Nutritional management of adult patients hospitalised with COVID-19 by dietitians in KwaZulu-Natal

Abstract

Background: The outbreak of a novel coronavirus disease (COVID-19) in December 2019 led to a worldwide pandemic. Dietitians treated patients hospitalised with COVID-19 without published guidelines on the nutritional management of the disease or prior training on its management.
Objectives: To determine how dietitians managed adult patients hospitalised with COVID-19 in KwaZulu-Natal (KZN).
Design: A cross-sectional study was conducted.
Setting: KZN, South Africa.
Subjects: Forty-two dietitians who had treated adult COVID-19 patients in KZN participated in the study.
Outcome measures: A self-administered questionnaire was developed and used to collect data via the online platform, Google Forms.
Results: Most dietitians (n = 29; 68%) consulted a nutrition society for recommendations on the nutritional management of COVID-19 patients, particularly the European Society for Parenteral and Enteral Nutrition (ESPEN) (n = 12; 28.6%). Values used to calculate macronutrient requirements included: 25–30 kcal/kg/day for energy (n = 12; 28.6%), 50–60% of total energy requirement (TER) for carbohydrates (n = 8; 19.0%), 1.2–1.5 g/kg/day for protein (n = 6; 14.3%), and 30% of TER for fat (n = 15; 35.7%). Dietitians used actual bodyweight (n = 13; 31.0%), or estimated bodyweight (n = 19; 45.2%), to calculate nutritional requirements (p = 0.004). Half of the dietitians used a nutrition screening tool to screen for malnutrition (n = 21; 50%), with the Nutrition Risk Screening 2002 (NRS-2002) tool being the most used (n = 13; 61.9%) (p < 0.05).
Conclusions: Nutritional requirements used by dietitians to manage patients with COVID-19 were similar to those recommended by ESPEN for critically ill patients. Weight and height of bed-bound patients were estimated. Dietitians used the NRS-2002 tool to screen patients for malnutrition. 

Keywords: adult patients, COVID-19, dietitians, KwaZulu-Natal, nutritional management