Klinische Ernährung bei Covid-19 Patienten – Eine systematische Literaturübersicht

Zusammenfassung

EinleitungAktuell fehlt die Evidenz zur klinischen Ernährung bei Covid-19. Ziel der Arbeit: Systematischer Überblick über die klinische Ernährung bei Covid-19.

Material und MethodeEine systematische Literatursuche: 2 Meta-Analysen, 12 systematische Reviews und Meta-Analysen, 9 prospektive randomisierte kontrollierte Studien, 3 prospektive Observationsstudien, 7 retrospektive Studien, 25 narrative Reviews.

Ergebnisse a) Adipöse Patienten haben ein erhöhtes Risiko auf einen schweren Krankheitsverlauf, b) es gibt einen Zusammenhang zwischen Adipositas und erhöhtem Sterberisiko, c) die Covid-19 Mortalität steigt ab einem BMI>27 kg/m², in allen BMI- Klassen um 1,6% pro 1 kg/m² bei Gewichtszunahme, bei starker Adipositas (> 40–45 BMI) um das 1,5 bis 2-fache und pro 5 kg/m², d) das Risiko für einen schweren Covid-19 Verlauf steigt ebenso bei erhöhtem viszeralen Fettgewebeanteil, Gesamtkörperfettmasse und Oberbauchumfang, e) die Sterblichkeitsrate kann bei mangelernährten Covid-19 Patienten 10-mal höher sein, f) das Serumalbumin liefert Hinweise auf einen schlechten Krankheitsverlauf, g) eine enterale Omega-3-Fettsäuren-Zufuhr könnte die Nierenfunktion stabilisieren und das Outcome verbessern, h) Lebensmittel mit niedrigen glykämischen Index sollten bevorzugt werden, i) ein Vitamin D Mangel ist zu vermeiden, eine tägliche Vitamin D und Zink Supplementierung kann von Vorteil sein, j) einmalig hochdosiertes Vitamin D und enterales Vitamin C bewirkt keinen Nutzen, jedoch könnte das Thromboserisiko reduziert und mit Zink die Antikörperreaktion verstärkt werden, k) eine ernährungsmedizinische Intervention reduziert die Sterblichkeit.

Schlussfolgerung Screening und Erfassung des Ernährungszustands sind bei Covid-19 Patienten von Bedeutung. Insgesamt liegen unzureichend klinische Ergebnisse zur spezifischen Ernährungstherapie vor.

Abstract

Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19.

Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews.

Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m², in all BMI classes 1,6% per 1 kg/m² in the event of weight gain, in the case of severe obesity (> 40–45 BMI) by a factor of 1,5 to 2 and per 5 kg/m², d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality.

Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.

Schlüsselwörter

Covid-19 - Ernährungszustand - Klinische Ernährung - Körperzusammensetzung - Ernährungstherapie

Key words

Covid-19 - nutritional status - clinical nutrition - body composition - nutritional therapy

Publikationsverlauf

Eingereicht: 19. Juli 2022

Angenommen: 19. Januar 2023

Artikel online veröffentlicht:
08. Mai 2023

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