CPhI Online

The importance of Pronutim® for COVID-19 patients

1 May 2020

The COVID-19 pandemic poses unprecedented challenges and threats to patients and healthcare systems worldwide.

According to recent ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines, patients with worst outcomes and higher mortality are reported to include immunocompromised subjects, namely old adults and polymorbid individuals and malnourished people in general.

In fact, Intensive Care Unit (ICU) stay, polymorbidity and older age are all commonly associated with high risk for malnutrition, representing a relevant risk factor for higher morbidity and mortality in chronic and acute diseases.

Also importantly, prolonged ICU stays are reported to be required for COVID-19 patients stabilization, and longer ICU stay may directly worsen or cause malnutrition, with severe loss of skeletal muscle mass and function which may lead to disability, poor quality of life and additional morbidity.

Loss of skeletal muscle mass and muscle function may be tremendous and a major problem in ICU survivors. Therefore prevention, diagnosis and treatment of malnutrition should be routinely included in the management of COVID-19 patients.

A very important secondary cause of malnutrition is the post-extubation swallowing disorder: this condition could be present for to up to 21 days after extubation mainly in the elderly and after prolonged intubation, which makes this complication particularly relevant for COVID-19 patients.

The main European Nutrition Societies and the most important Italian Nutrition Centers have become aware of the topic, finding different areas of intervention:
This is a publication by the two main authors of San Matteo di Pavia, who studied Pronutim® on cancer patients, in this case on non-critical COVID-19 patients: "Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol ". Nutritionists, who have also included whey protein in the nutritional management of patients, are convinced that an immediate nutritional approach is potentially beneficial for clinical outcomes and effective in preventing the consequences of malnutrition in this patient population.
ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 INFECTION: is the title of Espen guidelines. (Barazzoni R et al., ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection, Clinical Nutrition)

The important role of PRONUTIM® in this context:
• Pronutim® is a Food for Special Medical Purposes based on DIF16WPI®, concentrate of whey protein (≥ 92.5%) isolate with high cysteine content (> 2.7%) and lactoferrin (0.7%), for specialized high quality Nutrition for patients in hospital, nursing home or own home;
• The proteins are extracted intact and in highly purified form, with a high biological value useful to mantain proper muscle & immune system function;
• Clinical trials: the last two in terms of time, published at the end of 2019 have reported:

1. Whey protein isolate supplementation improves body composition, muscle strength, and treatment tolerance in malnourished advanced cancer patients undergoing chemotherapy. Cereda E. et al. Cancer Medicine 2019;00:1–10
“In malnourished advanced cancer patients undergoing CT, receiving nutritional counseling, a 3-month supplementation with WPI resulted in improved body composition, muscle strength, body weight, and reduced CT (chemotherapy) toxicity. […] In the randomized population, the WPI group had a lower risk of toxicity than the group receiving counseling alone (P=.009), particularly of multiple toxicity (P=.007) and severe toxicity events (P=.001).”

2. Change of some oxidative stress parameters after supplementation with whey protein isolate in patients with type 2 diabetes Derosa G. et al. Nutrition 73 (2020) 110700
“[…] This is the first study to demonstrate that daily supplementation of undenatured cysteine-richWPI for 3 months at a low dose of 4,625 g/d has improved oxidative stress and inflammatory markers compared with placebo and at baseline in patients with T2DM.”