Recomendaciones de la Academia Nacional de Medicina sobre alimentación y nutrición frente a la infección por SARS-CoV-2 - covid-19
DOI:
https://doi.org/10.56050/01205498.1542Palabras clave:
covid-19, Nutritional Risk Screening 2002, soporte nutricional, proteína de suero, suplementos nutricionales orales, ácidos grasos Omega 3Resumen
La Organización Mundial de la Salud (OMS) declaró alerta sanitaria mundial por el aumento de casos y la aparición del COVID-19 en otros países, que llevó con el paso de los días, a declarar por parte de esta organización el estado de pandemia, el 11 de marzo de 2020. En Colombia, el primer caso se registró el día 6 de marzo de 2020. El estado nutricional por exceso o déficit y las enfermedades crónicas no transmisibles se consideran factores que incrementan el riesgo de complicaciones en pacientes con COVID-19. Si bien no hay alimentos o suplementos nutricionales que puedan prevenir la infección por COVID-19, mantener una dieta saludable y hacer ejercicio es una parte transcendental para apoyar un sistema inmunológico competente.
La recomendación existente sugiere que los pacientes infectados deben evaluarse nutricionalmente a su ingreso hospitalario, y aquellos que se encuentran en riesgo, deben recibir fortificación y/o suplementación oral desde un principio, idealmente con adición de vitaminas, en especial vitamina D y minerales. Se recomienda una fórmula que aporte alrededor de 30 g de proteína y 400 kcal por toma. Una herramienta fácil y práctica es el “Nutritional Risk Asssessment” (NRS-2002) debido a que considera el estado de gravedad de la enfermedad como también la edad.
En los pacientes con COVID-19 no críticos, la alimentación enteral es siempre la vía de elección, aunque es necesario evaluar si cubre más del 60% de los requerimientos proteico-calóricos, en caso negativo se debe considerar la nutrición parenteral total o suplementaria. Se recomienda la nutrición enteral por sonda nasogástrica y a un goteo continuo para evitar la distensión, favorecer la tolerancia y disminuir el riesgo de contaminación. En los pacientes en estado crítico es necesario evaluar el riesgo de síndrome de realimentación, común en pacientes con Índice de Masa Corporal (IMC) bajo, multimórbidos y ayunos prolongados. El soporte nutricional en cuidado crítico debe comenzar con el 70% de los requerimientos calóricos y se progresa paulatinamente. El aporte proteico debe estar entre 1,3 a 2,0 g de proteína, administrar viales de vitaminas y minerales diariamente. El empleo de emulsiones de lípidos a base de soya exclusivamente, no se recomienda, por sus efectos proinflamatorios.
Una vez dado de alta de la UCI se debe continuar con una monitoría nutricional, debido a que se puede presentar disfagia y un desgate proteico/calórico importante.
La oportuna intervención nutricional dentro del manejo integral de los pacientes con COVID-19, acelera la recuperación, disminuye las complicaciones, la mortalidad, la estancia hospitalaria y los costos de hospitalización.
Biografía del autor/a
Patricia Savino Lloreda, Centro Latinoamericano de Nutrición
ND, MBA. Miembro Asociado Academia Nacional de Medicina. Expresidente Fundador de la Asociación Colombiana de Nutrición Clínica. Director Centro Latinoamericano de Nutrición.
Martha Patricia Rodríguez, Academia Nacional de Medicina de Colombia
MD, FACP. Especialista en Medicina Interna y Nefrología, Fundación Universitaria Juán N. Corpas. Miembro Correspondiente Academia Nacional de Medicina. Presidente Asociación Colombiana Medicina Interna - Capítulo Central 2018 - 2020. Profesor Asistente Pontificia Universidad Javeriana - Hospital Universitario San Ignacio. Jefe Servicio de Nefrología Clínica Marly.
Oswaldo Borráez, Tribunal de Ética Médica de Bogotá
MD. Médico, especialista en cirugía general, Universidad Nacional de Colombia. Expresidente de la Asociación Colombiana de Cirugía. Maestro de la Cirugía Colombiana. Miembro Correspondiente de la Academia Nacional de Medicina. Presidente del Tribunal de Ética Médica de Bogotá.
Referencias bibliográficas
1. Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam. N Engl J Med. 2020;382(9):872–4.
2. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.
3. Bouadma L, Lescure F-X, Lucet J-C, Yazdanpanah Y, Timsit J-F. Severe SARS-CoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med. 2020;46(4):579–82.
4. Coronavirus Disease (COVID-19) - events as they happen [Internet].2019 (consultado el 28 de julio de 2020]. Disponible en:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
5. Maruyama T, Fujisawa T, Suga S, Nakamura H, Nagao M, Taniguchi K, et al. Outcomes and Prognostic Features of Patients With Influenza Requiring Hospitalization and Receiving Early Antiviral Therapy: A Prospective Multicenter Cohort Study. Chest. 2016;149(2):526–34.
6. Calder PC. Nutrition, immunity and COVID-19. BMJ Nutrition, Prevention & Health [Internet]. 2020 [consultado el 29 de julio de 2020];3(1). Disponible en:
https://nutrition.bmj.com/content/3/1/74
7. Correia M. Nutrition in times of Covid-19, how to trust the deluge of scientific information. Curr Opin Clin Nutr Metab Care. 2020;23(4):288–93.
8. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62.
9. Stefan N, Birkenfeld AL, Schulze MB, Ludwig DS. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. 2020;16(7):341–2.
10. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;
11. Costa D, Barbalho MC, Miguel GPS, Forti EMP, Azevedo JLMC. The impact of obesity on pulmonary function in adult women. Clinics (Sao Paulo). 2008;63(6):719–24.
12. Short KR, Kedzierska K, van de Sandt CE. Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Front Cell Infect Microbiol. 2018;8:343.
13. Ministerio de Salud y Protección Social. Encuesta Nacional de Situación Nutricional de Colombia. [Internet]. 2015 [consultado el 28 de julio de 2020]. Disponible en:
https://www.minsalud.gov.co/Paginas/Gobierno-presenta-Encuesta-Nacional-de-Situaci%C3
14. Obesity and overweight. [Internet].2020 [consultado el 20 de julio de 2020]. Disponible en: https://www.who.int/newsroom/factsheets/detail/obesity-and-overweight
15. Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020;16(6):297–8.
16. COVID-19 and Food Safety: Guidance for Food Businesses [Internet].2019 [consultado el 28 de julio de 2020]. Disponible en:
https://www.who.int/publicationsdetail-redirect/covid-19and-food-safety-guidance-forfood-businesses
17. Centers for Disease Control and Prevention CDC. Coronavirus Disease 2019 (COVID-19). [Internet]. 2020 (consultado el 28 de julio de 2020). Disponible en:
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/ foodand-COVID-19.html
18. Centers for Disease Control and Prevention CDC. Steps to Safe and Healthy Fruits & Vegetables. [Internet]. 2020 [consultado el 28 de julio de 2020]. Disponible en:
https://www.cdc.gov/foodsafety/communication/stepshealthyfruits-veggies.html
19. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv. 2020;
20. Cena H, Calder PC. Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease. Nutrients. 2020;12(2).
21. Zhang J, Taylor EW, Bennett K, Saad R, Rayman MP. Association between regional selenium status and reported outcome of COVID-19 cases in China. Am J Clin Nutr [Internet].2020 [consultado el 28 de abril de 2020];111(6):1297-1299. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197590/
22. Carmona-Fonseca J, Guzmán-Pérez V. Estudio piloto sobre selenio plasmático en personas sanas de Antioquia, Colombia. Perspectivas en nutrición humana. 2011;13(1):11–20.
23. U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. 8th ed. Parker Publishing Company; 2020. 144p p.
24. Vargas M. Alimentación saludable y balanceada – Guías alimentarias basadas en alimentos. En: Cubillos S, Vargas M, Guerrero L, Pinzón G, Pinzón O, Molina N, editores. Recomendaciones de alimentación y nutrición ante la declaración de emergencia sanitaria por COVID-19 en Colombia. Primera. Bogotá, Colombia: Universidad Nacional de Colombia; 2020. p. 23–31.
25. ICBF. Educación Alimentaria y Nutricional. [Internet].2020 [consultado el 28 de julio de 2020]. Disponible en: https://www.icbf.gov.co/bienestar/nutricion/educacion-alimentaria
26. Strengthening the health system response to COVID-19 – Recommendations for the WHO European Region: policy brief, 1 April 2020 [Internet].2020 [consultado el 28 de julio de 2020). Disponible en:
https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/strengthening-the-health-system-response-to-covid-19/
strengthening-the-health-system-response-to-covid19-recommendations-for-the-who-europeanregionpolicybrief,-1-april-2020
27. Krznarić Ž, Bender DV, Laviano A, Cuerda C, Landi F, Monteiro R, et al. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic. Clin Nutr. 2020;39(7):1983–7.
28. Varios. Atención y recomendaciones de alimentación y nutrición en COVID-19. Conexión nutrición [Internet]. 2020 [consultado el 28 de abril de 2020]. Disponible en:
https://conexionnutricion.com/producto/suplemento2/
29. How to stay physically active during COVID-19 selfquarantine [Internet]. 2020 [consultado el 28 de julio de 2020]. Disponible en:
https://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/news/news/2020/3/how-to-stay-physically-active-during-covid-19-self-quarantine
30. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405–7.
31. Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, et al. Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer. 2016;7(2):131–5.
32. Jin Y-H, Cai L, Cheng Z-S, Cheng H, Deng T, Fan Y-P, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4.
33. 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(6):1631–8.
34. “MUST” Toolkit [Internet].2020 [consultado el 29 de julio de 2020].Disponible en: https://www.bapen.org.uk/screening-and-must/must/must-toolkit
35. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.
36. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13.
37. Howard P. Practical nutritional support: working together to make it happen. Proc Nutr Soc. 2001;60(3):415–8.
38. McPherson RA, Hardy G. Clinical and nutritional benefits of cysteine-enriched protein supplements. Curr Opin Clin Nutr Metab Care. 2011;14(6):562–8.
39. Rondanelli M, Faliva MA, Gasparri C, Peroni G, Spadaccini D, Maugeri R, et al. Current opinion on dietary advice in order to preserve fat-free mass during a low-calorie diet. Nutrition. 2020;72:110667.
40. Cross ML, Gill HS. Immunomodulatory properties of milk. Br J Nutr. 2000;84 Suppl 1:S81-89.
41. Ng TB, Cheung RCF, Wong JH, Wang Y, Ip DTM, Wan DCC, et al. Antiviral activities of whey proteins. Appl Microbiol Biotechnol. 2015;99(17):6997–7008.
42. Teixeira FJ, Santos HO, Howell SL, Pimentel GD. Whey protein in cancer therapy: A narrative review. Pharmacol Res. 2019;144:245–56.
43. Cereda E, Turri A, Klersy C, Cappello S, Ferrari A, Filippi AR, et al. Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cancer Med. 2019;8(16):6923– 32.
44. Olsen MF, Abdissa A, Kæstel P, Tesfaye M, Yilma D, Girma T, et al. Effects of nutritional supplementation for HIV patients starting antiretroviral treatment: randomised controlled trial in Ethiopia. BMJ [Internet]. 2014 [consultado el 29 de julio de 2020];348. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022776/
45. Jiménez-Sousa MÁ, Martínez I, Medrano LM, Fernández-Rodríguez A, Resino S. Vitamin D in Human Immunodeficiency Virus Infection: Influence on Immunity and Disease. Front Immunol. 2018;9:458.
46. Havers F, Smeaton L, Gupte N, Detrick B, Bollinger RC, Hakim J, et al. 25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings. J Infect Dis. 2014;210(2):244–53.
47. Gruber-Bzura BM. Vitamin D and Influenza-Prevention or Therapy? Int J Mol Sci. 2018;19(8).
48. ASPEN. Informe de ASPEN sobre procesos de práctica de soporte nutricional con COVID-19. American Society for Parenteral and Enteral Nutrition. [Internet]. 2020 [consultado el 29 de julio de 2020];14. Disponible en:
https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines-and-Clinical-Resources/COVID19/ASPEN-Nutrition-Support-COVID-19-The-First-Response-Spanish.pdf
49. Singer P, Rattanachaiwong S. To eat or to breathe? The answer is both! Nutritional management during noninvasive ventilation. Crit Care. 2018;22(1):27.
50. Kogo M, Nagata K, Morimoto T, Ito J, Sato Y, Teraoka S, et al. Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure. Respir Care. 2017;62(4):459–67.
51. 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(5):766–73.
52. Sobotka L, Soeters P, Jolliet P, Pichard C, Singer P. Nutritional support in the critically ill and septic patients. En: Sobotka L, Allison S, Meier R, Schneider S, Soeters P, editores. Basics in clinical nutrition. 5th ed. Prague: House Galén; 2019. p. 402–9.
53. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28(4):387–400.
54. 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(2):159–211.
55. Savino P, Patiño JF. Metabolismo y nutrición del paciente en estado crítico. Rev Colomb Cir. 2016;31(2):108–27.
56. Calder PC, Grimble RF. Nutrients that influence inflammation and immunity: omega-3 fatty acids. En: Sobotka L, editor. Basics of Clinical Nutrition. 4th edición. [Internet]. Galen; 2011 [consultado el 16 de marzo de 2019]. p. 292–9. Disponible en:
https://eprints.soton.ac.uk/337381/
57. Calder PC, Jensen GL, Koletzko BV, Singer P, Wanten GJA. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med. 2010;36(5):735–49.
58. Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J. Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med. 2008;34(9):1580–92.
59. Mizock BA, DeMichele SJ. The acute respiratory distress syndrome: role of nutritional modulation of inflammation through dietary lipids. Nutr Clin Pract. 2004;19(6):563–74.
60. Wanten GJA, Calder PC. Immune modulation by parenteral lipid emulsions. Am J Clin Nutr. 2007;85(5):1171–84.
61. Calder PC. Lipids for intravenous nutrition in hospitalised adult patients: a multiple choice of options. Proc Nutr Soc. 2013;72(3):263–76.
62. Green P, Theilla M, Singer P. Lipid metabolism in critical illness. Curr Opin Clin Nutr Metab Care. 2016;19(2):111–5.
63. Adolph M, Carpenttier P, Sobotka L. Lipids. En: Sobotka L, Allison S, Meier R, Schneider S, Soeters P, editores. Basics in clinical nutrition. 5th ed. Prague: House Galén; 2019. p. 383–9.
64. ASPEN. Nutrition therapy in the patient with COVID-19 disease requiring ICU. ASPEN; 2020 p. 9.
65. Berger MM. Nutrition Status Affects COVID-19 Patient Outcomes. JPEN J Parenter Enteral Nutr. 2020;
66. Zhao X, Li Y, Ge Y, Shi Y, Lv P, Zhang J, et al. Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID-19 Patients. JPEN J Parenter Enteral Nutr. 2020;
67. Singer P, BlaserAR, Berger MM,Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.
68. Berger MM, Berger MM, editores. General ICU Patients. En: Critical Care Nutrition Therapy for Non-nutritionists [Internet]. Switzerland: Springer International Publishing; 2018 [citado el 28 de julio de 2020].p.1–13. Disponible en: https://www.springer.com/gp/book/9783319586519
69. Stanga Z, Sobotka L, Schueltz P. Refeeding syndrome. En: Sobotka L, Allison S, Forbes, A, Meier R, Schneider S, Soeters P, editores. Basics in clinical nutrition. 5th ed. Prague: House Galén; 2019. p. 383–9.
70. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495–8.
71. Singer P, Cohen J. How could we make nutrition in the intensive care unit simple? Rev Bras Ter Intensiva. 2016;28(4):369–72.
72. Arkin N, Krishnan K, Chang MG, Bittner EA. Nutrition in critically ill patients with COVID-19: Challenges and special considerations. Clin Nutr. 2020;39(7):2327–8.
73. Kaafarani HMA, Moheb ME, Hwabejire JO, Naar L, Christensen MA, Breen K, et al. Gastrointestinal Complications in Critically Ill Patients With COVID-19. Ann Surg. 2020;
74. Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA, et al. Enteral Nutrition in Patients Receiving Mechanical Ventilation in a Prone Position. JPEN J Parenter Enteral Nutr. 2016;40(2):250–5.
75. Adam MD, Dhaliwal R, Rupinder D, Day AG, Andrew GD, Ridley EJ, et al. Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis. Crit Care. 2013;17(3):R125.
76. Beck MA, Levander OA. Host nutritional status and its effect on a viral pathogen. J Infect Dis. 2000;182 Suppl 1:S93-96.
77. Calder PC. The 2008 ESPEN Sir David Cuthbertson Lecture: Fatty acids and inflammation--from the membrane to the nucleus and from the laboratory bench to the clinic. Clin Nutr. 2010;29(1):5–12.
78. Vanek VW, Seidner DL, Allen P, Bistrian B, Collier S, Gura K, et al. A.S.P.E.N. position paper: clinical role for alternative intravenous fat emulsions. Nutr Clin Pract. 2012;27(2):1–43.
79. Bousie E, van Blokland D, Lammers HJW, van Zanten ARH. Relevance of non-nutritional calories in mechanically ventilated critically ill patients. Eur J Clin Nutr. 2016;70(12):1443–50.
80. Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, et al. Monitoring nutrition in the ICU. Clin Nutr. 2019;38(2):584–93.
81. Berger MM, Achamrah N, Pichard C. Parenteral nutrition in intensive care patients: medicoeconomic aspects. Curr Opin Clin Nutr Metab Care. 2018;21(3):223–7.
82. Petros S, Horbach M, Seidel F, Weidhase L. Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial. JPEN J Parenter Enteral Nutr. 2016;40(2):242–9.
83. Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381(9864):385–93.
84. Oshima T, Heidegger C-P, Pichard C. Supplemental Parenteral Nutrition Is the Key to Prevent Energy Deficits in Critically Ill Patients. Nutr Clin Pract. 2016;31(4):432–7.
85. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Internet]. 2020 [consultado el 28 de julio de 2020]. Disponible en:
https://www.who.int/publications-detail-redirect/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)
86. Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007;297(16):1772–4.
87. Inoue S, Hatakeyama J, Kondo Y, Hifumi T, Sakuramoto H, Kawasaki T, et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;6(3):233–46.
88. Ferrando AA, Lane HW, Stuart CA, Davis-Street J, Wolfe RR. Prolonged bed rest decreases skeletal muscle and whole body protein synthesis. Am J Physiol. 1996;270(4 Pt 1):E627-633.
89. Frajkova Z,Tedla M,TedlovaE,Suchankova M,GeneidA. Postintubation Dysphagia During COVID-19 OutbreakContemporary Review. Dysphagia. 2020;35(4):549–57.
90. Burgos R, Segurola H, Bretón I. Soporte nutricional del paciente con ictus. Nutr Hosp. 2014;29(2):57–66.
91. International Dysphagia Diet Standardisation Initiative. What is the IDDSI Framework? – IDDSI [Internet]. 2019 [consultado el 26 de marzo de 2019]. Disponible en: https://iddsi.org/framework/
2. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.
3. Bouadma L, Lescure F-X, Lucet J-C, Yazdanpanah Y, Timsit J-F. Severe SARS-CoV-2 infections: practical considerations and management strategy for intensivists. Intensive Care Med. 2020;46(4):579–82.
4. Coronavirus Disease (COVID-19) - events as they happen [Internet].2019 (consultado el 28 de julio de 2020]. Disponible en:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
5. Maruyama T, Fujisawa T, Suga S, Nakamura H, Nagao M, Taniguchi K, et al. Outcomes and Prognostic Features of Patients With Influenza Requiring Hospitalization and Receiving Early Antiviral Therapy: A Prospective Multicenter Cohort Study. Chest. 2016;149(2):526–34.
6. Calder PC. Nutrition, immunity and COVID-19. BMJ Nutrition, Prevention & Health [Internet]. 2020 [consultado el 29 de julio de 2020];3(1). Disponible en:
https://nutrition.bmj.com/content/3/1/74
7. Correia M. Nutrition in times of Covid-19, how to trust the deluge of scientific information. Curr Opin Clin Nutr Metab Care. 2020;23(4):288–93.
8. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–62.
9. Stefan N, Birkenfeld AL, Schulze MB, Ludwig DS. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. 2020;16(7):341–2.
10. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;
11. Costa D, Barbalho MC, Miguel GPS, Forti EMP, Azevedo JLMC. The impact of obesity on pulmonary function in adult women. Clinics (Sao Paulo). 2008;63(6):719–24.
12. Short KR, Kedzierska K, van de Sandt CE. Back to the Future: Lessons Learned From the 1918 Influenza Pandemic. Front Cell Infect Microbiol. 2018;8:343.
13. Ministerio de Salud y Protección Social. Encuesta Nacional de Situación Nutricional de Colombia. [Internet]. 2015 [consultado el 28 de julio de 2020]. Disponible en:
https://www.minsalud.gov.co/Paginas/Gobierno-presenta-Encuesta-Nacional-de-Situaci%C3
14. Obesity and overweight. [Internet].2020 [consultado el 20 de julio de 2020]. Disponible en: https://www.who.int/newsroom/factsheets/detail/obesity-and-overweight
15. Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020;16(6):297–8.
16. COVID-19 and Food Safety: Guidance for Food Businesses [Internet].2019 [consultado el 28 de julio de 2020]. Disponible en:
https://www.who.int/publicationsdetail-redirect/covid-19and-food-safety-guidance-forfood-businesses
17. Centers for Disease Control and Prevention CDC. Coronavirus Disease 2019 (COVID-19). [Internet]. 2020 (consultado el 28 de julio de 2020). Disponible en:
https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/ foodand-COVID-19.html
18. Centers for Disease Control and Prevention CDC. Steps to Safe and Healthy Fruits & Vegetables. [Internet]. 2020 [consultado el 28 de julio de 2020]. Disponible en:
https://www.cdc.gov/foodsafety/communication/stepshealthyfruits-veggies.html
19. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv. 2020;
20. Cena H, Calder PC. Defining a Healthy Diet: Evidence for The Role of Contemporary Dietary Patterns in Health and Disease. Nutrients. 2020;12(2).
21. Zhang J, Taylor EW, Bennett K, Saad R, Rayman MP. Association between regional selenium status and reported outcome of COVID-19 cases in China. Am J Clin Nutr [Internet].2020 [consultado el 28 de abril de 2020];111(6):1297-1299. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197590/
22. Carmona-Fonseca J, Guzmán-Pérez V. Estudio piloto sobre selenio plasmático en personas sanas de Antioquia, Colombia. Perspectivas en nutrición humana. 2011;13(1):11–20.
23. U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. 8th ed. Parker Publishing Company; 2020. 144p p.
24. Vargas M. Alimentación saludable y balanceada – Guías alimentarias basadas en alimentos. En: Cubillos S, Vargas M, Guerrero L, Pinzón G, Pinzón O, Molina N, editores. Recomendaciones de alimentación y nutrición ante la declaración de emergencia sanitaria por COVID-19 en Colombia. Primera. Bogotá, Colombia: Universidad Nacional de Colombia; 2020. p. 23–31.
25. ICBF. Educación Alimentaria y Nutricional. [Internet].2020 [consultado el 28 de julio de 2020]. Disponible en: https://www.icbf.gov.co/bienestar/nutricion/educacion-alimentaria
26. Strengthening the health system response to COVID-19 – Recommendations for the WHO European Region: policy brief, 1 April 2020 [Internet].2020 [consultado el 28 de julio de 2020). Disponible en:
https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/technical-guidance/strengthening-the-health-system-response-to-covid-19/
strengthening-the-health-system-response-to-covid19-recommendations-for-the-who-europeanregionpolicybrief,-1-april-2020
27. Krznarić Ž, Bender DV, Laviano A, Cuerda C, Landi F, Monteiro R, et al. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic. Clin Nutr. 2020;39(7):1983–7.
28. Varios. Atención y recomendaciones de alimentación y nutrición en COVID-19. Conexión nutrición [Internet]. 2020 [consultado el 28 de abril de 2020]. Disponible en:
https://conexionnutricion.com/producto/suplemento2/
29. How to stay physically active during COVID-19 selfquarantine [Internet]. 2020 [consultado el 28 de julio de 2020]. Disponible en:
https://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/news/news/2020/3/how-to-stay-physically-active-during-covid-19-self-quarantine
30. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39(5):405–7.
31. Caccialanza R, Pedrazzoli P, Cereda E, Gavazzi C, Pinto C, Paccagnella A, et al. Nutritional Support in Cancer Patients: A Position Paper from the Italian Society of Medical Oncology (AIOM) and the Italian Society of Artificial Nutrition and Metabolism (SINPE). J Cancer. 2016;7(2):131–5.
32. Jin Y-H, Cai L, Cheng Z-S, Cheng H, Deng T, Fan Y-P, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4.
33. 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(6):1631–8.
34. “MUST” Toolkit [Internet].2020 [consultado el 29 de julio de 2020].Disponible en: https://www.bapen.org.uk/screening-and-must/must/must-toolkit
35. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22(4):415–21.
36. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13.
37. Howard P. Practical nutritional support: working together to make it happen. Proc Nutr Soc. 2001;60(3):415–8.
38. McPherson RA, Hardy G. Clinical and nutritional benefits of cysteine-enriched protein supplements. Curr Opin Clin Nutr Metab Care. 2011;14(6):562–8.
39. Rondanelli M, Faliva MA, Gasparri C, Peroni G, Spadaccini D, Maugeri R, et al. Current opinion on dietary advice in order to preserve fat-free mass during a low-calorie diet. Nutrition. 2020;72:110667.
40. Cross ML, Gill HS. Immunomodulatory properties of milk. Br J Nutr. 2000;84 Suppl 1:S81-89.
41. Ng TB, Cheung RCF, Wong JH, Wang Y, Ip DTM, Wan DCC, et al. Antiviral activities of whey proteins. Appl Microbiol Biotechnol. 2015;99(17):6997–7008.
42. Teixeira FJ, Santos HO, Howell SL, Pimentel GD. Whey protein in cancer therapy: A narrative review. Pharmacol Res. 2019;144:245–56.
43. Cereda E, Turri A, Klersy C, Cappello S, Ferrari A, Filippi AR, et al. Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cancer Med. 2019;8(16):6923– 32.
44. Olsen MF, Abdissa A, Kæstel P, Tesfaye M, Yilma D, Girma T, et al. Effects of nutritional supplementation for HIV patients starting antiretroviral treatment: randomised controlled trial in Ethiopia. BMJ [Internet]. 2014 [consultado el 29 de julio de 2020];348. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4022776/
45. Jiménez-Sousa MÁ, Martínez I, Medrano LM, Fernández-Rodríguez A, Resino S. Vitamin D in Human Immunodeficiency Virus Infection: Influence on Immunity and Disease. Front Immunol. 2018;9:458.
46. Havers F, Smeaton L, Gupte N, Detrick B, Bollinger RC, Hakim J, et al. 25-Hydroxyvitamin D insufficiency and deficiency is associated with HIV disease progression and virological failure post-antiretroviral therapy initiation in diverse multinational settings. J Infect Dis. 2014;210(2):244–53.
47. Gruber-Bzura BM. Vitamin D and Influenza-Prevention or Therapy? Int J Mol Sci. 2018;19(8).
48. ASPEN. Informe de ASPEN sobre procesos de práctica de soporte nutricional con COVID-19. American Society for Parenteral and Enteral Nutrition. [Internet]. 2020 [consultado el 29 de julio de 2020];14. Disponible en:
https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines-and-Clinical-Resources/COVID19/ASPEN-Nutrition-Support-COVID-19-The-First-Response-Spanish.pdf
49. Singer P, Rattanachaiwong S. To eat or to breathe? The answer is both! Nutritional management during noninvasive ventilation. Crit Care. 2018;22(1):27.
50. Kogo M, Nagata K, Morimoto T, Ito J, Sato Y, Teraoka S, et al. Enteral Nutrition Is a Risk Factor for Airway Complications in Subjects Undergoing Noninvasive Ventilation for Acute Respiratory Failure. Respir Care. 2017;62(4):459–67.
51. 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(5):766–73.
52. Sobotka L, Soeters P, Jolliet P, Pichard C, Singer P. Nutritional support in the critically ill and septic patients. En: Sobotka L, Allison S, Meier R, Schneider S, Soeters P, editores. Basics in clinical nutrition. 5th ed. Prague: House Galén; 2019. p. 402–9.
53. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28(4):387–400.
54. 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(2):159–211.
55. Savino P, Patiño JF. Metabolismo y nutrición del paciente en estado crítico. Rev Colomb Cir. 2016;31(2):108–27.
56. Calder PC, Grimble RF. Nutrients that influence inflammation and immunity: omega-3 fatty acids. En: Sobotka L, editor. Basics of Clinical Nutrition. 4th edición. [Internet]. Galen; 2011 [consultado el 16 de marzo de 2019]. p. 292–9. Disponible en:
https://eprints.soton.ac.uk/337381/
57. Calder PC, Jensen GL, Koletzko BV, Singer P, Wanten GJA. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med. 2010;36(5):735–49.
58. Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J. Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Intensive Care Med. 2008;34(9):1580–92.
59. Mizock BA, DeMichele SJ. The acute respiratory distress syndrome: role of nutritional modulation of inflammation through dietary lipids. Nutr Clin Pract. 2004;19(6):563–74.
60. Wanten GJA, Calder PC. Immune modulation by parenteral lipid emulsions. Am J Clin Nutr. 2007;85(5):1171–84.
61. Calder PC. Lipids for intravenous nutrition in hospitalised adult patients: a multiple choice of options. Proc Nutr Soc. 2013;72(3):263–76.
62. Green P, Theilla M, Singer P. Lipid metabolism in critical illness. Curr Opin Clin Nutr Metab Care. 2016;19(2):111–5.
63. Adolph M, Carpenttier P, Sobotka L. Lipids. En: Sobotka L, Allison S, Meier R, Schneider S, Soeters P, editores. Basics in clinical nutrition. 5th ed. Prague: House Galén; 2019. p. 383–9.
64. ASPEN. Nutrition therapy in the patient with COVID-19 disease requiring ICU. ASPEN; 2020 p. 9.
65. Berger MM. Nutrition Status Affects COVID-19 Patient Outcomes. JPEN J Parenter Enteral Nutr. 2020;
66. Zhao X, Li Y, Ge Y, Shi Y, Lv P, Zhang J, et al. Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID-19 Patients. JPEN J Parenter Enteral Nutr. 2020;
67. Singer P, BlaserAR, Berger MM,Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.
68. Berger MM, Berger MM, editores. General ICU Patients. En: Critical Care Nutrition Therapy for Non-nutritionists [Internet]. Switzerland: Springer International Publishing; 2018 [citado el 28 de julio de 2020].p.1–13. Disponible en: https://www.springer.com/gp/book/9783319586519
69. Stanga Z, Sobotka L, Schueltz P. Refeeding syndrome. En: Sobotka L, Allison S, Forbes, A, Meier R, Schneider S, Soeters P, editores. Basics in clinical nutrition. 5th ed. Prague: House Galén; 2019. p. 383–9.
70. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495–8.
71. Singer P, Cohen J. How could we make nutrition in the intensive care unit simple? Rev Bras Ter Intensiva. 2016;28(4):369–72.
72. Arkin N, Krishnan K, Chang MG, Bittner EA. Nutrition in critically ill patients with COVID-19: Challenges and special considerations. Clin Nutr. 2020;39(7):2327–8.
73. Kaafarani HMA, Moheb ME, Hwabejire JO, Naar L, Christensen MA, Breen K, et al. Gastrointestinal Complications in Critically Ill Patients With COVID-19. Ann Surg. 2020;
74. Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA, et al. Enteral Nutrition in Patients Receiving Mechanical Ventilation in a Prone Position. JPEN J Parenter Enteral Nutr. 2016;40(2):250–5.
75. Adam MD, Dhaliwal R, Rupinder D, Day AG, Andrew GD, Ridley EJ, et al. Comparisons between intragastric and small intestinal delivery of enteral nutrition in the critically ill: a systematic review and meta-analysis. Crit Care. 2013;17(3):R125.
76. Beck MA, Levander OA. Host nutritional status and its effect on a viral pathogen. J Infect Dis. 2000;182 Suppl 1:S93-96.
77. Calder PC. The 2008 ESPEN Sir David Cuthbertson Lecture: Fatty acids and inflammation--from the membrane to the nucleus and from the laboratory bench to the clinic. Clin Nutr. 2010;29(1):5–12.
78. Vanek VW, Seidner DL, Allen P, Bistrian B, Collier S, Gura K, et al. A.S.P.E.N. position paper: clinical role for alternative intravenous fat emulsions. Nutr Clin Pract. 2012;27(2):1–43.
79. Bousie E, van Blokland D, Lammers HJW, van Zanten ARH. Relevance of non-nutritional calories in mechanically ventilated critically ill patients. Eur J Clin Nutr. 2016;70(12):1443–50.
80. Berger MM, Reintam-Blaser A, Calder PC, Casaer M, Hiesmayr MJ, Mayer K, et al. Monitoring nutrition in the ICU. Clin Nutr. 2019;38(2):584–93.
81. Berger MM, Achamrah N, Pichard C. Parenteral nutrition in intensive care patients: medicoeconomic aspects. Curr Opin Clin Nutr Metab Care. 2018;21(3):223–7.
82. Petros S, Horbach M, Seidel F, Weidhase L. Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial. JPEN J Parenter Enteral Nutr. 2016;40(2):242–9.
83. Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381(9864):385–93.
84. Oshima T, Heidegger C-P, Pichard C. Supplemental Parenteral Nutrition Is the Key to Prevent Energy Deficits in Critically Ill Patients. Nutr Clin Pract. 2016;31(4):432–7.
85. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Internet]. 2020 [consultado el 28 de julio de 2020]. Disponible en:
https://www.who.int/publications-detail-redirect/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)
86. Kortebein P, Ferrando A, Lombeida J, Wolfe R, Evans WJ. Effect of 10 days of bed rest on skeletal muscle in healthy older adults. JAMA. 2007;297(16):1772–4.
87. Inoue S, Hatakeyama J, Kondo Y, Hifumi T, Sakuramoto H, Kawasaki T, et al. Post-intensive care syndrome: its pathophysiology, prevention, and future directions. Acute Med Surg. 2019;6(3):233–46.
88. Ferrando AA, Lane HW, Stuart CA, Davis-Street J, Wolfe RR. Prolonged bed rest decreases skeletal muscle and whole body protein synthesis. Am J Physiol. 1996;270(4 Pt 1):E627-633.
89. Frajkova Z,Tedla M,TedlovaE,Suchankova M,GeneidA. Postintubation Dysphagia During COVID-19 OutbreakContemporary Review. Dysphagia. 2020;35(4):549–57.
90. Burgos R, Segurola H, Bretón I. Soporte nutricional del paciente con ictus. Nutr Hosp. 2014;29(2):57–66.
91. International Dysphagia Diet Standardisation Initiative. What is the IDDSI Framework? – IDDSI [Internet]. 2019 [consultado el 26 de marzo de 2019]. Disponible en: https://iddsi.org/framework/
Cómo citar
[1]
Savino Lloreda, P. et al. 2020. Recomendaciones de la Academia Nacional de Medicina sobre alimentación y nutrición frente a la infección por SARS-CoV-2 - covid-19. Medicina. 42, 3 (oct. 2020), 456–485. DOI:https://doi.org/10.56050/01205498.1542.
Descargas
Los datos de descargas todavía no están disponibles.
Publicado
2020-10-03
Número
Sección
La Academia
Licencia
Derechos de autor 2020 Medicina
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Copyright
ANM de Colombia
Los autores deben declarar revisión, validación y aprobación para publicación del manuscrito, además de la cesión de los derechos patrimoniales de publicación, mediante un documento que debe ser enviado antes de la aparición del escrito. Puede solicitar el formato a través del correo revistamedicina@anmdecolombia.org.co o descargarlo directamente Documento Garantías y cesión de derechos.docx
Copyright
ANM de Colombia
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent.
