Summary

Keywords

۱٫ Introduction

۱٫۱٫ COVID-19 and malnutrition

۱٫۲٫ Obesity and COVID-19: an additional risk factor with nutritional implications

۲٫ Nutritional management of persons with obesity in the COVID-19 pandemic

۳٫ Conclusions

Conflict of interest

Acknowledgements

References

Summary

The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-rvelated lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

۱٫ Introduction

۱٫۱٫ COVID-19 and malnutrition

COVID-19 is a primarily respiratory disease caused by SARS-CoV-2 infection that can spread from upper to lower airways, leading to respiratory insufficiency requiring respiratory support and intensive care, where it may be fatal [[1], [2], [3], [4], [5]]. Patient groups with pre-existing comorbidities ranging from diabetes and cardiovascular disease to cancer and chronic organ failures, as well as older age, are burdened with higher risk for complications and COVID-19 mortality [[1], [2], [3], [4], [5]]. Importantly, both older age and pre-existing chronic diseases in polymorbid individuals are per se associated with high risk and prevalence of undernutrition (which will be hereafter referred to as MALNUTRITION, to align with the utilization of this term in clinical practice as supported by clinical nutrition Societies) [6,7], due to catabolic derangements, low food intake and low physical activity whose various combinations result in loss of body and skeletal muscle mass and muscle function [[6], [7], [8]]. In COVID-19, infection with related inflammation and potential organ failure with systemic complications and immobilization may further contribute to enhance muscle loss and malnutrition risk. Also notably, malnutrition is an independent major cause of morbidity and mortality in most disease conditions, through mechanisms including high risk of infections or superinfection [9], caused by its deleterious impact on immune function [10] as well as respiratory and cardiac muscle function [11,12].