COVID-19 and micronutrient deficiency symptoms - is there some overlap?

BACKGROUND & AIMS: COVID-19 is highly inflammatory and when it affects the elderly who have multiple comorbidities, the risk of malnutrition is high. The aim of this review is to highlight the evidence for COVID-19 and risk for malnutrition (macro- and micro-nutrient deficiency) sharing two case reports. METHODS: We report two cases of patients with COVID-19. The first case includes a 75-year-old male with increasing confusion, delirium and malnutrition once he had clinically resolved from his COVID-19 diagnosis. The patient had a number of comorbidities and was treated with diuretics before and after his hospital admission. He was treated with intravenous thiamine and enteral nutrition. The second case includes a 77-year-old male with diabetes who presented with suspected vitamin C deficiency likely due to chronic aspirin use nearly two weeks prior to being diagnosed with pneumonia and COVID-19. The patient recovered from his COVID-19 diagnosis but continued to decline nutritionally and was readmitted sixty days later with failure to thrive. RESULTS: The first case had significant improvements in his appetite and neurological conditions following thiamine infusion and enteral nutrition and was discharged to home after a 19-day hospital stay. The second case presented with a vitamin C deficiency before testing positive for COVID-19. Although he did recover from COVID-19 he struggled to meet nutritional needs post-COVID and passed away 60 days after his COVID-19 diagnosis with pneumonia and failure to thrive. CONCLUSION: Elderly patients with chronic diseases who use nutrient depleting medications are particularly high risk for micronutrient deficiency when they also experience the inflammatory insult of COVID-19. Patients who continue to have poor nutrition intake even after they appear to be clinically resolved from the virus should be closely monitored.

Nutrition Care Process Quality Evaluation and Standardization Tool: The Next Frontier in Quality Evaluation of Documentation.

Documentation is essential for communicating care between credentialed nutrition and dietetics practitioners and other health care providers. A validated tool that can evaluate quality documentation of the Nutrition Care Process (NCP) encounter, including progress on outcomes is lacking. The aim of the NCP Quality Evaluation and Standardization Tool (QUEST) validation study is to revise an existing NCP audit tool and evaluate it when used within US Veterans Affairs in all clinical care settings. Six registered dietitian nutritionists revised an existing NCP audit tool. The revised tool (NCP-QUEST) was analyzed for clarity, relevance, and reliability. Eighty-five documentation notes (44 initial, 41 reassessment) were received from eight volunteer Veterans Affairs sites. Five of six registered dietitian nutritionists participated in the interrater reliability testing blinded to each other's ratings; and two registered dietitian nutritionists participated in intrarater reliability reviewing the same notes 6 weeks later blinded to the original ratings. Results showed moderate levels of agreement in interrater reliability (Krippendorff's α = .62 for all items, .66 for total score, and .52 for quality category rating). Intrarater reliability was excellent for all items (α = .86 to .87 for all items; .91 to .94 for total score and.74 to .89 for quality category rating). The NCP-QUEST has high content validity (Content Validity Index = 0.78 for item level, and 0.9 for scale level) after two cycles of content validity review. The tool can facilitate critical thinking, improved linking of NCP chains, and is a necessary foundation for quality data collection and outcomes management. The NCP-QUEST tool can improve accuracy and confidence in charting.

Etiology Intervention Link Predicts Resolution of Nutrition Diagnosis: A Nutrition Care Process Outcomes Study from a Veterans' Health Care Facility.

In this article, we evaluate relationships between Nutrition Care Process (NCP) chain links and improvement or resolution of the nutrition diagnosis. We conducted a retrospective record review for 12 months in a single Veterans Health Administration health care system using the Veterans Health Administration-specific monitoring and evaluation terms, NCP terminology, and its etiology categories to evaluate outcomes. Logistic regression analysis revealed that the strongest predictor for diagnosis improvement was the etiology-intervention link. The odds of improving the nutrition diagnosis were 51.43 times higher when the etiology-intervention link was present. The odds of improving the nutrition diagnosis were 19.74 times higher when the evidence-diagnosis link was present and 9.46 times higher when the intervention-goal link was present. For every added nutrition visit by the registered dietitian nutritionist, the odds of improving the nutrition diagnosis increased by 32.5%. For every increased point on the NCP audit score, the odds of resolving or improving the nutrition diagnosis increased by 37.7%. When applying the NCP, the presence of the etiology-intervention link significantly improves the odds of resolving the nutrition diagnosis in a Veterans Health Administration population. For the first time, we show evidence that the NCP works as designed. Also, we demonstrate that the quality of NCP documentation impacts resolution of the diagnosis, and we describe the methodology for how to evaluate NCP outcomes. Registered dietitian nutritionists are encouraged to critically evaluate links of the NCP chain, assess NCP documentation for quality, and pursue follow-up visits to improve resolution of nutrition problems.

Feeding tube use in patients with head and neck cancer.

BACKGROUND: Use of a prophylactic feeding tube before concurrent chemotherapy and radiotherapy (CRT) for patients with head and neck cancer is often debated. METHODS: A retrospective, exploratory study of 109 veterans with stage III/IV head and neck cancer who completed standard CRT was conducted. Relationships among 3 feeding tube status groups: prophylactic feeding tube (PFT), reactive feeding tube (RFT), and no feeding tube (no-FT) were compared for clinical outcomes. RESULTS: Patients with a PFT had significantly less weight loss during CRT, fewer nutrition-related emergency department visits or hospitalizations, and higher proportions of chemotherapy cycles completed compared to those with an RFT or no-FT. At 12 months post-CRT, there was no relationship between the use of a PFT and 100% feeding tube dependency. CONCLUSION: Use of a PFT in this veteran population with stage III/IV head and neck cancer produced better outcomes when compared to both an RFT or no feeding tube without higher rates of long-term dysphagia.