5 aspects to understand dietary recommendations for patients with post-COVID-19 syndrome

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COVID-19 can cause different clinical manifestations, from asymptomatic infection to mild respiratory illness to severe multi-organ failure and death. In addition to its effects on the lungs, SARS-CoV2 infection can also affect the body's inflammatory status, blood sugar, and blood pressure control. The prognosis and recovery of COVID-19 involves multiple factors, and new research has found that post-COVID-19 syndrome has been identified, characterized by malnutrition, degreased body weight loss, and mild inflammation. In addition, persistent functional impairments (such as fatigue and muscle weakness, dysphagia, loss of appetite, and altered taste/smell) and psychological distress may complicate recovery in people with COVID-19. Therefore, the goal of nutritional therapy for post-COVID-19 syndrome should be to focus on correcting nutritional deficiencies to support the recovery of physical and functional status and mental health.

1

Energy intake

The energy needs of people with post-COVID-19 syndrome depend on their actual nutritional status, and most people with COVID-19 experience decreased appetite and swallowing disturbances due to inflammation, taste/smell changes during the disease, which leads to weight loss. In addition, patients may experience early satiety after eating. Therefore, it is important to correct imbalances in energy expenditure and intake. Based on assessing an individual's energy needs (based on age, sex, and weight), patients are advised to adopt practical strategies to increase food intake, such as eating fewer and more meals, limiting intake on a light, low-fat diet, and increasing energy intake with small doses of oral nutritional supplements. However, some people were overweight/obese before COVID-19, and some people experienced weight gain due to changes in eating habits, increased mental stress, and decreased physical activity during isolation. For overweight/obese patients with post-COVID-19 syndrome, weight loss is advocated.

2

Macronutrients

Patients are advised to consume high-quality protein from foods and animals, and to consume 15-30 g of protein per meal based on body weight to ensure that all essential amino acids that may exert anti-inflammatory effects are consumed.

It is recommended to consume 1.5-3 g of omega-3 fatty acids per day to improve the inflammatory state. Intake is also recommended for monounsaturated fatty acids with anti-inflammatory and antioxidant properties, vitamin E and polyphenols.

Total carbohydrate intake is not a major problem for patients with post-COVID-19 syndrome, and since food intake with a high glycemic index is associated with increased inflammation and oxidative stress, it is highly recommended to consume foods with a lower glycemic index.

3

micronutrient

During the COVID-19 pandemic, the role of nutrition, especially micronutrients and vitamins, in regulating immunity received widespread attention. ESPEN guidelines recommend that patients should consume 100% of the recommended daily intake. For people with micronutrient deficiencies who need higher intakes, it is recommended to supplement with multivitamins and minerals at least once a day. International nutrition recommendations point to the importance of vitamin D (400 IU), especially for people who receive less light (such as those in long-term isolation or hospitalization).

4

Nutraceuticals

Other biologically active compounds may play an important role in mitigating severity or improving the immune response. Polyphenols, N-acetylcysteine (NAC), and hexadecanoethanol (PEA) have been shown to be antiviral. Inositol supplementation may reduce the cytokine storm of COVID-19 and may play a role in disease recovery. Glutathione supplementation can improve several tissue oxidative damage.

Immunostimulants, lactoferrin and peptides have been used as potent immune enhancers. In addition, probiotics (Lactobacillus and Bifidobacterium) may also improve the immune response. Several nutritional compounds have been proposed as immunomodulators to treat COVID-19 or alleviate its symptoms, such as glycophosphopeptides (AM3), white velvet keel extract, and glutamine.

5

Mediterranean diet

There is growing evidence that dietary intake, including nutrients and non-nutritional bioactive compounds, can modulate inflammation and the immune system. Combining these foods with different characteristics throughout the dietary pattern can be used as a nutritional regimen for patients with post-COVID-19 syndrome.

The Mediterranean diet has anti-inflammatory and immunomodulatory effects for several diseases associated with chronic low-grade inflammation, and for patients with post-COVID-19 syndrome, it is recommended to consume more plant foods (fruits, vegetables, whole grains and legumes), high-quality animal protein (fish, lean meats, poultry, eggs and low-fat cheeses), and extra virgin olive oil as a major source of fat.

Patients with post-COVID-19 syndrome who need adequate hydration (30 ml/kg actual body weight) should increase their daily fluid intake (2.5–3 L/day) through drinking water, milk, juice, broth, sports drinks, coffee, and tea.

In summary, personalized nutritional status assessments are needed for patients with post-COVID-19 syndrome to identify potential nutritional or non-nutritional deficiencies and improve patients' physical and mental complications and overall health. It is recommended that patients consume several foods of bioactive compounds that are naturally anti-inflammatory and immunostimulatory, and the Mediterranean diet is recommended. For malnutrition and patients with post-COVID-19 syndrome, nutritional supplements and nutritious foods are recommended.

Figure Dietary recommendations for patients with post-COVID-19 syndrome

参考来源:Barrea L, Grant WB, et al. Dietary Recommendations for Post-COVID-19 Syndrome. Nutrients. 2022 Mar 20;14(6):1305. doi: 10.3390/nu14061305. PMID: 35334962.