Implementation of the nutrition care process on mortality risk in critically ill COVID-19 patients - a registry longitudinal cohort study

Authors

Lindsay Woodcock, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, USA.
Alexa Steiber, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, USA.
Zhongqui Fan, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
Lauren E. Louck, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.
Alison Steiber, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, USA.
Constantina Papoutsakis, Research, International and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, USA.
Taylor C. Wallace, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA.

Document Type

Journal Article

Publication Date

12-1-2025

Journal

Annals of medicine

Volume

57

Issue

1

DOI

10.1080/07853890.2025.2598901

Keywords

COVID-19; death; dietetics; intensive care units; nutrition care process; nutritionists

Abstract

BACKGROUND: COVID-19 impacts the nutritional status of patients. There is limited longitudinal research on the impact of nutrition care provided to COVID-19 patients in the intensive care unit (ICU). OBJECTIVE: We assessed the real-world effectiveness of the nutrition care process (NCP) used by registered dietitian nutritionists (RDNs) on mortality in COVID-19 ICU patients. METHODS: RDNs in 8 ICUs throughout the United States utilized the Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII) registry to document standard care practices, per the NCP, used with COVID-19 patients admitted from April 2021 to April 2022. Mortality, the primary outcome, was reported at the last visit. A multivariable logistic regression model, adjusted for sex, age, body mass index (BMI), and number of visits, estimated mortality risk as a function of the NCP problem status (improving/resolved). RESULTS: Participants (N = 90) were mostly male (68.2%), with a mean age of 57.2 ± 15.7 years. Participants' baseline c-reactive protein (CRP) levels were high (55.9 ± 74.2 mg/L) and about two-thirds were obese (63.7%), per BMI. 33 patients died over the study duration. The most common NCP problems identified were related to inadequate energy and protein intake, with 62.5% resolved through enteral nutrition interventions. Improvement and resolution of the NCP problem by the RDN was associated with 86% (OR: 0.14, 95% CI: 0.03-0.52, p = 0.004) and 89% (OR: 0.11, 95% CI: 0.01-0.67, p = 0.023) reduced risk of death, respectively. CONCLUSION: We show for the first time in a real-word setting that implementing the NCP to identify and address nutritional problems during ICU admission is associated with lower mortality risk in critical COVID-19 patients. Due to limitations in longitudinal registries and use of logistic models, future larger-scale cohorts and clinical trials are needed.

APA Citation

Woodcock, Lindsay; Steiber, Alexa; Fan, Zhongqui; Louck, Lauren E.; Steiber, Alison; Papoutsakis, Constantina; and Wallace, Taylor C., "Implementation of the nutrition care process on mortality risk in critically ill COVID-19 patients - a registry longitudinal cohort study" (2025). GW Authored Works. Paper 8464.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8464

Department

Clinical Research and Leadership