Table 2.
Energy and nutrient recommendations for patients with coronavirus disease 2019 with or without liver injury
| Energy/Nutrient | Criteria | Recommendation |
| Estimation of REE | All individuals with COVID-19 | Estimation by indirect calorimetry |
| Prediction equations | ||
| Calories | Normal oral diets | 1500-2000 kcals/d |
| Increase 400-500 kcals in stress or infection crisis | ||
| Polymorbid, old patients > 65 yr | 27 kcals/kg Bw/day | |
| Low weight, older patients | 30 kcals/kg Bw/day | |
| Malnourish chronic patients and muscle depletion | 30-35 kcals/kg Bw/day | |
| -Patients with COVID-19 outside ICU | ONS with low oral intolerance: | |
| 150-400 kcals/service | ||
| 70-100 g protein/service | ||
| Carbohydrates, fiber, PUFAs, vitamins, minerals, probiotics | ||
| Consuming for a month | ||
| Protein | Normal individuals (prevent loss and muscle mass) | 1 g/kg Bw/day |
| 70-100 g/d | ||
| Form animal (milk, yogurt, meat, fish, chicken, cheese) and vegetable sources (beans, soy, nuts, peas) | ||
| Patients with liver cirrhosis sarcopenic | 1.2-1.5 g/kg Bw/day | |
| Obese sarcopenic | Oral supplementation of BCAA 0.20-0.25 g/kg Bw/day or 30 g/d | |
| Glutamine and arginine supplementation | ||
| Carbohydrates/fat | Patients with COVID-19 without respiratory impairment | Ratio 70:30 carbohydrates/fat |
| Medium and low glycemic | ||
| Fiber 25-30 g/d | ||
| PUFAs: DHA, EPA, ALA | ||
| Patients with ventilator support | Ratio 50:50 carbohydrates/fat | |
| Vitamins | All individuals with COVID-19 | A, C, D, E, folate, B6 and B12 (monitoring in patients with liver abnormalities) |
| Minerals | All individuals with COVID-19 | Zinc, copper, selenium (monitoring in patients with liver abnormalities) |
| Critically ill patients | EN after 24-36 h. after ICU admission | |
| Initiate with trophic low-dose (10-20 mL/h.) | ||
| Polymeric formula: 15-20 kcals/kg Bw and 1.2-2.0 g/kg Bw/day of protein vitamins, minerals, fiber, probiotics | ||
| Provide 70%-80% needs in over 1 wk | ||
| Sever obese patients BMI > 50 | Energy 22-25 kcals/kg IBW | |
| Protein 2 g/kg per day (Class I, II) or 2.5 g/kg IBW/day of (Class III) | ||
| Vitamins, minerals, fiber, probiotics | ||
| Gastric intolerance individuals | Use prokinetics | |
| Post-pyloric feeding in persistence intolerance or at high risk of aspiration | ||
| Patients with no GI feasible | PN recommended | |
| Poor nutrition status | Limit the use of omega-6 soy-based ILE during first week | |
| Prolonged stay at ICU | Mixture of lipids such as olive oil based ILE or SMOF (soy, medium chain triglycerides, olive oil, fish oil) |
ALA: Alpha linoleic acid; BCAA: Branch chain amino acids; DHA: Docosahexaenoic acid; EN: Enteral nutrition; EPA: Eicosanoid acid; GI: Gastrointestinal; IBW: Ideal body weight; ICU: Intensive care unit; ILE: Intravenous lipid emulsion. ONS: Oral nutritional supplements; PN: Parenteral nutrition; PUFAs: Polyunsaturated fatty acids; REE: Resting energy expenditure.