To say the least, the COVID-19 has brought about disruption and impacted the lives of every person in the world. Be it through contact with the illness itself or dealing with the impact that lockdown restrictions have placed on lifestyle, social interactions, employment and income, COVID-19 has jeopardized the overall health and wellbeing of even the healthiest individuals

The World Health Organization has emphasized the importance of an appropriate diet and lifestyle measures, so as to support a healthy immune system. Now, more than ever before, it is vital that patients achieve an optimal nutritional and health status to protect against the COVID-19 virus.

Nutrition is involved in our everyday life and plays a role in protecting against the virus as it has an impact on the immune system. Adequate protein and energy intake is vital in a fully functional and strong immune system. The same is true for the adequate intake of micronutrients (vitamins, minerals and trace elements) with a few being especially important. Dieticians are trained to assess patients to determine whether their dietary intake of these nutrients is sufficient as well as how to implement appropriate interventions to rectify any short-falls.

Dieticians play multi-faceted role in the healthcare of patients during this pandemic.

Their role in patient care can be categorized as follows:

• CARING FOR THE A POSITIVE COVID-19 PATIENT:
  • With any infection, the body has increased nutritional requirements (especially when fever is present). This is even more so when the respiratory system, especially the lungs are impacted as it leads to a much higher energy expenditure. Dieticians help in providing strategies to help patients to meet these requirements.
  • In a hospital setting, dieticians play a role in calculating and prescribing enteral or parenteral feeds to patients that are sedated and/or ventilated. Due to the fact that they are incapable of oral intake, these patients are at a massive risk of malnutrition which can lead to a weaker immune system and increased risk of mortality. On the flip side, overfeeding can also lead to complications. Dieticians have been trained in assessing and monitoring the patient to find the right balance and prevent either from happening.
  • Whether it is due to the disease itself, or the medications that the patient is using, symptoms (like fatigue, weakness, anorexia, nausea, vomiting, diarrhea etc.) can make it difficult for the patient to meet their nutritional requirements. Dieticians play a role in providing education on fortifying foods and making it more nutrient dense or providing advice regarding the use of oral supplements; thus enabling them to achieve a sufficient nutrient intake. This is essential in helping the body fight infection as well as to repair and heal properly.

• CARE FOR CLINICAL PATIENTS:
  • Dieticians play a critical role in helping patients with the management of chronic conditions (Diabetes Mellitus, Hypertension, Cholesterol, Obesity, Kidney Disease etc.) which, if uncontrolled, increases the risk and severity of COVID-19. With ongoing fear about contracting COVID-19, patients may not routinely consult with health care professionals. This coupled with restricted social interaction and/or isolation can lead to a lack of accountability and therefore diminished compliance with the treatment plan. Through online sessions, dieticians can safely provide the support and nutritional advice that these patients need to help manage their chronic disease.
  • With many people being forced to work from home or self-isolate (as well as dealing with the increased stress thereof), there has been an increase in poor eating patterns with many patients. Dieticians may help to provide healthier alternatives as well as behavioural strategies to help patients to overcome these obstacles and conserve their health.
  • Optimal nutrition is essential for a healthy gut. A healthy gut is associated with improved immunity, decreased inflammation, better mental health as well as better control of chronic illnesses. Dieticians help in providing education on eating behaviours that are conducive to achieving and maintaining a healthy gut.
  • People that struggle with mental wellness are at a high risk of poor eating patterns and therefore diminished immunity. Dieticians can help create eating plans or strategies that fit into these patients’ lifestyles and preferences that provide adequate nutrition that supports a healthy mind.
  • Nutrition is one of the factors that plays a key role in the onset of inflammation. Inflammation is often present in, and can exacerbate chronic illnesses, making the management thereof complex. It can also disrupt immunity. Dieticians can also assist with medical nutrition therapy in the management of inflammation.
  • One industry that probably benefited most from this pandemic is that of the nutritional supplement industry. People are now more than ever concerned with meeting their micronutrient requirements to ensure a healthy immune system. Dieticians can help by providing recommendations as to which supplements are beneficial and which are ineffective in boosting the immune system. They can also help identify potential areas where supplements can interfere with the action of chronic or other medications.

• • Populations like growing children, pregnant women, the elderly, professional sport athletes, patients with chronic inflammatory diseases and so forth are vulnerable in terms of developing nutrient deficiencies as they often have increased nutrient requirements and/ or symptoms or other factors that make it difficult to meet these demands. Again, dieticians are trained to provide them with the advice and education that they need to meet these demands.
  • Besides providing nutritional information, dieticians are also advocating for enforcing a healthy lifestyle (participating in regular physical activity, managing stress, getting enough sleep, quitting smoking etc.) In this regard they provide information within their scope of practice or refer to relevant health care practitioners should they see that the patient is not coping.
  • Within the COVID-19 setting, they also encourage and hold patients accountable for doing their part in helping to stop the spread of the virus.

Within all the settings, dieticians conduct a thorough assessment of the patient so to provide nutritional education, medical nutritional therapy and/or eating plans that are appropriate to the patient in terms of their age, current medical conditions, current medication use, lifestyle, current eating patterns, food preferences and beliefs, body measurements, goals and expectations. This is all to make the advice or meal plans as accessible and easy to implement as possible.

Eating is something we do daily and many times without thinking about it. Reaching out to a practitioner specializing in nutrition to learn how to implement the correct food and nutrition in your lifestyle may have a positive impact on your life and/or health.

Author: Cecile Niebuhr, RD(SA)