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This knowledge hub is constantly being reviewed and updated. We welcome your comments or feedback about it.
Please contact abigail.troncohernandez@plymouth.ac.uk and we will get back to you promptly.
Information on strategies and tools to identify nutritional issues and improve patient-centred care
HCP should discuss goals with patients. It is advisable that goals are SMART. i.e. “specific, measurable, attainable, relevant and time based.”
Some examples that patients could report are:
For patients who have been hospitalised it is important to assess for sarcopenia, respiratory support, cognitive status and dysphagia, additional to weight loss to improve functional status and quality of life (Brugliera et al., 2021). Guidance recommends that healthcare professionals think about remote rehabilitation care from hospital and conditions at home, ask about symptoms, specific diagnostic tests, using open questions. Monitoring of pre-existing comorbid conditions in COVID-19 survivors during rehabilitation is warranted to guarantee safety of the rehabilitative interventions, and to optimize health of these patients. This may require availability of a multidisciplinary team of medical specialists (B Balbi et al., 2020). People who suffered more severely from COVID-19 (e.g. ICU patients) need regular review and monitoring (Barazzoni et al., 2020; Cawood et al., 2020; Malnutrition Pathway, 2020).
The aims for monitoring nutritional status (Barazzoni et al., 2020):
Value of support and communication
Professionals can:
How self-monitoring can help
Active involvement of patients is empowering and their involvement with monitoring is necessary. Self-monitoring is particularly important where infection control measures prevent face to face meetings.
There may be situations where the patient does not wish to engage, or is unable to do so until they receive some psychological support to put coping strategies in place. Signpost to available resources and services. Watching the Psychological wellbeing and communication with healthcare professionals video with Chandanee Kotecha, our psychologist, on our Nutrition and COVID-19 Recovery talks page may help.
Self-monitoring by the patient can:
Interventions should be tailored to the individual where the dietitian will be responsible for leading on any nutritional components of the intervention. This may require for the dietitian to liaise with other members of the MDT as and when appropriate.
Listed below are different tools that have been recommended to assist in monitoring recovery. Some use recalled and subjective measurements, some are suitable for virtual consultations, and some are self-assessment tools.
Older adults
Those who are under hospital care or have recently been discharged from hospital
Use validated tools to monitor progress according to NICE guidelines. See more details in our Identifying who needs nutritional care during COVID-19 recovery section.
Body mass index, body circumferences, bioelectric impedance analysis (simple, quick, non invasive technique to measure body fat and muscle mass).
Assessment should at least include measures that allow understanding of persistent physiological limitations (e.g., lung function, exercise and functional capacity, muscle function, balance) and patient-reported outcomes (e.g., symptoms and health-related quality of life) (B Balbi et al., 2020).
Exercise training and/or physical activity coaching in non-infectious COVID-19 patients with residual lung function impairment should be done by a health professional with previous experience in rehabilitation of patients with respiratory limitations (B Balbi et al., 2020).
Sarcopenia, respiratory support, impact on cognitive status and dysphagia, additional to weight loss should be monitored to improve functional status and quality of life (Brugliera et al., 2021).
Specific conditions and how these need a tailored approach
Everybody
Goals should be based on what matters to the person and what they see as their priorities. It is nonetheless important to prevent muscle mass loss and provide support for patient to improve stamina, resume normal hobbies, achieve functional independence and reach a desirable weight (Malnutrition Pathway, 2020). This should be combined with gradual increase of physical activity. Discussion with a physiotherapist and/or GP should occur to ensure a suitable approach for patients.
It is recommended that general monitoring plans last to up to 2 years. For nutritional care, please refer to local guidance or service level agreements.
Following dietitian assessment, if the patient is undernourished or has a poor quality diet, it is important to determine if supplements of A, C, D, E, B6 and B12, Zinc and Selenium and high fibre should be included in the diet (Chen et al., 2020). A dietitian can also explain the importance of a varied and nutritionally adequate diet and discuss frequency to assess vitamin levels how to monitor this.
For a prolonged home stay due to quarantine (for those at risk or who have COVID-19), maintenance of indoor physical activity is crucial. See below useful links for physical activity and exercise.
Patients who are able to self-manage and access digital services can use the following freely available resources. We also include resources that are not specifically related to nutrition but to other symptoms or post COVID syndrome and may affect nutrition and/or may be worsen or improved through diet.
Dietary advice
General for post-COVID syndrome
LongCovidSOS includes a list of post COVID clinics as well as a list of online support resources in different languages that some UK or international organisations have provided, mainly about respiratory health and rehabilitation but with useful links to support groups across the world.
Physiotherapy
Post critical care recovery
Mental health
Fatigue
Loss of smell
This knowledge hub is constantly being reviewed and updated. We welcome your comments or feedback about it.
Please contact abigail.troncohernandez@plymouth.ac.uk and we will get back to you promptly.
Aytür, Y.K. et al. (2020) ‘Pulmonary rehabilitation principles in SARS-COV-2 infection (COVID-19): A guideline for the acute and subacute rehabilitation’, p. 17.
B Balbi et al. (2020) ‘Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors (version April 3, 2020).’ doi: https://ers.app.box.com/s/npzkvigtl4w3pb0vbsth4y0fxe7ae9z9 [accessed 25.05. 20].
Barazzoni, R. et al. (2020) ‘ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection’, Clinical Nutrition, 39(6), pp. 1631–1638. doi:10.1016/j.clnu.2020.03.022.
Bauer, J.M. and Morley, J.E. (2021) ‘Editorial: COVID-19 in older persons: the role of nutrition’, Current Opinion in Clinical Nutrition and Metabolic Care, 24(1), pp. 1–3. doi:10.1097/MCO.0000000000000717.
Brugliera, L. et al. (2021) ‘Response to: Nutritional strategies for the rehabilitation of COVID-19 patients’, European Journal of Clinical Nutrition, 75(4), pp. 731–732. doi:10.1038/s41430-020-00801-5.
Butler, T. et al. (2020) Joint BACPR/BDA/PHNSG statement on nutrition and cardiovascular health post-COVID-19 pandemic. Available at: https://bjcardio.co.uk/2020/09/joint-bacpr-bda-phnsg-statement-on-nutrition-and-cardiovascular-health-post-covid-19-pandemic/ (Accessed: 22 October 2021).
Cawood, A.L. et al. (2020) ‘A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community’, Nutrients, 12(11), p. 3230. doi:10.3390/nu12113230.
Chen, Q. et al. (2020) ‘Recommendations for the prevention and treatment of the novel coronavirus pneumonia in the elderly in China’, AGING MEDICINE, 3(2), pp. 66–73. doi:10.1002/agm2.12113.
Eekholm, S. et al. (2020) ‘Gaps between current clinical practice and evidence-based guidelines for treatment and care of older patients with Community Acquired Pneumonia: a descriptive cross-sectional study’, BMC Infectious Diseases, 20(1), p. 73. doi:10.1186/s12879-019-4742-4.
Gem COVID (2020) ‘Post-COVID-19 global health strategies: the need for an interdisciplinary approach’, Aging Clinical and Experimental Research, pp. 1–8. doi:10.1007/s40520-020-01616-x.
Gobbi, M. et al. (2021) ‘Nutritional status in post SARS-Cov2 rehabilitation patients’, Clinical Nutrition [Preprint], ((Gobbi, Brunani, Arreghini, Baccalaro, Dellepiane, Lucchetti, Barbaglia, Cova, Fornara, Galli, Capodaglio) Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy). doi:10.1016/j.clnu.2021.04.013.
Goodwin, V.A. et al. (2021) ‘Rehabilitation to enable recovery from COVID-19: a rapid systematic review’, Physiotherapy (United Kingdom), 111((Goodwin, Allan, Bethel, Day, Hall, Howard, Morley, Thompson Coon, Lamb) University of Exeter, United Kingdom), pp. 4–22. doi:10.1016/j.physio.2021.01.007.
Lawrence, V. et al. (2021) ‘A UK survey of nutritional care pathways for patients with COVID-19 prior to and post-hospital stay’, Journal of human nutrition and dietetics: the official journal of the British Dietetic Association, 34(4), pp. 660–669. doi:10.1111/jhn.12896.
Malnutrition Pathway (2020) ‘A Community Healthcare Professional Guide to the Nutritional Management of Patients During and After COVID-19 Illness’, p. 9.
NHS (2020) National guidance for post-COVID syndrome assessment clinics (6 November 2020), Patient Safety Learning – the hub. Available at: https://www.pslhub.org/learn/coronavirus-covid19/guidance/national-guidance-for-post-covid-syndrome-assessment-clinics-6-november-2020-r3465/ (Accessed: 9 January 2021).
NICE (2020) ‘COVID-19 rapid guideline: managing the long-term effects of COVID-19’, p. 35.
NIHR, E. (2021) Living with Covid19 - webinars - Informative and accessible health and- care research. Available at: https://evidence.nihr.ac.uk/themedreview/living-with-covid19-webinars/?source=chainmail (Accessed: 26 April 2021).
Ochoa, J.B. et al. (2020) ‘Lessons Learned in Nutrition Therapy in Patients With Severe COVID‐19’, Journal of Parenteral and Enteral Nutrition, p. jpen.2005. doi:10.1002/jpen.2005.
Weekes, C.E., Emery, P.W. and Elia, M. (2009) ‘Dietary counselling and food fortification in stable COPD: a randomised trial’, Thorax, 64(4), pp. 326–331. doi:10.1136/thx.2008.097352.
WHO (2021) Living with the Times: new toolkit helps older adults maintain good mental health and wellbeing during the COVID-19 pandemic. Available at: https://www.who.int/news/item/01-04-2021-living-with-the-times-new-toolkit-helps-older-adults-maintain-good-mental-health-and-wellbeing-during-the-covid-19-pandemic (Accessed: 16 March 2022).
In creating the knowledge hub we worked with expert panels to form a consensus on the nutritional care for people recovering from COVID-19 infection. Each section of the knowledge hub includes a consensus statement produced by the relevant expert panel. For information on the background of the Nutrition and COVID-19 recovery knowledge hub project visit the 'about us' page.
Consensus statements