“The role of nutrition in the COVID-19 era”: Scientific conclusions based on a webinar organized by the Hellenic Dietitian Association
In this report we present the main scientific conclusions of the webinar “The role of nutrition in the era of COVID-19: Prevention, treatment and the factor of obesity”. The webinar was organized by the Hellenic Dietetic Association (HDA), in collaboration with the Groups of Specialists in Clinical Nutrition, Weight Management and Public Health. It was moderated by Dr. Dorina Sialvera, president of the HDA and Dr. Christina Katsagoni, President of the Specialist Group of Clinical Nutrition.
“Scientific evidence on the role of nutrition in the prevention of COVID-19: the role of vitamins and other micronutrients”:
Dr Anastasia Z. Kalea,Programme Director, MSc Obesity and Clinical Nutrition & MSc Clinical and Public Health Nutrition, Associate Professor, UCL Division of Medicine, Hon. Associate Professor, UCL Institute of Cardiovascular Science
Inadequate nutritional intake of various vitamins and minerals is linked to a fragile immune system and often to poorer immunological response against pathogens.
A vast variety of micronutrients is involved in the immune response pathoways. Vitamins C, D and zinc are the three micronutrients most extensively studied for their potential role in strengthening the immune system
Vitamin D is at the center of scientific interest. Vitamin D deficiency seems to be positively associated with COVID-19 severity and hospitalization. Vitamin D deficiency is common even in Greece, especially during the winter.
“Dietary habits during the lockdown and the role of healthy nutrition in the COVID-19 era” –Dr. Antonis Vlassopoulos, Research Fellow Agricultural University of Athens & International Hellenic University, Honorary Research Fellow University of Glasgow.
The presentation included the first preliminary results of two studies in Greece[i] around the eating habits of children and adults during the first lockdown. Many of those continue recruitment during the second lockdown.
The results about the changes in eating habits and physical activity during the first COVID-19 wave were:
Despite low adherence in the Mediterranean Diet on average, participants reported improved eating habits during lockdown. Reduced intake of fast foods was the major finding, although larger improvements were seen in participants with healthier diets before lockdown. Participants also reported higher intake of homemade sweets and baked goods as well as spending more time cooking.
In the COVIDiet study, 45% of the participants reported reduced levels of physical activity with higher reduction among those with BMI>30 kg/m2. Reduced physical activity and an increase in sedentary behaviours were also seen for children in the COV-EAT study.
Weight gain was reported by 21% of the adults and 32% of the children and adolescents in the two studies. Weight gain was more common among individuals with BMI>25 kg/m2 before the lockdown.
“Obesity: a major risk factor for COVID-19 but also a result of restrictive measures. The paradoxical relationship with mortality “-Dr. Anastasia Kolombotsou, Dietitian-Nutritionist, Doctor of the Agricultural University of Athens, Hygienist M (Med) Sc
The presentation included basic characteristics of the virus SARS-CoV-2 and explored the role of obesity in COVID-19 and vice versa.
According to different reviews and meta-analysis, obesity seems to be an important factor for the development of the disease, the hospitalization in the intensive care unit as well as in mortality.
COVID-19 plays a role in the increase in prevalence of obesity and vice versa. This seems to happen on the basis of food insecurity that results from the difficult social and economical situation that follows the political measures for dealing with the pandemic and also, due to the increase in psychological distress. All these reasons seem to influence food intake, nutritional habits and the nutritional behavior taking also in consideration the change in the levels of physical activity due to the periods of lockdown.
Furthermore, obesity seems to influence also the effectiveness of the COVID-19 drug therapy in situations, where comorbidities exist, like in the case of hypertension, or in vaccination, due to decreased development of immunological response.
However, it is still inconclusive, whether it is possible for “obesity paradox” to play a positive role in the mortality of COVID-19. “Obesity paradox” refers to a protective role of obesity in some infections, like pneumonia where, an obese person seems to have a better clinical outcome in comparison with a patient of normal body weight, probably due to the delayed cachexia, due to the increased body fat.
“Exploring potential mechanisms linking obesity to COVID-19” – Dr. Maria Baskini, Clinical Dietitian-Nutritionist, MSc, RD, PhD
The presentation explored the complex biological mechanisms involved in the obesity/COVID-19 relationship.
The increased adipose tissue increases the morbidity and mortality risk through biochemical, cellular, molecular and immunological dysfunctions. Moreover, obesity is related to various comorbidities, which are independently related toCOVID-19 severity. For example, insulin resistance seems to aggravate COVID-19 symptoms. Additionally, obesity is related to gut microbialdysbiosis and this may beanother potent mechanism that may contribute to an unfavorable outcome.
Weight loss in obese may lead to an increase in total lung capacity, reverse obese-related dysfunctions, decrease procoagulant factors and reduce insulin resistance.
The closing session of the webinar included the clinical experience of colleagues regarding the nutritional management of patients with COVID-19, who need hospitalization. In these two presentations, distinguished clinical dietitians shared their knowledge of clinical practice within COVID-19 clinics, as well as recent recommendations for the nutritional treatment of patients:
“Nutritional management of patients with confirmed SARS-CoV-2 infection. Recommendations and experience in the hospital. “Dr. Paraskevi Detopoulou, Clinical Dietitian-Nutritionist, Head of Clinical Nutrition Department, General Hospital Korgialenio Benakeio.
In the speech of Dr. Detopoulou, emphasis was placed on the assessment of nutritional status and the regular re-evaluation of patients with COVID-19 in order to prevent malnutrition and ensure nutritional coverage of patients. The importance of high-energy and protein-rich foods and beverages, oral nutritional supplements as well as the importance of early initiation of enteral and/ or parenteral nutrition (if required) were also discussed.
“A Case study: COVID-19 patient in the ICU”-Dr. Dimitris Karagiannis, Clinical Dietitian-Nutritionist, Head of Nutrition Department, GNA Evangelismos
Adequate energy intake while avoiding overeating and adequate protein intake were analyzed in depth in this talk, as critical factors in preventing severe loss of muscle mass and functional strength in patients with COVID-19.
[i] : COVIDiet study (Department of Food Science & Human Nutrition, Agricultural University of Athens): Multicenter study in 16 European countries, including Greece. In Greece, the study was conducted in April and May 2020 on 1488 participants.
COV-EAT study (Department of Nutrition Dietetics, University of Thessaly): Nationwide study in children and adolescents during the first wave of pandemic and inclusion, in 397 families.