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Malnutrition and COVID-19: RDN’s Role

What is malnutrition?

September is Spotlight on Malnutrition Month and with the changes in 2020, malnutrition continues to be a very important topic to highlight. According to the Academy of Nutrition and Dietetics, malnutrition is a detrimental condition that occurs commonly. Malnutrition can come in two forms: undernutrition and overnutrition. Undernutrition typically occurs in areas without adequate access to drinking water and food. This type of malnutrition is prevalent when individuals are not consuming enough calories, protein, or another nutrient. On the other hand, overnutrition occurs when individuals are consuming too many calories and not enough nutrients. For example, though they are consuming more than their estimated calorie needs for the day, they are not consuming enough nutritious foods, such as lean proteins, non-starchy vegetables, fruits, whole grains, low-fat dairy, and fibrous foods. Both types of malnutrition are essential to address quickly and comprehensively for all patients, including those with COVID-19.

Malnutrition and COVID-19

Malnutrition increases the chances of an individuals becoming sick, staying sick and dying. It

does this by weakening the immune system and increasing the body’s risk of infection. The cycle of malnutrition is exacerbated by the present pandemic. Many families throughout the United States are facing challenges, related to increase in food cost, unemployment, restricted mobility, disruption to health and social services, as well as changes to education programs.

These challenges may greatly affect their nutritional intake, which in turn affects their health, if action is not taken to begin to increase access to healthy food. Pre-existing conditions and micronutrient deficiencies may increase the severity of COVID-19 consequences. In fact, emerging research shows individuals who have multiple comorbidities, are older adults, or who are malnourished, are at an increased risk of being admitted to the intensive care unit (ICU) and of mortality from COVID-19. This means, nutrition care is critical to identify and address malnutrition to prevent further adverse health outcomes.

Registered Dietitians and Malnutrition

Medical nutrition therapy (MNT) plays an important role in the prevention and treatment of malnutrition. Registered Dietitians provide care to malnourished adults in a variety of settings during the COVID-190 pandemic. The process for this is as follows: screening using the Malnutrition Screening Tool, comprehensive nutrition assessment to identify malnutrition, comprehensive nutrition recommendations and interventions, and monitoring and evaluation. For individuals with malnutrition in the ICU with suspected or confirmed COVID-19 infection, the dietitian will work as part of the multi-disciplinary team to ensure adequate protein and energy intake. When needs are not being met orally, the dietitian will work with the multidisciplinary team to initiate enteral nutrition to treat and prevent further malnutrition. It is recommended nutrition support is initiated within 36 hours of hospitalization or within 12 hours of intubation if adults with COVID-19 infection in the ICU are not able to meet their

needs orally. Daily, dietitians will monitor nutrition support tolerance and work with the

multidisciplinary team to promote tolerance.

In conclusion, MNT is a critical aspect of managing malnutrition due to COVID-19 infection.

Registered dietitians should work as a multidisciplinary team to implement nutrition care plans to assess, prevent, and treat malnutrition for individuals suspected to have or confirmed COVID-19 infections.

Blog Provided by Allysa Ballantini, MPP-D, RD, LD



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