Nutritional Care for Patients With Ebola Virus Disease

Mija Ververs; Magi Gabra

Disclosures

Emerging Infectious Diseases. 2020;26(1):20-25. 

In This Article

Discussion

In this literature review, we summarize existing practices and research findings on nutritional care for EVD patients. A wealth of literature exists on the clinical management and supportive care, but our review found only a limited number of publications on specific nutritional care, and they often lacked detailed descriptions of the actual nutritional care provided. The results could lead to the conclusion that the role of nutritional care in ETUs is perceived to have limited importance. However, the importance of good nutrition in fighting infection is widely known, and several researchers emphasized the need for good nutritional care for EVD patients.[11–14,17,21,22] In addition, it is well established that adequate nutrition is essential in the management of critical illness or sepsis.[26,27] Our review showed that nutritional care is poorly described and therefore the optimal composition and implementation of care remains unknown. One noticeable finding was the use of total parenteral nutrition (TPN) only in high-resource settings. It is unclear whether TPN is preferred over enteral nutrition and whether the role of enteral nutrition for patients' survival is different in high- or low-resource settings.

We intended to compare actual nutritional care in ETUs with the 2014 WHO/UNICEF/WFP interim guidelines. However, various care descriptions from our literature review preceded the availability of these guidelines.[2,3,5,6,8,9,14,17,22,24] This restricted our ability to compare recommended and actual practices. Only 3 works published after November 2014 commented on using the guidelines or reported any successes or challenges with attempting to follow them.[12,13,21]

WHO recommends that EVD patients should be provided with a minimum recommended daily allowance (RDA) of nutrients through normal traditional or fortified foods[1,16] or micronutrient powders.[28] It also states that, until further evidence is available, excess use of any micronutrient for EVD patients is not recommended, unless correcting for a specific micronutrient loss (e.g., treating hypokalemia). However, in many EVD-affected countries in sub-Saharan Africa, malnutrition, including micronutrient deficiencies, is widely prevalent,[29,30] and 1 RDA of, for example, vitamins would not sufficiently address existing suboptimal levels in EVD patients.

To improve nutritional care for EVD patients, more documentation is needed on nutritional care in ETUs. We recommend that researchers and practitioners share specific and practical details of their experiences in providing nutritional support within ETUs to further facilitate the scientific base and ultimately improve the nutritional care for an increasingly prevalent patient population. In addition, research is necessary to determine whether specific macronutrients or micronutrients improve treatment outcomes in ETUs and elucidate their mechanism of action. For instance, the roles of albumin,[14] selenium,[31,32] and electrolytes[33,34] deserve further exploration, and the recognized importance of vitamin A in mounting an immune response to infectious diseases urgently merits further studies. It is also worth investigating whether anthropometric changes in patients admitted to ETUs relate to outcomes of illness and death. In addition, we see a need to examine whether the recommendation of providing 1 RDA is sufficient for managing patients with nutrient losses secondary to EVD-induced enteropathy, complicated by an underlying suboptimal nutritional status. We further underline the need for immediate research on breast milk and transmissibility of EVD.[35] Last, we propose to not only examine whether specific nutritional care can raise patient survival rates, but to assess how it may contribute to symptom relief in the critically ill. Although adequate nutrition cannot cure patients with EVD, maintaining an optimal nutritional status could improve their response to treatment.

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