How to Meet New Standards in Elder and Patient Care

• It is especially important to support immunity in senior adults and patients, who are more vulnerable to infection and disease due to weakened immune function. Optimal nutrition is well-known to beneficially influence immune health. So how can the nutritional care of older adults and patients be elevated to support them in staying healthier for longer? 
• In the third and final instalment of dsm-firmenich’s ‘Supporting Immunity in Elder Care’ webinar series, we were joined by Prof. Hon. Mette Berger, Prof. Sumantra Ray and Shane McAuliffe to better understand what steps are being taken to raise the standards of nutritional management and care in clinical settings, particularly in light of the COVID-19 pandemic. 
• In this blog, we share a roundup of the key takeaways for medical directors, portfolio managers, R&D and innovation managers, including unique insights from the upcoming ESPEN micronutrient guidelines, to help inspire the development of medical nutrition solutions that will support the health and quality of life of elderly people and patients. 
  

We already know that optimal nutritional status helps to fuel an appropriate immune response as it plays a vital role in the development and maintenance of physical barriers, production of antimicrobial proteins, proper functioning of immune cells and mediation of inflammatory processes.^1,2,3 We also know that a bidirectional relationship exists between nutrition and infection, whereby poor nutritional status predisposes someone to infection, and infection is also exacerbated by poor nutritional status. This ultimately results in a cycle of deficiency, disease and poor outcomes, and highlights the significant burden malnutrition can place on the care of patients suffering from diseases or infections like COVID-19. 

To better understand the role of nutrients in COVID-19 specifically, a range of micronutrients and trace elements – such as vitamins C, D, zinc and selenium – have been explored and observational evidence indicates that they may have an important role to play in the infection.^4,5 These insights are now being translated into new nutritional interventions as part of patient care, and are even being considered as part of preventative strategies.⁶   

Below, we outline the key insights from our latest webinar, ‘Raising standards in elder and patient care’, including the significant role vitamin D may play in the nutritional care of COVID-19 patients. 

Interested in catching up on-demand? Click here to watch webinar. 

ESPEN micronutrient guidelines: where do we stand?  

Currently, no comprehensive micronutrient guidelines – that provide nutritional recommendations in the context of specific disease states – exist. This gap in nutritional guidance has not gone unnoticed during the COVID-19 pandemic. For instance, it led to accelerating the identification and development of new micronutrient-based, patient-oriented ESPEN guidelines that will provide practical advice to clinicians and dieticians to help them recognize the nutritional needs of patients and provide better nutritional care.   

During the webinar, Prof. Hon. Mette Berger, Consultant Intensivist at CHUV, Lausanne University Hospital, shared unique insights into the methodology and practicality for the development of the guidelines – which will become available this year – and how exactly they will help medical professionals. She explained that the final document will offer biomarkers for inflammation – which can affect nutritional status – and advice on which micronutrient deficiencies are commonly observed in specific diseases, including cancer cachexia, diabetes and liver disease. It will then provide guidance on the optimal nutritional care based on the nutritional deficiencies present in these patients. 

Best practice for knowledge sharing 

Prof. Sumantra Ray, Founding Chair and Executive Director, NNEdPro Global Centre for Nutrition & Health, also highlighted the importance of knowledge sharing in light of the current health crisis, the challenges faced during the pandemic, and key considerations learned. He advised that the best way to enable rapid, safe and effective decision making concerning the care of patients during a health crisis – like COVID-19 – is through evidence-informed practice (rather than evidence-based practice, which a pandemic does not allow). Evidence-informed practice includes making use of the best available, current, valid and relevant scientific evidence. It involves bringing together expertise from research, clinical practice and public health sectors to collate existing knowledge that will help to develop a range of communication materials and guidelines for the public and medical community. Prof. Sumantra Ray explained how evidence-informed practice was utilized during the COVID-19 pandemic specifically.   

A vitamin D case-study   

merging scientific evidence highlights the potential benefits of good vitamin D status in COVID-19 patients, indicating that it may help individuals defend themselves against the infection and also lower the severity of infection.^{7,8,9,10,11,12} As well as being more at risk of infection generally due to immunosenescence – the deterioration of immune function that can happen with aging – senior adults are also more likely to be vitamin D deficient.13 This is due to reduced dietary intakes, impaired nutrient absorption, decreased exposure to sunlight and lower ability to synthesize vitamin D if exposed to UV light. The risk of deficiency has also been amplified during the pandemic due to shielding, because of less time outdoors and poorer access to foods. Vitamin D deficiency has also been hypothesized as one of the factors responsible for the disproportionate prevalence of COVID-19 infection in specific ethnic groups, particularly in people with darker skin who live in higher altitudes. So, how can the nutrition and medical communities utilize the benefits of vitamin D to support these populations better?   

Prof. Hon. Mette Berger outlined ESPEN’s strategy for vitamin D therapy in acute illness, depending on the level of deficiency and any presenting medical conditions. She summarized the following steps:

1. Vitamin D supplementation is advised, using at least the recommended dietary allowance for healthy subjects  
2. High dose supraphysiological intervention that aims to improve or correct vitamin D blood levels rapidly   
3. Higher therapeutic doses of vitamin D may be delivered orally, enterally, intravenously or via the intramuscular route  
   

It is important to remember that while emerging scientific findings suggest that vitamin D supplementation – in adjunct to other treatment – may help to reduce the severity of a COVID-19 infection, there is no evidence to suggest that adequate vitamin D serum levels prevent or treat COVID-19. 

The key to better nutritional care is more clinical trials   

While the current science is promising, further research and carefully designed studies are vital to identify the cause and effect of micronutrients, including vitamin D. This starts by analyzing existing data from both population and patient sources, and conducting micronutrient screening both in public health and clinical settings. The development and findings of new studies will help to further optimize the nutritional management, care and quality of life of patients and the elderly.