We know that patients with metabolic problems such as obesity or diabetes are at increased risk of more severe COVID-19 symptoms and hospital admission. Helping patients to better manage such metabolic conditions through a holistic approach is therefore important.
Common metabolic problems are:
- Obesity
- Diabetes
- High blood pressure
- Heart disease
- Sedentarism (due to lockdowns, shielding or other reasons)
What do these symptoms have to do with diet?
- What you eat can affect a condition the patient may already have, such as diabetes, high blood pressure or obesity
- These metabolic diseases relate to nutrition since what we eat may worsen or improve each of them. The patient may need additional dietary changes on top of those that COVID-19 symptoms may produce
- It is important for patients to follow the dietary advice for pre-existing conditions provided by their healthcare professional before making any changes. If you are concerned or need further advice or support, talk to the patient's GP, consultant or nurse specialist. You may also need to talk to a dietitian and/or refer the patient for dietetic assessment and advice
Resources to support pre-existing conditions
Weight loss and healthy eating
Malnutrition
The Malnutrition Universal Screening Tool ('MUST') has generic care plans for low, medium and high risk of malnutrition generated through the online screening tool. The Malnutrition Pathway also has advice for healthcare professionals on care plans for people at risk of malnutrition, as well as information on malnutrition in the community [PDF]. They also provide information on managing malnutrition in specific conditions:
Type 5 diabetes
Type 5 diabetes or 'malnutrition-related diabetes' became a recognised condition in April 2025. It is primarily caused by chronic undernutrition, particularly during childhood and is most prevalent in Asia and Africa. The International Diabetes Federation estimates that 20-25 million people are affected worldwide. Find out more from the International Diabetes Federation.
Histamine intolerance
Whilst there is not enough evidence to recommend a low histamine diet, some people with Long Covid are interested in low histamine diets. These are restrictive diets and so advice from a registered nutrition expert is recommended to make sure you have the right nutrition.
A freelance dietitian provides an article on histamine intolerance and post-COVID [PDF], which may be helpful.
CAUTION: Seek advice and support from your healthcare professional or GP survey if you are worried about your nutrition or plan to make significant dietary changes.
Useful links for further guidance
- Practising yoga has been found to decrease various proinflammatory markers, especially when practised in long time spans, therefore improving cardio-metabolic health (Khoramipour et al., 2021)
- A medium-quality paper reviewed a myriad of types of exercise under different clinical conditions and discussed guidelines to be used by patients with long COVID (Khoramipour et al., 2021)
- This document (Killerby et al., 2020) presents an example of a triage program to manage incoming patients however, it touches more on the risk of people with underlying conditions being hospitalised
- Physical activity or exercise should be personalised and overseen by a physiotherapist or occupational therapist with specialist training and expertise. A clinical review should be undertaken after each session, especially when exercise is used as a rehabilitation tool (NIHR, 2021)
- Monitoring patients during their COVID-19 recovery
- Assessing nutritional needs and setting realistic goals
Physical activity for older adults
Increases in physical activity can become integrated into daily life. This may mean a ‘triage’ type system locally that knows all the available services in the area (online, face to face, evidence-based falls prevention and more health promotion strength and balance sessions).
Those at highest risk of falls should be seen by a multi-disciplinary team and offered evidence-based falls prevention programmes - for example, FaME (Falls Management Exercise) and Otago - delivered by appropriately qualified individuals: physiotherapists, trained rehabilitation assistants, postural stability instructors and Otago exercise programme leaders.
Others, who have not transitioned into frailty but need to work on their strength and balance so they are confident in increasing their general physical activity, can be directed to community-based face-to-face and online options delivered by personal trainers and other qualified exercise instructors.
For individuals with long-term conditions, increasing physical activity from levels seen during the pandemic should be considered as part of a general approach to supporting individuals to manage their own conditions.
Finally, it is important to note some of the differences in activity levels between different groups of older adults, with the largest reductions in physical activity seen in males aged 65 to 74, and females aged 65 to 84 – suggesting that efforts aimed at encouraging resumption of past physical activity should be particularly focussed upon these groups.
Some apps and websites have been scientifically analysed and peer reviewed by McGarrigle et al (2020), thus recommended for more active older adults
Many organisations recommend ‘Make Movement Your Mission’, which runs 15-minute movement ‘snacks’ 3 times a day, 7 days a week on Facebook and YouTube. It is important to consider the functional levels of the individual and signpost to the most appropriate local or online programmes available.
