The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. METHODS: We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). RESULTS: Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75-1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD -3.44% per week, 95% CI -4.99 to -1.90; p < 0.0001). CONCLUSION: In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530.

[Results of a survey aimed at dietitians-nutritionists on the management of clinical nutrition teams during the COVID-19 pandemic in hospitals in Catalonia]. / Resultados de una encuesta dirigida a dietistas-nutricionistas sobre la gestión de los equipos de nutrición clínica durante la pandemia de COVID-19 en centros hospitalarios de Cataluña.

INTRODUCTION: Introduction: the COVID-19 pandemic has had direct implications for clinical nutrition teams (NT), both at an organizational and healthcare level. Since March 2020, expert recommendations on nutritional intervention for patients with COVID-19 have been available. Objectives: to describe the nutritional intervention that has been carried out in patients with COVID-19, to estimate the presence of clinical dietitians-nutritionists (DN) in hospitals in Catalonia, and to know the organization of NTs. Methods: a cross-sectional study through an online survey directed to clinical DNs at hospitals in Catalonia (March 2021) was made. Results: the surveys of 36 NTs, made up of 104 DNs, have been analysed. A total of 44.44 % of NTs had to interrupt or reduce some of their usual activities during the pandemic. When nutritional screening was used, it was carried out early (24-48 h) in 56.25 % of cases, and the most common tool was the NRS-2002 (66.67 %). In 41.67 % of NTs a specific hospital diet was established, this being generally hyperproteic (89.66 %). Oral nutritional supplementation was systematically prescribed by 41.67 % of NTs, prioritizing hyperproteic (97.14 %) and hypercaloric (74.29 %) formulas. It is estimated that clinical DNs are present in approximately 61.54 % of public acute hospitals in Catalonia. Conclusions: the results reflect the adaptive capacity of NTs, reorganizing and redistributing their usual tasks and establishing infrequent measures to ensure nutritional support.

INTRODUCCIÓN: Introducción: la pandemia por COVID-19 ha tenido implicaciones directas en los equipos de nutrición (EN) clínica a nivel tanto organizativo como asistencial. Desde marzo de 2020 se dispone de recomendaciones de expertos sobre la intervención nutricional en pacientes con COVID-19. Objetivos: describir la intervención nutricional que se ha llevado a cabo en los pacientes con COVID-19, estimar la presencia de dietistas-nutricionistas (DN) clínicos en los hospitales de Cataluña y conocer la organización de los EN. Métodos: estudio transversal realizado a través de una encuesta online dirigida a los DN clínicos de los hospitales de Cataluña (marzo 2021). Resultados: se han analizado las encuestas de 36 EN, formados por 104 DN. El 44,44 % de los EN han tenido que dejar de hacer o reducir alguna de sus actividades habituales durante la pandemia. Cuando se ha empleado el cribado nutricional, este se ha realizado de forma precoz (24-48 h) en el 56,25 % de los casos y la herramienta más común ha sido el NRS-2002 (66,67 %). El 41,67 % de los EN han instaurado una dieta hospitalaria específica, siendo esta generalmente hiperproteica (89,66 %). El 41,67 % de los EN han pautado la suplementación nutricional oral de forma sistemática, priorizando las fórmulas hiperproteicas (97,14 %) e hipercalóricas (74,29 %). Se estima que la figura del DN clínico está presente en aproximadamente el 61,54 % de los hospitales de agudos públicos de Cataluña. Conclusiones: los resultados reflejan la capacidad de adaptación de los EN, reorganizando y redistribuyendo sus tareas habituales e instaurando medidas poco habituales para asegurar el soporte nutricional.

Management of COVID-19 infection in organic acidemias.

The COVID-19 pandemic has affected the health and healthcare of individuals of all ages worldwide. There have been multiple reports and reviews documenting a milder effect and decreased morbidity and mortality in the pediatric population, but there have only been a small number of reports discussing the SARS-CoV-2 infection in the setting of an inborn error of metabolism (IEM). Here, we report two patients with underlying metabolic disorders, propionic acidemia and glutaric aciduria type 1, and discuss their clinical presentation, as well as their infectious and metabolic management. Our report demonstrates that individuals with an underlying IEM are at risk of metabolic decompensation in the setting of a COVID-19 infection. The SARS-CoV-2 virus does not appear to cause a more severe metabolic deterioration than is typical.

Health Benefits of Plant-Based Nutrition: Focus on Beans in Cardiometabolic Diseases.

Cardiovascular disease (CVD) is the leading cause of death worldwide, claiming over 650,000 American lives annually. Typically not a singular disease, CVD often coexists with dyslipidemia, hypertension, type-2 diabetes (T2D), chronic system-wide inflammation, and obesity. Obesity, an independent risk factor for both CVD and T2D, further worsens the problem, with over 42% of adults and 18.5% of youth in the U.S. categorized as such. Dietary behavior is a most important modifiable risk factor for controlling the onset and progression of obesity and related disease conditions. Plant-based eating patterns that include beans and legumes support health and disease mitigation through nutritional profile and bioactive compounds including phytochemical. This review focuses on the characteristics of beans and ability to improve obesity-related diseases and associated factors including excess body weight, gut microbiome environment, and low-grade inflammation. Additionally, there are growing data that link obesity to compromised immune response and elevated risk for complications from immune-related diseases. Body weight management and nutritional status may improve immune function and possibly prevent disease severity. Inclusion of beans as part of a plant-based dietary strategy imparts cardiovascular, metabolic, and colon protective effects; improves obesity, low-grade inflammation, and may play a role in immune-related disease risk management.

Malnutrition and nutritional therapy in patients with SARS-CoV-2 disease.

RATIONALE: The prevalence of malnutrition and the provided nutritional therapy were evaluated in all the patients with SARS-CoV-2 infection (COVID-19) hospitalized in a 3rd level hospital in Italy. METHODS: A one-day audit was carried out recording: age, measured or estimated body weight (BW) and height, body mass index (BMI, kg/m2), 30-day weight loss (WL), comorbidities, serum albumin and C-reactive protein (CRP: nv < 0.5 mg/dL), hospital diet (HD) intake, oral nutritional supplements (ONS), enteral (EN) and parenteral nutrition (PN). Modified NRS-2002 tool and GLIM criteria were used for nutritional risk screening and for the diagnosis of malnutrition, respectively. RESULTS: A total of 268 patients was evaluated; intermediate care units (IMCUs, 61%), sub-intensive care units (SICUs, 8%), intensive care units (ICUs, 17%) and rehabilitation units (RUs, 14%): BMI: <18.5, 9% (higher in RUs, p = 0.008) and ≥30, 13% (higher in ICUs, p = 0.012); WL ≥ 5%, 52% (higher in ICUs and RUs, p = 0.001); CRP >0.5: 78% (higher in ICUs and lower in RUs, p < 0.001); Nutritional risk and malnutrition were present in 77% (higher in ICUs and RUs, p < 0.001) and 50% (higher in ICUs, p = 0.0792) of the patients, respectively. HD intake ≤50%, 39% (higher in IMCUs and ICUs, p < 0.001); ONS, EN and PN were prescribed to 6%, 13% and 5%, respectively. Median energy and protein intake/kg BW were 25 kcal and 1.1 g (both lower in ICUs, p < 0.05) respectively. CONCLUSIONS: Most of the patients were at nutritional risk, and one-half of them was malnourished. The frequency of nutritional risk, malnutrition, disease/inflammation burden and decrease intake of HD differed among the intensity of care settings, where the patients were managed according to the severity of the disease. The patient energy and protein intake were at the lowest limit or below the recommended amounts, indicating the need for actions to improve the nutritional care practice.

[Nutritional management of the critically ill inpatient with COVID-19. A narrative review]. / Manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19. Una revisión narrativa.

INTRODUCTION: The current COVID-19 pandemic mainly affects older people, those with obesity or other coexisting chronic diseases such as type-2 diabetes and high blood pressure. It has been observed that about 20 % of patients will require hospitalization, and some of them will need the support of invasive mechanical ventilation in intensive care units. Nutritional status appears to be a relevant factor influencing the clinical outcome of critically ill patients with COVID-19. Several international guidelines have provided recommendations to ensure energy and protein intake in people with COVID-19, with safety measures to reduce the risk of infection in healthcare personnel. The purpose of this review is to analyze the main recommendations related to adequate nutritional management for critically ill patients with COVID-19 in order to improve their prognosis and clinical outcomes.

INTRODUCCIÓN: La pandemia actual por COVID-19 afecta principalmente a personas mayores, con obesidad o con otras enfermedades crónicas coexistentes como diabetes de tipo 2 e hipertensión arterial. Se ha observado que alrededor del 20 % de los pacientes requerirán hospitalización y algunos de ellos necesitarán soporte de ventilación mecánica invasiva en unidades de cuidados intensivos. El estado nutricional parece ser un factor relevante que influye en el resultado clínico de los pacientes con COVID-19 críticamente enfermos. Diversas guías internacionales han publicado recomendaciones para asegurar la ingesta energética y proteica de las personas con COVID-19, junto con medidas de seguridad para disminuir el riesgo de infección por parte del personal de salud. El propósito de esta revisión es analizar las principales recomendaciones relacionadas con el adecuado manejo nutricional del paciente hospitalizado críticamente enfermo con COVID-19 con la finalidad de mejorar el pronóstico y los resultados clínicos.

Short Report - Medical nutrition therapy for critically ill patients with COVID-19.

No Abstract Available.