Gut, metabolism and nutritional Support for COVID-19: Experiences from China

Hua Jiang; Jian-Cheng Zhang; Jun Zeng; Lu Wang; Yu Wang; Charles Damien Lu; Lei Deng; Hongfei Deng; Kai Wang; Ming-Wei Sun; Ping Zhou; Ting Yuan; Wei Chen

doi:10.1093/burnst/tkaa048

您当前的位置：

首页 >

文章列表页 >

Gut, metabolism and nutritional Support for COVID-19: Experiences from China

更新时间：2022-06-09

- Gut, metabolism and nutritional Support for COVID-19: Experiences from China
- Gut, metabolism and nutritional Support for COVID-19: Experiences from China
- Burns & Trauma 2020年8卷第1期
- 作者机构：
  
  1. Institute for Emergency Medicine and Disaster Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China
  2. Emergency Intensive Care Unit
  3. University of Electronic Science and Technology of China
  4. Department of Acute Care Surgery
  5. Medical Task Force of Sichuan Provincial People’s Hospital to Union Red Cross Hospital of Wuhan
  6. Department of Clinical Nutrition, Peking Union Medical College Hospital
- 作者简介：
- 基金信息：
  
  This work was supported by the Joint Program for Fighting COVID-19, from the Sichuan Department of Science and Technology (grant number: 2020YFS0006, to HJ), and funding to the Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, also from the Sichuan Department of Science and Technology (grant number: 2019YFS0534, to JZ). This work was also supported by the Health Commission of Sichuan Province (grant number: 20ZDCX002).
- DOI：10.1093/burnst/tkaa048
  中图分类号：
- 纸质出版日期：2020，
  
  网络出版日期：2020-12-21，
扫描看全文
Hua Jiang, Jian-Cheng Zhang, Jun Zeng, 等. Gut, metabolism and nutritional Support for COVID-19: Experiences from China[J]. Burns & Trauma, 2020,8(1).

Hua Jiang, Jian-Cheng Zhang, Jun Zeng, Lu Wang, Yu Wang, Charles Damien Lu, Lei Deng, Hongfei Deng, Kai Wang, Ming-Wei Sun, Ping Zhou, Ting Yuan, Wei Chen, Gut, metabolism and nutritional Support for COVID-19: Experiences from China, Burns & Trauma, Volume 8, 2020, tkaa048, https://doi.org/10.1093/burnst/tkaa048
Hua Jiang, Jian-Cheng Zhang, Jun Zeng, 等. Gut, metabolism and nutritional Support for COVID-19: Experiences from China[J]. Burns & Trauma, 2020,8(1). DOI： 10.1093/burnst/tkaa048.

Hua Jiang, Jian-Cheng Zhang, Jun Zeng, Lu Wang, Yu Wang, Charles Damien Lu, Lei Deng, Hongfei Deng, Kai Wang, Ming-Wei Sun, Ping Zhou, Ting Yuan, Wei Chen, Gut, metabolism and nutritional Support for COVID-19: Experiences from China, Burns & Trauma, Volume 8, 2020, tkaa048, https://doi.org/10.1093/burnst/tkaa048 DOI：

摘要

Abstract

There is little research that focuses on the relationship between the gut

metabolism

nutritional support and COVID-19. As a group of Chinese physicians

nutritionists and scientists working on the frontline treating COVID-19 patients

we aim to integrate our experiences and the current clinical evidence to address this pressing issue in this article. Based on our clinical observations and available evidence

we recommend the following practice. Firstly

the Nutritional Risk Screening 2002 tool should be used routinely and periodically; for patients with a score ≥3

oral nutritional supplements should be given immediately. Secondly

for patients receiving the antiviral agents lopinavir/ritonavir

gastrointestinal side effects should be monitored for and timely intervention provided. Thirdly

for feeding

the enteral route should be the first choice. In patients undergoing mechanical ventilation

establishing a jejunal route as early as possible can guarantee the feeding target being achieved if gastric dilatation occurs. Fourthly

we suggest a permissive underfeeding strategy for severe/critical patients admitted to the intensive care unit during the first week of admission

with the energy target no more than 20 kcal/kg/day (for those on mechanical ventilation

this target may be lowered to 10–15 kcal/kg/day) and the protein target around 1.0–1.2 g/kg/day. If the inflammatory condition is significantly alleviated

the energy target may be gradually increased to 25–30 kcal/kg/day and the protein target to 1.2–1.5 g/kg/day. Fifthly

supplemental parenteral nutrition should be used with caution. Lastly

omega-3 fatty acids may be used as immunoregulators

intravenous administration of omega-3 fatty emulsion (10 g/day) at an early stage may help to reduce the inflammatory reaction.

关键词

Keywords

COVID-19Intensive careNutritional riskNutritional supportEnergyProteinOmega-3 fatty acidsChinaGutMetabolism

references

1.World Health Organization. Coronavirus disease (COVID-19) outbreak situation. 2020; Available at: https://covid19.who.int. Accessed 20 November 2020.

2.Pan L, Mu M, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, Multicenter study. Am J Gastroenterol. 2020;115:766–73.

3.Zou X, Chen K, Zou J, Han P, Hao J, Han Z. The single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to Wuhan 2019-nCoV infection. Front Med. 2020;14:185–92.

4.National Health Commission of the People’s Republic of China. Diagnosis and treatment scheme of COVID-19 (7th tentative standard); 2020; Available at: http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf. Accessed 20 November 2020.

5.Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr. 2020;39:1631–8.

6.Martindale R, Patel JJ, Taylor B, Arabi YM, Warren M, McClave SA, et al. Nutrition therapy in the patient with COVID-19 disease requiring ICU care. 2020; Available at: https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/Nutrition%20Therapy%20COVID-19_SCCM-ASPEN.pdf. Accessed 20 November 2020.

7.Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020. https://doi.org/10.1016/j.ebiom.2020.102763.

8.Hu B, Huang S, Yin L. The cytokine storm and COVID-19. J Med Virol. 2020. doi:10.1002/jmv.26232.

9.Liu X, Wang R, Qu G, Wang Y, Liu P, Zhu Y, et al. Report on anatomy observation from patient who died on COVID-19. Fa Yi Xue Za Zhi (in Chinese) 2020;36:21–3. doi: 10.12116/j.issn.1004-5619.2020.01.00.

10.Ding YQ, Bian XW. Analysis of coronavirus disease-19 (COVID-19) based on SARS autopsy. Zhonghua Bing Li Xue Za Zhi. 2020;49:291–3.

11.Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146:110–8.

12.Cui XY, He GZ, Dong LG, Chen X-F. Effect of mesenteric lymphatic duct ligation on acute lung injury after intestinal ischemia-reperfusion in rat. Chinese Journal of Clinical Nutrition. 2007;15:364–7.

13.He GZ, Cui XY, Dong LG, Shu H, Chen XF. Impact of ligation of the mesenteric lymphatic duct on gut barrier function after intestinal ischemia/reperfusion in rat. Chinese Journal of Clinical Nutrition. 2007;15:155–9.

14.He GZ, Dong LG, Cui XY, Chen X-F, Shu H. Effect of mesenteric lymphatic duct ligation on the system inflammation during the intestinal ischemia-reperfusion. Chin J Gastrointes Surg. 2008;11:469–71.

15.Zhu Q, He G, Wang J, Wang Y, Chen W. Protective effects of fenofibrate against acute lung injury induced by intestinal ischemia/reperfusion in mice. Sci Rep. 2016. https://doi.org/10.1038/srep22044.

16.Yao XH, Li HZ, He ZC, Ping YF, Liu HW, Yu SC, et al. A pathological report of three COVID-19 cases by minimally invasive autopsies. Zhonghua Bing Li Xue Za Zhi. 2020;49:411–7.

17.Yang XH, Sun RH, Chen DC. Diagnosis and treatment of COVID-19: acute kidney injury cannot be ignored. National Medical Journal of China. 2020;100:1205–8.

18.Fang D, Ma JD, Guan JL, Wang M, Song Y, Tian D, et al. Manifestations of digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Chin J Dig 2020;40:151–6.

19.Zhang W, Du RH, Li B, Zheng X-S, Yang X-L, Hu B, et al. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020;9:386–9.

20.Pan L, Mu Mi, Yang P, Sun Y, Wang R, Yan J, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. Am J Gastroenterol. 2020;115:766–73.

21.Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut. 2020. https://doi.org/10.1136/gutjnl-2020-320891.

22.Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, et al. Angiotensin-converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). J Pathol. 2020;251:228–48.

23.Smyk W, Janik MK, Portincasa P, Milkiewicz P, Lammert F, Krawczyk M. COVID-19: focus on the lungs but do not forget the gastrointestinal tract. Eur J Clin Invest. 2020. https://doi.org/10.1111/eci.13276.

24.Bradley BT, Maioli H, Johnston R, Chaudhry I, Fink SL, Xu H, et al. Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington state: a case series. Lancet. 2020;396:320–32.

25.Mitsuyama K, Tsuruta K, Takedatsu H, Yoshioka S, Morita M, Niwa M, et al. Clinical features and pathogenic mechanisms of gastrointestinal injury in COVID-19. J Clin Med. 2020. https://doi.org/10.3390/jcm9113630

26.Jiang H, Deng HF, Wang Y, Liu Z, Sun M, Zhou P, et al. The possibility of using Lopinave/Litonawe (LPV/r) as treatment for novel coronavirus 2019-nCov pneumonia: a quick systematic review based on earlier coronavirus clinical studies. Chin J Emerg Med. 2020;29:182–6.

27.Yan D, Liu X-Y, Zhu Y-N, Huang L, Dan B-T, Zhang G-J, et al. Factors associated with prolonged viral shedding and impact of lopinavir/ritonavir treatment in hospitalised non-critically ill patients with SARS-CoV-2 infection. Eur Respir J. 2020. https://doi.org/10.1183/13993003.00799-2020.

28.Walmsley S, Bernstein B, Arribas J, King M, Beall G, Ruane P, et al. Lopinavir-ritonavir versus nelfinavir for the initial treatment of HIV infection. N Engl J Med. 2002;346:2039–46.

29.Li ZJ, Chen W. Essentials of nutritional support therapy in critically ill patients. Chinese Journal of Practical Surgery. 2018;38:289–92.

30.Chen W. Nutritional dietary guidelines for the prevention and treatment of coronavirus disease (COVID-19) clinical application interpretation. Beijing Medical Journal. 2020;42:298–9.

31.Jones JM. The methodology of nutritional screening and assessment tools. J Hum Nutr Diet. 2002;15:59–75.

32.McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40:159–211.

33.Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48–79.

34.Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37:601–9.

35.Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care. 2016. https://doi.org/10.1186/s13054-016-1538-4.

36.Jiang H, Sun M-W, Hefright B, Chen W, Lu CD, Zeng J. Efficacy of hypocaloric parenteral nutrition for surgical patients: a systematic review and meta-analysis. Clin Nutr. 2011;30:730–7.

37.McKeever L, Peterson SJ, Cienfuegos S, Rizzie J, Lateef O, Freels SA, et al. Real-time energy exposure is associated with increased oxidative stress among feeding-tolerant critically ill patients: results from the FEDOX trial. JPEN J Parenter Enteral Nutr. 2020;44:1484–91.

38.Chinese Society of Critical Care Medicine, Chinese Association of Critical Care Physicians. Consensus of experts on management of severe coronavirus disease (COVID-19). 2020.03.18; Available at: http://www.cmda.net/xhdt/13626.jhtml.

39.Patel JJ, Martindale RG, McClave SA. Controversies surrounding critical care nutrition: an appraisal of permissive underfeeding, protein, and outcomes. JPEN J Parenter Enteral Nutr. 2017;42:508–15.

40.Leyderman I, Yaroshetskiy A, Klek S. Protein requirements in critical illness: do we really know why to give so much?. JPEN J Parenter Enteral Nutr. 2020;44:589–98.

41.Preiser JC. High protein intake during the early phase of critical illness: yes or no?. Crit Care. 2018. https://doi.org/10.1186/s13054-018-2196-5.

42.Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365:506–17.

43.Wischmeyer P, Hasselmann M, Kummerlen C, Kozar R, Kutsogiannis DJ, Karvellas CJ, et al. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Crit Care. 2017. https://doi.org/10.1186/s13054-017-1736-8.

44.van Niekerk G, Meaker C, Engelbrecht A. Nutritional support in sepsis: when less may be more. Crit Care. 2020. https://doi.org/10.1186/s13054-020-2771-4.

45.Wei C, Hua J, Bin C, Klassen K. Impact of lipid emulsion containing fish oil on outcomes of surgical patients: systematic review of randomized controlled trials from Europe and Asia. Nutrition. 2010;26:474–81.

46.Rice TW, Wheeler AP, Thompson BT, deBoisblanc BP, Steingrub J, Rock P, et al. Enteral Omega-3 fatty acid, gamma-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306:1574–81.

47.Chen W, Jiang H, Zhou Z, Tao Y-X, Cai B, Liu J, et al. Is Omega-3 fatty acids enriched nutrition support safe for critical ill patients? A systematic review and meta-analysis. Nutrients. 2014;6:2148–64.

48.Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8:420–2.

49.Jiang ZM, Jiang H, Fürst P. The impact of glutamine dipeptides on outcome of surgical patients: systematic review of randomized controlled trials from Europe and Asia. Clinical Nutrition Supplements. 2004;1:17–23.

50.Heyland DK, Elke G, Cook D, Berger MM, Wischmeyer PE, Albert M, et al. Glutamine and antioxidants in the critically ill patient: a post hoc analysis of a large-scale randomized trial. JPEN J Parenter Enteral Nutr. 2015;39:401–9.

查看原文

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

The impact of COVID-19 on clinical outcomes of burn patients

Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis