Preliminary study on nutritional diet management in the prevention and treatment

Jun Meng

Sichuan University of Arts and Science School of Heallth caring Industry, Sichuan, China.

Abstract Through the painstaking efforts, the situation of epidemic prevention and control is now developing in a positive direction.Nutritional Diet health management is an important part of health management.The main objective of nutritional diet health management is to improve the clinical outcomes, quality of life and cost-effectiveness ratio of patients with COVID-19 through standardized nutritional support, nutritional diet supplement and medical nutritional diet therapy, for the benefit of patients with COVID-19.

Keywords: COVID-19; Prevention and treatment; Nutritional diet management

Introduction

Prevention and treatment of diseases, giving priority to prevention, is our consistent policy [1], but at all times and at home and abroad, nutritional diet treatment has not attracted as much attention as basic medicine and clinical medicine in many countries.In fact,nutritional diet medicine is supposed to be integrated medicine, which requires the integration of medicine,not only to integrate preventive medicine disciplines such as epidemiology and medical statistics, but also to integrate basic medicine, clinical medicine and social medicine, and so on.COVID-19 epidemic is the result of the interaction of environmental factors and body factors.How to effectively prevent and treat the epidemic of COVID-19 also depends on nutritional diet medicine.Nutritional diet medicine plays a role of "one before and one after" in integrated medicine.Prevention research must be given priority in the early stage, and intervention must be followed up continuously in the later stage.Nutritional dietary medicine runs through integrated medicine from beginning to end.In COVID-19's prevention and health management during the epidemic, effective prevention and control plans and health strategies can only be put forward after the comprehensive integration of nutritional and dietary medicine, basic medicine,clinical medicine and preventive medicine.We must improve the status of nutritional diet medicine and pay attention to it [2].

1.Discussion on the nutritional Diet Theory of COVID-19's Prevention and treatment

The third edition of COVID-19's diagnosis and treatment plan released by the National Health Commission, began to emphasize the role of intestinal microecological therapy in COVID-19."It is required to avoid the blind or inappropriate use of antibiotics,especially the combined use of broad-spectrum antibiotics.For the treatment of severe and critical cases, intestinal microecology can be used to maintain intestinal microecological balance and prevent secondary bacterial infection." The special committees of the Chinese Nutrition Association and the Enteral and Parenteral Nutrition Branch of the Chinese Medical Association also suggested that probiotics should be supplemented in the prevention and treatment of COVID-19 and health management to maintain the balance of intestinal microecology.

Years of research and practice in integrated medicine has proved that 60% to 70% of modern diseases are closely related to people's lifestyle, including diet, sleep habits, stress and so on.Studies have shown that when we are exposed to chronic stress,the continuous activation of hypothalamic-pituitaryadrenal (HPA) axis (and cortisol) increases cortisol levels, impairing immune response, leading to the occurrence and development of some types of cancer.It also reduces the immune defense function in the face of foreign microorganisms, so faced with ubiquitous microorganisms such as viruses and bacteria, if we want to stay healthy for a long time, what we can do is to make our body and mind at its best.Health is a dynamic process, and only with the continuous strengthening and updating of the health concept of the whole people, can we restrain ourselves from diet,exercise, and sleep every day and maintain a state of balance [3].

This paper combines the sixth edition of the diagnosis and treatment Plan for COVID-19 issued by the National Health Commission, the prevention and control suggestions on COVID-19 issued by various branches of the Chinese Medical Association, and the latest research results on COVID-19, sorting out the current issues of greatest concern to the public, such as virus, immunity, inflammation, diet, nutrition ,from the perspective of functional medicine.The purpose of this paper is to provide a reference for improving the health and physique of the people and preventing the epidemic situation in the future.

"This is the age of microbes, in the past, in the present, and in the future, until the end of the world"this is Stephen, a world-famous biologist.Gould's summary of the nature of natural life phenomenon,yes, the emergence of life on earth begins with a single bacteria, and our surroundings, including our bodies,are filled with trillions of bacteria and viruses.Most of the time, these microbes coexist peacefully with human beings, and when microbes cause disasters, that is,when infectious diseases are prevalent, human beings often cross the boundary and start a fire, and it is time to look back and reflect calmly.

Let's focus on novel coronavirus.Novel coronavirus is the lowest nanoscale life form making people headache,and is more painful to human beings than bacteria.Bacteria are individuals who live independently.In the struggle with human beings, because of the invention of antibiotics, bacteria can no longer make a big stir.But novel coronavirus is different.Novel coronavirus has two characteristics that make it difficult for human beings to conquer it: first, novel coronavirus cannot survive independently.Novel coronavirus has a simple structure with no cellular structure, so it can only live in living cells and rely on its own genetic material.Using the material in the cell to create a new virus is its reproduction.When the virus infects humans, the virus integrates itself into our body cells, so killing the virus means killing human cells.We can only use antiviral drugs to eliminate viruses that cause chronic diseases,such as hepatitis B virus, which are often taken for life.Because as long as the drug is stopped, the virus will replicate and reproduce when the time is ripe.However, because of its DNA genetic material (DNA is more stable than RNA), the mutation rate is low and it is easier to detect and identify.Vaccine prevention and control is a very mature technology.Hepatitis B virus is a double-stranded DNA retrovirus.Since hepatitis B vaccination, the incidence has decreased significantly.But the virus that causes acute infection is often RNA virus, which has the second characteristic of "instability" of the virus.Novel coronavirus, the culprit of this epidemic, belongs to RNA virus.For a detailed description of novel coronavirus, please refer to the virological characteristics section of “on issuing COVID-19's diagnosis and treatment Plan”issued by the Health Commission.Just because of such characteristics, the mutation rate of RNA virus is also high when it replicates in the host, so the positive rate of novel coronavirus nucleic acid test needs to be evaluated.The above characteristics determine that COVID-19 is the same as the SARS at that time, we need to re-isolate the virus and develop a vaccine.But time is life, those lost lives do not have a chance to wait for the birth of the vaccine, for the virus, where should we go?

The sequencing sequence of novel coronavirus also confirmed that novel coronavirus is 96.2% similar to a bat coronavirus, indicating that it is very likely to come from bats.But the popular methods such as “excessive use of antibiotics, cesarean section and bottle feeding”in modern society have seriously affected the diversity of intestinal flora.The disinfection procedure emphasized in this epidemic can only be a temporary behavior during the epidemic of the virus, and it is not advocated to be used to restore normal life in the future.we should not wipe out all microorganisms.After all, the immunity of the human body grows with microorganisms.

It is necessary to eat antioxidant food every day.The"rainbow diet" now advocated refers to the eating habit of eating a large number of antioxidant vegetables and fruits, which is also in line with the theory of"five colors into the five internal organs" in traditional Chinese medicine.Many drugs are also common causes of mitochondrial damage, which should be prevented in the treatment of chronic diseases in the future.Commonly used antioxidants include many plant compounds, such as anthocyanin, lycopene and curcumin (Curcumin, which is the extract of curry eaten by Indian people every day, can also inhibit the effect of NF- κB molecule on inflammatory switch, so it is a natural anti-inflammatory nutrient), Astaxanthin,quercetin, green tea polyphenols, vitamin C, vitamin E.Now the international popular "Mediterranean diet" is an anti-inflammatory diet rich in antioxidants,Omega-3 unsaturated fatty acids and so on.In order to improve immune homeostasis and avoid immune senescence, Omega-3 essential fatty acids, coenzyme Q10 and vitamin D are essential key factors.In the joint prevention and control press conference of the State Council's "Joint War epidemic" on February 12 this year, it was mentioned that nutrients are an important means of disease prevention for health, especially for COVID-19's prevention.

In the face of ubiquitous microorganisms such as viruses and bacteria, in order to keep healthy for a long time, what we can do is to make our body and mind at its best state.Health is a dynamic process, and the health concept of the whole people is constantly strengthened and updated.Only in this way can we restrain ourselves from diet, exercise, and sleep every day and maintain a state of balance [6].

2.Nutritious Diet Therapy of traditional Chinese Medicine in the Prevention and treatment of COVID-19

Patients often have symptoms of fever during the onset of the disease, and heat pathogens are easy to injure Yin and Jin, resulting in symptoms such as yin deficiency of lung and stomach [4].It is recommended to choose the medicinal diet with the effects of replenishing qi and nourishing yin and recuperating the spleen and stomach, such as Shanyao (Dioscoreae Rhizoma),Baihe (Lilii Bulbus), sweet potato, tofu, honey, etc., as well as Tremella Fritillaria snow pear soup, yam barley sauce porridge, yam lentil porridge and so on.At the same time, according to their own situation, Huangjing(Polygonati Rhizoma), Dangshen (Changii radix),Renshen Jianpi pills, Buzhong Yiqi pills and other traditional Chinese medicine or proprietary Chinese medicine can be added to promote rehabilitation [5].

3.The role of nutritious Diet in COVID-19's Prevention and treatment

Nutritious diet plays an important role in the prevention and treatment of COVID-19.Nutritional diet health management can improve people's nutritional status,immune status, clinical outcome and quality of life.The health management of nutritional diet should be included in the whole process of COVID-19's prevention, treatment and rehabilitation.

This COVID-19 has a general susceptibility to the population, and may cause adverse clinical consequences of the elderly, low immunity and patients with chronic underlying diseases (such as increased mortality, etc.).

Now it is generally believed that the health management of nutritious diet plays an important role in the comprehensive measures for the prevention and treatment of COVID-19.We should pay more attention to the role of nutritious diet health management in improving human nutritional and immune status,improving clinical results and quality of life,accelerating patients' physical recovery and reducing the risk of COVID-19's relapse.As a basic measure,nutritious diet health management was incorporated into the whole process of COVID-19's prevention,treatment and rehabilitation.

The following is about the purpose and significance of health management of nutritious diet in COVID-19's prevention and treatment, the composition of nutritious diet health management team, the steps of diagnosis and treatment of nutritious diet, the selection of nutritional screening tools, the methods and ways of nutritional support and treatment, and the matters needing attention in the nutritional diet of COVID-19 patients during rehabilitation.

3.1 The purpose and significance of nutritious diet health management

Nutritious diet health management is an important part of health management.The main goal of nutritional diet health management is to improve patients' clinical results, the quality of life and cost-effectiveness ratio through standardized nutritional diet support(nutritional support), nutritional diet supplement and medical nutritional diet treatment, so as to benefit patients [7].

In the prevention of COVID-19, maintaining the good nutritional health and immune function of the human body is an important basis for the prevention of various infectious diseases, including COVID-19.Reasonable nutritious diet and maintenance of immune function are hot fields of nutritional dietetics in recent years.At the micro level of medicine, it focuses on the molecular mechanism of immunomodulatory effects of certain or some nutrients (including proteins, fats,micronutrients, plant compounds, etc.) or their active metabolites; at the macro level of medicine, through nutritious diet to improve the overall function of the human immune system, in order to improve the clinical results of COVID-19 patients and promote human health.It is now believed that protein-energy malnutrition can have serious adverse effects on human lymphatic organs, cellular immune function,immunoglobulins and antibodies, complement system and phagocytes, lysozyme and iron-binding proteins,resulting in increased susceptibility to various viruses and bacterial infections.The elderly, some patients with chronic or malignant diseases, etc.[8], is a high incidence of malnutrition, but also a high-risk group of infectious diseases which we should pay attention to it.Relevant studies have proved that for patients with nutritional risk, if they do not accept reasonable and standardized health management of nutritious diet, the hospitalization time of patients will be prolonged and the rate of readmission will be significantly increased[9].

In the treatment of COVID-19, standardized and reasonable nutritional diet support treatment can effectively improve the clinical results of patients with nutritional risk.In the multicenter prospective cohort study conducted in China and the United States, standardized nutritional diet support treatment was given to patients with nutritional dietary risk.The incidence of infectious complications and total complications was significantly lower than that of patients without nutritional dietary support [10,11],and the cost-effectiveness ratio was significantly improved [11].In the newly published clinical case report of COVID-19, it has been made clear that nutritional dietary support therapy should be one of the auxiliary ways of comprehensive treatment, and its role has been affirmed.For all kinds of respiratory critically ill patients, meta-analysis also shows that when gastrointestinal function permits, early use of enteral nutrition dietary support therapy can effectively maintain intestinal mucosal barrier and immune function and improve clinical outcomes, including reducing the incidence of infectious complications and mortality in COVID-19 patients.When the gastrointestinal function of COVID-19 patients is not allowed and enteral nutrition dietary support therapy is not feasible, starting parenteral nutrition dietary support therapy within 48 hours of admission can reduce the incidence of infectious complications and mortality of COVID-19 patients.

3.2 Composition of nutritious Diet Health Management Group

A nutritious diet health management team composed of clinical specialists, nutritious diet physicians, nutritious diet specialist nurses, health managers and clinical pharmacists was established to provide comprehensive nutritional diet health management for COVID-19 patients.

The work contents and responsibilities of the nutritional diet health management team include: 1)screening patients for nutritional dietary risks and assessment of nutritional dietary health status; 2)individualized nutritional dietary health management programs for patients with nutritional dietary health risks and / or malnutrition; 3) carrying out standardized nutritional dietary health support treatment; 4) quality control and efficacy monitoring of nutritious diet support treatment; 5) nutritional diet health education and follow-up for COVID-19 patients discharged from hospital; 6)implementing family nutritional dietary support for COVID-19 patients in need; 7)conducting nutritional diet related research to promote the development of nutritious diet health management discipline.

Our clinical studies of COVID-19 suggest that the establishment of a nurse-led and multidisciplinary nutritional diet health management team to carry out standardized nutritional diet support treatment is helpful to improve the nutritional dietary health status,clinical results and quality of life of COVID-19 patients with chronic disease in the elderly.It has become a clinical medical model for the reference use of COVID-19's nutritious diet health management.

3.3 The steps of diagnosis and treatment of nutritious diet and the selection of screening tools for nutritious diet

The steps of COVID-19's nutritional diet diagnosis and treatment include: first, screening the nutritional dietary health risk of COVID-19 patients; secondly,to assess the nutritional dietary health status of COVID-19 patients who are positive in nutritional dietary health risk screening (that is, the existence of nutritious dietary health risk).If the initial screening is negative, the screening will be carried out 3 days later, and once the positive results are found, the nutritional diet will be evaluated; thirdly, according to the results of the assessment of the health status of the nutritious diet, the individual nutritional dietary support treatment program will be made; then, the nutritional dietary support treatment will be carried out.Finally,the quality control and effect monitoring of nutritional dietary support treatment were carried out, and the nutritional dietary support treatment program was adjusted or terminated.

Nutritional dietary risk refers to the existing or potential risk of adverse clinical outcomes associated with nutritious diet.The purpose of nutritional diet risk screening is to determine whether patients have indications for nutritional diet support treatment.Nutritional dietary risk screening 2002 is a nutritional dietary screening tool that takes into account nutritional dietary status, patient age and disease severity.It is recommended as the preferred tool for nutritional dietary risk screening for adult non-severe inpatients in China, Europe and the United States.For critically ill COVID-19 patients, the critical care professional committee of the Respiratory Physicians Branch of the Chinese Medical Association and the critical Care Medicine Group of the Respiratory Medicine Branch of the Chinese Medical Association "the consensus of experts on nutritional support treatment of critical respiratory diseases" recommended the application of critically ill nutritional risk score for screening.COVID-19 patients with NUTRIC score ≥ 6 can benefit from nutritional diet support treatment.

3.4 The time and path of nutritional diet support treatment

For COVID-19 patients with mild illness, when the risk of operating and raising diet is positive (that is,there is a risk of nutritious diet), nutritional diet support treatment can be formulated and implemented; for critically ill patients, under the condition of stable vital signs and hemodynamics, nutritional dietary support treatment program can be started.Before starting nutritional diet support therapy, the energy and nutrient needs of COVID-19 patients should be determined, that is, the target feeding amount.If the gastrointestinal function of COVID-19 patients is allowed, the first choice is oral natural nutritional diet, oral nutritional dietary supplement, formula food for special medical purposes and/or enteral nutrition treatment; if the patient's gastrointestinal function is not allowed, parenteral nutrition treatment is given to the patient.

3.5 Matters needing attention in nutritious diet of COVID-19 patients during convalescence

For all discharged COVID-19 convalescent patients,the goal of nutritional diet health management is to maintain the health status of patients' nutritious diet, improve their quality of life and reduce the risk of COVID-19 recurrence.The daily nutritious diet should follow the basic requirements of "the Dietary guidelines for Chinese residents".COVID-19 patients with nutritional diet health risk or malnutrition, as well as elderly patients, can continue to give oral natural nutritional diet or oral nutritional dietary supplement after discharge.At the same time, nutritional diet health status indicators, metabolic indicators and infectionrelated indicators should be routinely monitored, such as body weight, body composition, grip strength,muscle status, hematuria routine, liver and kidney function, blood lipids and blood sugar, etc.Family nutritional diet health support should be given if necessary.

Nutritious diet plays an irreplaceable role in the prevention and control of COVID-19.As an important part of health management, we should pay attention to the special position of nutritional diet health management in improving the nutritional status,immune status, clinical results and quality of life of COVID-19 patients.Bring the health management of nutritious diet into the whole process of COVID-19's prevention, treatment and rehabilitation.