Nutritional therapy for COVID-19 patients: practical protocol from a single highly affected center by the outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

Abstract Introduction : Coronavirus disease 2019 (COVID-19) carries a high risk of malnutrition, due to the state of debilitation that results from acute respiratory failure symptoms. The presented protocol aims to provide an approach to reduce the risk of malnutrition and improve the clinical outcomes. Methods : Short age-adjusted Nutritional Risk Screening was performed for all 94 non-ICU patients admitted to the Giovanni Borea Civil Hospital in Sanremo. The 49 ICU patients were considered at risk of malnutrition without screening and were fed with EN plus supplemental PN. In non-ICU setting, patients underwent a personalized nutritional protocol, considering their conditions, which consisted of a high-protein and high-calories pureed diet, Oral Nutritional Supplements and/or Artificial Nutrition or other personalized nutritional path. Results : The nutritional treatment was well tolerated by patients. The 19.1% of non-ICU patients died, they were mainly women, with higher BMI and older in age. On the other hand, the 53.1% of ICU patients died. The non-ICU patients scoring positive on at least one nutritional risk screening item (excluding age) were 72 out of 94. Patients > 70 years old were 68 out of 94. Non-ICU patients who did not meet their energy and protein needs were older (P=0.01) and died more frequently (P Conclusions : This protocol should not be considered as a guideline, but it is intended to report the clinical experience of a nutrition team in an Italian reference center for the treatment of COVID-19 patients. Nutritional strategies should be implemented to prevent worsening of clinical outcomes.