Assessing nutritional needs

What is a nutrition assessment?

Nutrition assessment examines an individual’s risk of nutrition problems in more detail than screening.

Given the diverse symptoms of COVID-19, a comprehensive holistic assessment of how symptoms affect individuals is advised. This includes how the symptoms affect the individual (NICE, 2020), the effect on underlying conditions, nutritional assessment and screening for malnutrition risk.  

Anyone identified as at risk of nutritional problems in screening should be assessed in more detail. The type of assessment will depend on the nature of the nutritional problem and underlying causes. 

A nursing assessment will commonly include assessment of factors which can influence nutritional risk, including:

• Appetite
• Food preferences
• Hydration
• Dentition
• Bowel movements
• Pain
• Independence around activities of daily living
• Risk of falls (frailty)
• Skin integrity
• Social and family support

Nutrition can be affected by wider factors which may not be part of screening but may need to be considered during assessment. These include:

• Sociodemographics: includes ethnicity, age, gender, employment status, income, living arrangements, education level
• Food Insecurity: Disruptions in food intake due to lack of money or resources (Gundersen and Ziliak, 2015)
• Hospitalisation: Increases the risk of malnutrition due to acute illness and often reduced ability due to symptoms to have adequate nutrition (Mechanick et al., 2020)

A detailed nutrition assessment is normally only required for those at high risk of malnutrition or with complex conditions or needs. This should be undertaken by a nutrition expert such as a registered dietitian or a health care professional who is trained to undertake this.

It is important to consider nutritional deficiencies, malnutrition, obesity and other diet-related comorbidities influenced by nutrition e.g. diabetes, cardiovascular disease.

Research and evidence for nutrition assessment and screening 

Research on nutrition assessment and screening for malnutrition risk in COVID-19 patients remains limited. Information is generally used from other relevant patient groups.

According to the National Taskforce for COVID-19, poor nutritional status and weight loss are common symptoms after acute COVID-19, making assessment necessary (National COVID-19 Clinical Evidence Taskforce, 2021).

The Malnutrition Pathway for COVID-19 provides information on screening people recovering from COVID-19 and next steps.

Current evidence-based practice supports routine nutritional screening and subsequent assessment as needed, with local guidance for this practice. This should include people who had COVID-19.

Key findings from studies

A French study found that providing enriched meals to patients with weight loss. They found that provision of nutrition support is crucial for preventing hospital readmission, refeeding syndrome and improving recovery (Bedock et al., 2021).

An Italian study reported that 26-45% of COVID-19 patients experienced malnutrition, highlighting the need to assess swallowing ability, nutritional status, and functional independence (Nalbandian et al., 2021).

A UK research team recommended a series of assessments for diagnosing long COVID in primary care (Greenhalgh et al., 2020):

• Clinical assessment: Physical exams and evaluations of health conditions, social, and financial situations.
• Clinical testing: Tests for inflammation and other health markers such as electrolytes, C reactive protein, troponin 
• Referral is recommended for patients experiencing worsening breathlessness, unexpected chest pain, new confusion, focal weakness or PaO2<96%.

Resources

Watch this Diet and COVID-19 video by Registered Dietitian Elaine Anderson that explains what type of foods can help to address symptoms.

Consensus statements from expert panels

Information included in this section is the result of the summarised consensus from our expert panels. Find out more about the panel.

• It is necessary to use a comprehensive battery of tests and methods (not only routine or traditional, e.g. assess vitamin levels, microbiome, etc) to screen and assess symptoms that are linked to nutrition and diet.
• Adapting and providing tools for self-screening, assessment, referral to non-dietitians (nurses, GPs, physiotherapists or any other allied health professional) and social care professionals (social prescribers, social workers, care home professionals and third sector representatives) that are nevertheless trusted sources is essential.
• There is a need to create a symptom-based, patient-led assessment for healthcare professionals and social care staff and resources to overcome nutrition-related issues and symptoms.
• There are some issues which should be explored from the first healthcare professional contact with patients, regardless of the undertaken tests or negative COVID results:
  • appetite and interest in eating
  • actual food consumption
  • changes and or distortion of smell and taste
  • general challenges about eating and drinking
  • ask about blood tests, food allergies, bowel habits
  • current dietary and nutrition knowledge and preferences
  • specific nutrition related symptoms (e.g. gut symptoms)