutrition Pathway and Chair of the BDA COVID-19 Clinical Guidance Group.  “Patients who have spent a period in intensive care should as a minimum receive tailored nutritional advice from a registered dietitian. There are however many patients recovering in the community who for a variety of reasons may not have access to a dietitian in a timely manner. These new resources provide the toolkit to help members of the multidisciplinary team, including the physiotherapists supporting rehabilitation, provide dietary advice to aid recovery and refer to dietetics when necessary.” 

Underlying malnutrition impairs the immune system,2 potentially making people more vulnerable to infections such as COVID-19 and impacting recovery. Patients recovering from severe illness are likely to have muscle wasting or feel weak and may have increased protein needs.3 In addition individuals who have been discharged from hospital may need ongoing nutritional rehabilitation.

Malnutrition left undetected and untreated can increase length of hospital stay, result in readmissions and impede recovery,4 it is therefore fundamental to patient outcomes that nutritional screening and appropriate nutritional care are an integral component of holistic care for people who have or have had COVID-19 illness.

References: 1. British Association of Parenteral and Enteral Nutrition (BAPEN). Practical guidance for using ‘MUST’ to identify malnutrition during the COVID-19 pandemic: Malnutrition Action Group (MAG) update. May 2020 https://www.bapen.org.uk/pdfs/covid-19/covid-mag-update-may-2020.pdf.; 2. Stratton RJ et al. Disease-related malnutrition: an evidence-based approach to treatment. Oxford: CABI publishing; 2003.; 3. Deutz NE et al. Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group. Clinical Nutrition. 2014; 33: 929-936.; 4. Elia M, on behalf of the Malnutrition Action Group (BAPEN) and the National Institute for Health Research Southampton Biomedical Research Centre. The cost of malnutrition in England and potential cost savings from nutritional interventions (full report). 2015. http://www.bapen.org.uk/pdfs/economic-report-full.pdf.

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