Balanced nutrition is vital for maintaining skeletal muscle and avoiding metabolic disturbances and becomes all the more important when patients are spending around two weeks being COVID-19 positive. Respiratory difficulties add an extra layer of complexity, preventing patients from eating effectively. A proportion of the patients require assisted ventilation, making it difficult to provide food and oral supplements. Oral nutrition intake can be inadequate even after extubating. People might not be able to eat enough food to meet their nutritional needs during recovery, contributing to further loss of lean muscle — which could occur in the ICU at the rate of up to 1kg per day.
This means that nutrition has had to become an important part of COVID-19 patients' recovery. Nutritional recommendations will depend on physical activity and disease-related symptoms, and upon other comorbidities. Energy intake can be lowered to approximately 300-600 kcal below the usual energy requirements as long as nutrition remains complete, which needs to be recovered as soon as possible. For these patient groups (with comorbid condition/with other diseases), nutrition is extremely complex. It is difficult to keep these patients in a stable condition, and what makes the difference in this balance is appropriate and timely nutrition support. Muscle wasting is the most common complication of critical illness, occurring in up to 50 percent of the patients, which can seriously lengthen recovery times, impaired immunity, increase infection risk and cause the development of wounds and pressure ulcers. Even those who didn't need any hospital support, mostly were afflicted with severe weakness even after being COVID negative, due to high catabolic condition during the duration of virus attack.
All this implies an underlying necessity of following dietary rules, such as:
- Energy and protein rich nutrition according to the condition must be supplied. Protein requirements: 1.2 to 2.0 g/kg actual bodyweight.
- Vitamins and minerals: All requirements determined by 100 percent RDA, unless there are indicated deficiencies or increased requirements. For COPD (chronic obstructive pulmonary disorder) patient:
- Calcium requirement is 1000-1200mg/day. Frequent consumption of corticosteroids as well as immobility contribute to osteoporosis risk.
- Vitamin D: recommendations/requirements according to public health recommendations are 1000 to 2000 IU per day for adults.
- Fluid: minimum of 2 to 2.5 litre and any losses, but need to avoid fluid intake at the time of meals to prevent vomiting. Potentially use a short straw when drinking if there is vomiting tendency.
- Appropriate spreading of nutrition across the day/increase the frequency of meals. It is preferred that every meal contains 25g of protein. Consume smaller-sized portions to prevent an empty stomach routinely, approximately 6-8 times per day. Resistance can be seen with larger portions.
- Introduce the largest meal of the day at the best moment of the day for the patient and ensure proper rest prior to meal.
- The soft foods and liquid can be less taxing for those that suffer from fatigue.
- Use lightweight cutlery so that eating and drinking takes minimal exertion.
- Eating in a slow and calm manner in the appropriate position.
- If there is uncertainty about achieving adequate energy and protein intake, oral nutritional supplements need to be started.
- Add dried fruits and food to improve the calorie intake.
- Limit strong smells coming from food and drink and extremely hot food.
- Limit the intake of lactose; opt for more sour milk products such as yoghurt instead of sweeter milk products. The taste can be made milder by the addition of a spoonful of yogurt.
- Strengthen the taste by adding herbs and spices. Mustard can be used to bring dishes to desired taste level.
- Stimulate the appetite by serving dish on a nice-looking plate or present dish in an appealing way.
- Variation in colours ensures the meal is appetising; Make use of different temperatures of smell and taste within a meal.