This week is dietitians week, in which the British Dietetic Association showcases the many places and specialist areas in which dietitians work. This year the main focus of the awareness campaign will be on the role of dietitians and the importance of adequate and appropriate nutrition during the COVID-19 pandemic.
Dietitians and medical educators Duane Mellor and Elaine Macaninch talk about the pandemic, and the part nutrition can play in tackling the virus.
In what ways is nutrition relevant to the current pandemic?
Nutrition is relevant to COVID-19 in a number of ways, including who it affects, treatment and ongoing rehabilitation.
Public health- understanding data and links to health equality and metabolic health.
Firstly, COVID-19 is not affecting people equally. We can clearly see from the data those most affected and at risk of poor health outcomes are older adults, lower-income families, certain ethnic groups and those with poorer metabolic health. High blood pressure, increased blood glucose and increased weight are all added risk factors. Elaine is collaborating along with Dr Kathy Martyn to submit a paper considering health inequality and poor nutrition; and its relevance to COVID-19.
As well as the potential role of poor nutrition in the development of metabolic risk factors, food has been a major consideration in the emergency response. We all saw the empty supermarket shelves at the start of the pandemic, many people self-isolating did not know how to get shopping and the use of food banks have already increased by 81%.
Acute treatment and recovery
Even in those with minor symptoms, we now know that there is a loss of taste and smell affecting the appetite. But for those who require hospital care, there are big nutritional challenges. Dietitians are an important part of the critical care team to help patients meet increased nutritional requirements – mainly via nasogastric tube feeding. Providing appropriate calories, protein and nutrients needs daily monitoring and adjusting to keep in balance with blood biochemistry, as well as for tracking the patient’s condition. For example, nutrition needs to be appropriate to the level of sedation and ventilation. Nutritional needs differ from the acute to the recovery stage of treatment, and nutrition plays a part in survival and how a patient recovers after critical illness.
We are still learning about how COVID-19 affects nutritional status and the role of specific micronutrients, which may be involved in both the risk or severity of COVID-19, and in the recovery process. We are seeing huge weight loss, particularly of lean body weight and muscle wasting. We also know that long periods in hospital can impact on mental well-being. Optimisation of nutrition is essential to rebuild physical and mental health in close collaboration with our colleagues, for example, physiotherapy, occupational therapy and many other healthcare professions. This really is a huge team effort.
How may this influence future nutrition care? And how might it be relevant to medical students and education?
The role of nutrition during COVID-19 shines a light on nutritional problems, such as malnutrition, food insecurity and the role of nutrients in our metabolic health – all of which were relevant before the pandemic.
We expect to see rising malnutrition levels – malnutrition is a term which applies to undernutrition and micronutrient deficiencies, but also being overweight and associated chronic health risks. COVID-19 has re-focussed attention on nutrition screening and the importance of planned nutritional care in primary and secondary settings. An understanding of the clinical relevance and actions to mitigate this is essential for medical and all healthcare students and practitioners.
At Brighton and Sussex Medical School (BSMS), we are working on case studies using COVID-19 as a case example of the complexity of nutrition within healthcare and how this is interlinked and becomes relevant to all healthcare professions.
I think we have an opportunity to make a contribution by improving interprofessional practice and building on new ways of working and learning. This will include blending online learning with face-to-face lectures and small group work that involves members of the public and patients; as we all face new challenges together.