Dear Sir,
Thank you very much for the opportunity to respond to the Letter by MD Cafer BALCI on our article concerning the relationships between mortality and nutritional status and BMI in older patients hospitalized for COVID-19 [1].
Firstly, in the data set used in this analysis, detailed information about nutritional intake and nutritional therapy for each patient during the hospitalization was not available. In general, nutrition of all COVID-19 patients was assured using parenteral nutrition when food intake was limited or oral nutrition was not possible. The caloric norms were assured as far as possible according to clinical assessment. For patients with special needs, e.g. kidney disease, the provided food and nutritional support were individualized accordingly.
Secondly, we agree that delirium is an important mortality risk factor [2]. In our data, information on delirium was not available systemically for all patients, and we consider this as a limitation of the study.
Thus, we agree that there may be some residual confounding factors that we were unable to address in this analysis due to data availability. Issues that were not considered in this analysis, like the ones proposed by Cafer BALCI, warrant further research in other data sets.
Ethical statement
The study was approved by the Swedish Ethical Review Authority in Stockholm Dnr 2020–02146, 2020–03345 and 2021–00595.
Author contribution
All authors participated in writing and reviewing of the response.
Sources of funding
This work was supported financially by the Swedish Research Council grants (2016-02317, 2018–02077, 2020-06101) and the regional agreement on medical training and clinical research between the Stockholm county council and the Karolinska Institutet (ALF), The Strategic Research Area in Epidemiology and Biostatistics grant, and the Academy of Finland through its funding to the Centre of Excellence in Research of Ageing and Care (CoEAgeCare, grant numbers 335870, 326567 and 336670).
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Conflict of interest
The authors declare no conflicts of interest.
References
- 1.Kananen L., Eriksdotter M., Boström A.M., Kivipelto M., Annetorp M., Metzner C., et al. Body mass index and Mini Nutritional Assessment-Short Form as predictors of in-geriatric hospital mortality in older adults with COVID-19. Clin Nutr. 2021 Jul 29 doi: 10.1016/j.clnu.2021.07.025. S0261-5614(21)00360-00365. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Marengoni A., Zucchelli A., Grande G., Fratiglioni L., Rizzuto D. The impact of delirium on outcomes for older adults hospitalised with COVID-19. Age Ageing. 2020;49(6):923–926. doi: 10.1093/ageing/afaa189. [DOI] [PMC free article] [PubMed] [Google Scholar]