Introduction
COVID-19, is an official name applied by the World Health Organization (WHO), referring to a recently emerged disease that has now become the pandemic of the twenty-first century.1 Recent anecdotal and scientific reports have provided an indication of a link between COVID-19 and chemosensory impairments such as anosmia.2 A treasure of swiftly evolving information further suggests that olfactory and gustatory stimuli can elicit potent emotional responses and are essential in food perception.3 Dietary guidelines regarding non critical COVID-19 in-patients are not currently available in India. The primary aim of the present study was to identify the dietary intake, food consumption patterns and nutritional status of non-critical COVID-19 patients during hospital quarantine. The secondary aim was to identify whether or not there is a statistically significant difference in the dietary intakes considering each independent factor by age, gender, occupation, dietary patterns and body mass index (BMI). It was postulated that the findings of the present study will be useful to develop most favourable dietary management strategies for non critical COVID-19 patients under hospital quarantine.4, 5, 6
Subjects and methods
A prospective observational study was conducted in non critical COVID -19 patients admitted in isolation wards of AIIMS, New Delhi from 1st November 2020 to mid of January 2021. The AIIMS food service department provided standard lacto-ovo vegetarian/lacto vegetarian/vegetarian diets, as per patients’ nutritional requirements, through computerized meal management system. Ethical clearance was taken before conducting the study. In-patients 18 years and above whom volunteered to participate were included in the study. Demographic variables and body mass index were also determined. A pre-validated questionnaire was telephonically administered by a dietician containing socio-demographic details and questions related to dietary choices and preferences.
The results were expressed as mean, standard deviation and median. Chi square tests were used to compare category variables. Statistical analysis were performed using SPSS 9 version 20.0.SPSS, Inc., Chicago IL).
Results
The survey was completed by 132 patients. The demographic, anthropometric and dietary characteristics distribution of the data obtained is given in Table 1. It was observed that maximum number of admitted patients were 26-35 years (42%). 61.36% were males and 38.64% were females. The mean body mass Index (BMI) was 23.75+ 4.15. Many of the patients were unmarried (39.39%). Most of the patients preferred lacto ovo vegetarian (88%) diet. It was observed that 116(87.88%), patients were on standard hospital diet. Out of 132 in-patients 125 were discharged the remaining required transfer in critical care wards.
The belief of patients regarding portion size and of food items and frequency of meals served in a day compared to their earlier eating trends are summarized in Table 2. Only 25 out of 132 patients felt that the portion size of food items to be increased. Only a few patients expressed that meal frequency needed to be increased (29.55%). Most of the in- patients (48.48%), conveyed that total number of food groups were increased from hospital diet. The data given in Table 3, further show that patients observed that the total number of food groups from the hospital diet served were higher.
The data presented in Table 4, further indicated that the number (%) of patients intake for protective food groups that is pulses/legumes75 (56.82%), milk and its products 71 (53.79%), fruits 78 (59.09%), vegetables 75 (56.82%) and herbs and spices (54.55%). However, the intake of cereals 73 (55.30%) and fats/oils was reduced 86 (65.15%). Preference for high protein, oral nutrition supplements (ONS) was also observed (78.79%). Shows that being overweight and obesity correlated with taste issues (Pearson’s x2< 0.05). However, trends of portion size of food items consumed, number of food groups in breakfast, lunch and dinner were not differentiated by BMI categories (Pearson’s x2>0.05).
Table 1
Demographic, anthropometric and dietary characteristics (n = 132)
Table 2
Food portion size, meal frequency and number of food groups
Table 3
Major meal consumption trends
Table 4
Change in portion size of food groups
Table 5
The frequency (%) of portion size, frequency of eating, no of food groups in the surveyed group (n=13) across the BMI groups
Discussion
In the case of COVID-19, health-care professionals and scientists around the world have noted a rise in reports of smell and taste impairments. A brief report of 88 patients hospitalized with SARS-CoV-2 infection in Italy found that 34% reported at least 1 olfactory or gustatory complaint. Ninety percent of these chemo sensory impairments occurred prior to hospitalization, and all participants reported that symptoms persisted to the time of the survey was conducted 10 to 21 days later (median of 15 days).7 Studies in the United Sates and across Europe have also highlighted smell and taste dysfunction in COVID-19 patients. Despite the critical importance of the chemical senses in daily life, they remain understudied in the context of health and disease.8, 9 Brugliera et al., (2020), in an Italian study reported that implementation of systematic management of the nutritional intake of COVID-19 patients is essential to guarantee an optimal nutritional status and to improve clinical outcomes.10 Cintoni et al., (2020), from Italy also reported of personalized meal provision combined with oral nutritional supplements, to all oral- feedable COVID -19 patients11 However, in the present study majority of patients reported an increase in dietary intake of number of protective food groups and reduction in portion size of cereals and fats/oils and preferred adding high protein nutrition supplements (ONS).
Ammar et al., (2020), in a study conducted in Germany reported that food consumption and meal patterns (the type of food, eating out of control, snacks between meals, number of meals) were more unhealthy during confinement.12 A study conducted in the United States reported that 28.3% reported eating healthier food since the beginning of pandemic, while 24.8% reported eating less healthy food.13 Self-reported dietary changes among Los Angeles County adults during the COVID-19 pandemic was also reported.14 In a six countries study, it was found that compared with participants who reported following low carbohydrates, high protein plant based diets or pescatarian diets were associated with lower odds of moderate to severe COVID-19.15 In the present study, it was observed that being overweight and obese correlated with taste issues. Review of literature further suggest that prevalence of co-morbidities in the COVID -19 patients and found that underlying diseases may be risk factors for patients.16, 17, 18
Conclusions
An overview of eating patterns of non-critical COVID-19 patients under hospital quarantine, provided an insight regarding their current dietary trends. However, keeping in view of the finding that being overweight and obese correlated with taste issues (Pearson’s x2< 0.05), strategic dietary approaches in a hospital setting are essential to potentially modify the negative effects of social isolation/quarantine particularly in these patients.
This is a small study with a limited number of patients. Further studies, preferably prospective randomized controlled trials are advocated with the co-operation of multi-disciplinary teams to further determine long term nutritional impact of COVID-19 during hospital quarantine.
