The COVOED study

From April to December 2020, we tracked the nutritional status, risk of sarcopenia and nutritional complaints of all patients with COVID-19 in four Dutch hospitals: Amsterdam UMC, Zuyderland MC and Franciscus & Vlietland hospital. This was measured during hospitalization and after discharge by 18 dieticians in the hospitals and by 64 dieticians outside the hospital. In other words, real teamwork!

The results were published in Clinical Nutrition ESPEN. On this page you can read the more about the results and recommendations. The results are also shown in the infographic and presentation below.

Nutritional care in COVID-19 is important in all sectors of care 1
Nutritional care in COVID-19 is important in all sectors of care 2

Prevention, timely recognition and treatment of malnutrition should be standard care for patients with COVID-19 European Society for Clinical Nutrition and Metabolism (ESPEN)

How big is the problem?

40-50% of patients with COVID-19 in the hospital are malnourished. 2-5
Intensive care patients lose a lot of muscle mass. This can be as high as 1 kg of muscle mass loss per day. 6,7


Individuals at high risk for a severe course of COVID-19 are also at high risk for malnutrition and sarcopenia1

  • Older persons8
  • Intensive care patients3
  • Chronically ill patients1

Malnutrition and sarcopenia have implications for disease progression and recovery4,8,11-13

  • Decreased functionality due to loss of muscle mass and strength.
  • Increased risk of complications.
  • A longer recovery period.
  • Greater risk of death.
  • Obese individuals7,9
Nutritional care in COVID-19 is important in all sectors of care 3

Why do patients with COVID-19 have a high risk of malnutrition and sarcopenia?

  • Almost all patients have nutritional complaints that make eating difficult.3
  • Increased energy consumption due to high disease activity.6,10
  • High muscle mass breakdown and low muscle mass gain due to bed rest, insulin resistance, and high disease activity.6,10

Results from the COVOED study3

Nutritional care in COVID-19 is important in all sectors of care 4
  • Despite 67% being overweight, 35% of patients were malnourished at admission to the hospital.

  • Almost all patients had one or more nutritional complaints. Of these complaints, decreased appetite, feeling of being full, altered taste, and loss of taste were the most common nutritional complaints (see figure).

Nutritional care in COVID-19 is important in all sectors of care 5
dietetic treatment
risk of sarcopenia
Nutritional care in COVID-19 is important in all sectors of care 6

In hospitals

  • There should be early screening for malnutrition; involve the dietitian early in treatment.
  • Patients in the hospital with an inadequate nutritional intake should switch to enteral or possibly parenteral nutrition in a timely manner. The loss of muscle mass is too rapid and severe to wait long to do so.
  • Patients in intensive care have high nutritional requirements. Choosing the amount and type of tube feeding should be tailored per patient.
  • After ventilation, many patients develop swallowing problems. Screening and early treatment of swallowing problems can prevent further deterioration of nutritional status.
  • Almost all patients who have been in the intensive care unit require dietetic care after discharge from the hospital. Transfer nutritional treatment to a dietitian in primary care or the rehabilitation center.

In the home situation

  • For the COVID-19 patient with (risk of) malnutrition, nutritional treatment must be continued by the dietitian after discharge from the hospital. Physical therapy, exercise therapy, occupational therapy and speech therapy should also be considered.
  • In case of swallowing problems, texture adjustments to the diet, after consulting a speech therapist, should be considered.
  • Patients and caregivers should be informed about the importance of following nutritional treatment, self-screening of nutritional risks, and indications of when to contact caregivers.
  • Patients who have been in intensive care for a long time are at very high risk for post ICU syndrome (PICS). Include this in treatment and evaluation.