After over six months of living amidst a pandemic, COVID-19 has impacted everyone-from those who have had a clinical diagnosis of COVID-19, to those who have felt the psychological effects of quarantine and social distancing. The state of self-isolation, lockdown, and social distancing are important measures to flattening the curve of the disease, although this act of confinement has led to changes in eating patterns, sleeping habits, and physical activity. It also has led to more sedentary behaviors that affect mental and physical health.
Optimal nutrition and dietary nutrient intake impact the immune system, which in turn can prevent negative outcomes of COVID-19. Key nutrients from food to support to a healthy immune system include:
- Protein – Helps build immune cells
- Vitamin C – Antioxidant that is involved with collagen synthesis
- Vitamin A – Anti-inflammatory critical in enhancing immune function
- Vitamin D – Regulates immune function
- Vitamin E – Antioxidant
- Zinc – Support production of new immune cells
Loss of appetite and decreased nutrient intake is common with most illnesses and COVID-19 is no different. Be mindful of the lingering effects:
- Loss of smell—the inability to smell food decreases the perception of food flavor and may decrease the gastric juices which can stimulate appetite.
- Loss of taste—loss of taste or impaired taste has been a sign of low immune system function even before COVID-19. Not being able to taste food can reduce the desire to eat.
- Breathing difficulty—with a lung disease like COVID-19, breathing can be difficult on its own. This can become even more difficult when trying to eat. If there is difficulty breathing, dietary intake may not be sufficient.
- GI issues (Nausea, Vomiting, Diarrhea) —Survivors may not enjoy the same foods they enjoyed in the past or may develop food sensitivities. Ongoing issues may also lead to dehydration or weakness.
- Weakness— Fatigue due to difficulty breathing or weakness due to loss of muscle mass may lead to impaired functional status affecting activities of daily living (ADL’s).
- Cognitive changes—Loneliness and social isolation have been linked to depression, worsening physical health, and increased stress and cognitive changes. Depression often leads to reduced intake and unintended weight loss.
Undernutrition, malnutrition and vitamin mineral deficiencies are all very likely in the post-acute setting. Enlist your dietitian to assess the residents and complete a comprehensive nutrition assessment. Some common consequences of recovery from inflammatory conditions may include changes in preferred food textures, changes in eating patterns, or difficulty using utensils. Observe for changes in mobility and functional status such as loss of balance, shuffling of feet, or not using assistive devices properly.
There are still many unknowns of COVID-19 and its nutritional implications. Being proactive in optimizing nutritional:
- Discontinue any therapeutic diet restrictions.
- Small, frequent, nutrient-dense meals and snacks may be better accepted due to decreased appetite and increased energy requirements.
- Use protein/calorie rich ingredients to fortify the caloric contents of food without adding to the volume of food.
- Make a list of high energy high protein foods and liquids that are best liked and tolerated.
- Identify the time of day when the appetite is best. Concentrate the intake of calorie-dense and nutrient-dense foods at that time.
- Modify food consistency to mechanical soft or pureed when fatigue and shortness of breath interfere with chewing and swallowing. Foods that easily melt in the mouth may be better accepted.
- Obtain Speech Therapy input as needed.
- Smaller bites may be necessary if experiencing difficulty breathing
- Ensure adequate flavor of foods since foods such as meat and vegetables may taste bland.
- Residents may favor cold and sweet foods.
- Physical and cognitive decline may lead to decreased feeding ability. Offer assistance as needed to help improve intakes.
- Nutritional Supplements may be considered to provide additional calories and nutrients for those who need them.
- House Nutritional Supplement, Nutritional Supplement given with medications, Juice based supplements, Fortified ice cream, Nutritional Puddings.
- Liquid protein product—protein foods may be difficult to chew and swallow so may be lacking in the diet.
- Multivitamin w/minerals should include B complex, Vit A, Vit C, Vit D, Mg, Zn, Selenium.
- Push fluids to avoid dehydration.
- Water is the best liquid to drink.
- Other good choices are milk, juice and flavored drinks.
- Coffee and tea cause the body to lose fluid so staff should encourage the intake of water and fruit juices instead.
- Foods can provide fluids too like popsicles, fruits, vegetables, sherbet, ice cream, broths, and soups.
Adequate nutrition and hydration are key weapons in the fight against COVID-19. Optimizing intakes now may lead to improved positive outcomes in the future.
Reference: Mary Litchford, PhD, RDN, LDN and Elizabeth Wall, MS, RDN-AP, CNSC. The Role of RDNs to Help COVID Patients/Survivors Become Thrivers. 23 July 2020. Webinar.