NZMP shines light on malnutrition risks in COVID-19 patients

07 May 2020 --- Fonterra-owned brand NZMP is highlighting the malnutrition risks that COVID-19 patients may face, in particular when they are seriously ill. NZMP’s Medical Nutrition team is using its platform to highlight guidelines issued by the European Society for Clinical Nutrition and Metabolism (ESPEN) (formerly European Society for Parenteral and Enteral Nutrition), which include guidance on the use of supplements in a range of possible scenarios.

“The patients with serious health impacts of COVID-19 are at risk of long-term hospitalization, including simple inactivity through bedrest or required intubation. If malnourished prior to infection, these elements can significantly impact the outcomes during and after this period, so the first recommendation in the ESPEN guidelines is to screen for malnutrition in order to plan early nutrition intervention focusing on supporting these patients who are at risk,” Jacqueline van Schaik, Global Lead Nutritionist for NZMP Medical Nutrition, tells NutritionInsight. 

NZMP explains that disease-related malnutrition is an important factor to measure to understand how to best support patient recovery and the first recommendation in the guidance is screening every new patient for the presence of malnutrition. When malnourished, the primary goal is to increase protein and energy intake with food.

It also notes that additional supplementation using ready-to-drink beverages or protein powders should follow before resorting to tube feeding or parenteral feeding.

Some of the other ESPEN guidelines, to be published in Clinical Nutrition, are summarized as:

• Optimize nutritional status through counseling from experienced professionals.
• Consider supplementation to meet sufficient vitamin and mineral levels in malnourished patients.
• Patients in quarantine should continue physical exercise at home to support muscle mass and resilience.
• High protein, high calorie oral nutritional supplements (ONS) should be used whenever possible to meet patient’s needs when dietary counseling and food fortification are not sufficient to meet dietary goals and should continue for at least one month. 
• Parenteral nutrition should be considered in patients with reasonable prognosis who cannot meet their requirements using ONS or via tube-feeding.
• Non-intubated patients should receive oral supplements prior to considering tube-feeding or parenteral nutrition.
• Nasogastric tube-feeding can be used in ventilated patients, without limitations by the prone position of the patient, but post-pyloric feeding should be considered in case of gastric intolerance of feeds.
• Tolerability of feeds should always be a primary measure for care and every case should be considered independently to meet nutrition needs with a preference for enteral over parenteral nutrition support.
• Texture-modified food should be considered post-intubation if swallowing is proven unsafe.

“Nutrition intervention and therapy need to be considered as an integral part of the approach to patients victim of SARS-CoV-2 infection in the ICU setting, internal medicine ward setting, as well as in general healthcare. At each step of the treatment, nutritional therapy should be part of patient care, with regard for older adults and frail, comorbid individuals,” ESPEN states.

It continues that optimal outcome can be improved by following recommendations to ensure the survival of the disease, as well as better and shorter recovery, particularly but not limited to the post-ICU period. “A comprehensive approach associating nutrition to life-support measures has the potential to improve outcomes particularly in the recovery phase,” ESPEN adds. 

Dairy milk is a naturally nutritious product, containing bioactive components, high-quality proteins, vitamins and minerals.Fighting misinformation
NZMP states that misinformation has been spreading quickly, meaning that it is important to seek scientific guidance to maintain a healthy diet and lifestyle. “In the Medical Nutrition team in NZMP, we want to use our platforms and communication channels to share information from recognized advising bodies that utilize research-backed guidelines for optimal nutrition support,” states the brand.

“Industry has a key role in supporting the fight against misinformation with consumers. Foremost, it can have a relevant role in ensuring the proliferation of science-based guidelines to increase easy access to those needing that information in their professional role and to ensure safety and efficacy of any nutrition measures,” adds Van Schaik.

NZMP also highlights that in recovered patients, there is an important consideration for recuperating from extended periods of bedrest. Even one week of bedrest impacts muscle mass and function substantially. Therefore, ensuring physical exercise, even if it is only walking, as well as quality protein intake in a balanced diet is pivotal to a well-supported recovery, the brand notes. 

“Recovery from bedrest after a period of inactivity with quality protein and concentrated nutrition, as well as exercise, is key to regaining independence. At NZMP, we’re fortunate that the source of our ingredients, dairy milk, is a naturally nutritious product, containing bioactive components, high-quality proteins, vitamins and minerals,” states Van Schaik. 

The New Zealand-based brand has also observed increased interest in products with the potential for immunity value propositions. It points to the World Health Organization (WHO) confirmation that a healthy, balanced diet supports good immunity, with generally good food practices, including consuming a variety of foods, including plenty of fresh fruit and vegetables; protein including dairy; and healthy fat sources. However, Van Schaik warns that as COVID-19 is a new coronavirus, there are no linkages that can be made to current products for immunity specifically against it.

With the importance of immunity becoming more pronounced, other dairy players are also spotlighting how overall health and wellness can be bolstered by their products – including lactoferrin – which are seeing increasing demand.

To keep readers informed of these rapid developments, NutritionInsight is updating its daily news feed for the coronavirus-related information and insights you need to guide your business through this challenging period.

By Katherine Durrell