A possible role for essential amino acid supplementation in improving functional recovery and reducing the risk for malnutrition in COVID-19 patients
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Keywords
sarcopenia , malnutrition, diet, essential amino acids
Abstract
Background and aim. In patients with severe forms of coronavirus disease-19 (COVID-19), prolonged hospitalization and immobilization decrease muscle mass and increase the risk of malnutrition. Moreover, catabolic molecules such as interleukins (IL)-1 and -6 and tumor necrosis factor (TNF) contribute to the reduction of body mass, increasing the risk of sarcopenia. Since sarcopenia represents a negative prognostic factor in COVID-19 patients, protein and/or essential amino acid (EAA) supplementation has been recommended in these patients, to counteract the loss of muscle mass and strength. Aim of this study was to evaluate the effects of a six-month dietary intervention (including a standardized protein intake and a supplementation of free EAAs) on risk of malnutrition, body composition, muscle strength and physical performance in 74 COVID-19 patients after discharge.
Methods: All subjects received a balanced diet according to ideal BMI, with protein intake of 1.2 -1.5 gr/kg/day. Each participant received a supplementation of EAAs twice a day during the first three months and once daily for the remaining period. Anthropometric measurements, and assessment of muscular strength, body composition and physical performance were performed during three different visits: immediately after the hospital discharge, after three months and at the end of the six-month observation period.
Results: Significant changes in body mass index (BMI), Malnutrition Universal Screening Tool (MUST) score, arm circumference and triceps fold values were observed, as well as a significant increase in total body water (TBW), and significant improvements in the S and T scores and in the short physical performance battery (SPPB) score.
Conclusions: these results suggest that in patients recovering from SARS-Cov2 infection, the dietary intake of 1.2-1.5 gr per kg of protein per day associated with EAA supplementation may contribute to BMI improvement and functional recovery, reducing the risk of malnutrition and osteosarcopenia.
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Vincenza Serra, Department of Gastroenterology and Digestive Endoscopy, Bolognini Hospital, Seriate, Italy
Dr Serra graduated in medicine and surgery at the University of Milan in 1996 and specialized in Nutrition in 2002 at the University of Pavia. Since 2017 she is employed at ASST Bergamo est.
Fabio Pace, Department of Gastroenterology and Digestive Endoscopy, Bolognini Hospital, Seriate, Italy
Graduated in Medicine and Surgery in 1979 at the University of Palermo, specialized in Diseases of the digestive system in 1983 at the same University.
Research assistant in Zurich (CH) and Johannesburg (SA).
From 1984 hospital assistant, from 1991 Assistant and subsequently first level manager at the division and chair of Gastroenterology of the "L. Sacco" University Hospital in Milan (director Prof. G. Bianchi Porro).
From November 2006 to March 2015 university researcher at the Department of Biomedical and Clinical Sciences "L. Sacco" - Milan.
Since March 2010 director of the complex operative unit of Gastroenterology of the "Bolognini" hospital in Seriate (BG).
Studies in the field of gastroesophageal reflux disease, digestive motility disorders, functional pathology in gastroenterology and psychogastroenterology with over 200 publications; Current overall Impact Factor of approximately 220.
He is the author of 14 books on gastroenterology.
Member of various scientific societies (Sige, Eage, Gismad).
Referee activity for various international journals (Digestive and Liver Disease, Scandinavian Journal of Gastroenterology, Gut, Gastroenterology, Drugs, Drug Development Research, Nature Clinical Practice Gastroenterology & Hepatology, Journal of Cellular and Molecular Medicine).
Marzia Contessi, Department of Gastroenterology and Digestive Endoscopy, Bolognini Hospital, Seriate, Italy
Degree obtained at the University of Pavia - Faculty of Dietology and Applied Dietetics in 1996 and 2012 Credit conversion at the University of Modena and Reggio Emilia - Faculty of Dietetics
I work at ASST Bergamo EST (Seriate Hospital) with the title of Dietitian since 2004.
My main tasks are: outpatient activity (dietary clinic), outpatient and inpatient food education, management of personalized ete for hospitalization, collaboration with U.O. Hospital Hygiene for periodic checks provided in the HACCP manual, drafting and processing of the hospital menu and related revisions.
I regularly do the refresher courses and thereforeI am in good standing with the CME credits.
I am regularly enrolled in the TSRM register of Bergamo.
Claudia Lampugnani, Department of Gastroenterology and Digestive Endoscopy, Bolognini Hospital, Seriate, Italy
Degree in Dietology and Applied Dietetics obtained in 1990 in Milan.
Currently employed at ASST Bergamo EST as a of Dietitian, primarily in charge of outpatient activity (dietary clinic), outpatient and inpatient food education, management of personalized diet for hospitalization, collaboration with U.O. Hospital Hygiene for periodic checks provided in the HACCP manual, drafting and processing of the hospital menu and related revisions.
Regularly fulfilled CME credits.
Regularly enrolled in the TSRM-PSTRP register of Bergamo.
Giuliana Invernici, Department of Gastroenterology and Digestive Endoscopy, Bolognini Hospital, Seriate, Italy
Graduated with honors in Dietetics in 2006 at the University of Milan.
She has been working as a clinical dietitian since 2007. After a solid and formative internship period, she began her career at the Ospedali Riuniti of Bergamo following projects related to early per os refeeding in patients undergoing major abdominal surgery and supporting nutrition in patients waiting for liver transplantation.
Since then she has been particularly fond of and has maintained a high level of interest in the nutritional management of malnutrition and malabsorption – including bariatric surgery.
She has a long experience with dietary patterns and nutrition education, continuing medical education both as a learner and as a trainer in nutrition field, quality management.
She collaborates in teams with other health professionals especially in the management of subjects undergoing major abdominal surgery, oncological surgery, onco-gynecological but also of gastroenterological, psychiatric, diabetological and medical origin.
Recently she is focusing her efforts in participating in a multidisciplinary network for the management of neurological dysphagia.
Francesca Spedicato, Department of Gastroenterology and Digestive Endoscopy, Bolognini Hospital, Seriate, Italy
Graduated in Dietetics at the University of Pavia in 2007. Master in "Eating Disorders in the developmental age" obtained in 2010 at the University of Florence.
Since 2012 I collaborate with the asst Bergamo est.
Alberto Tedeschi, Department of Medicine, Bolognini Hospital, Seriate, Italy
Medical doctor, specialist in Internal Medicine.Since March 2018 director of the complex operative unit of Internal Medicine of the "Bolognini" hospital in Seriate (BG).
Fabio De Stefano, Department of Medicine, Bolognini Hospital, Seriate, Italy
Dr De Stefano Fabio graduated in medicine and surgery at the University of Padua on 10/16/2006, specialized in Geriatrics on 08/04/2011 and obtained PhD on 03/26/2015. Currently employed at ASST Bergamo est as geriatrician.
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