Malnutrition in hospitalized patients can lead to prolonged recovery times, increased risk of complications, and a higher likelihood of hospital readmission. Patients hospitalized for COVID-19 have been shown to be at high risk of malnutrition1 and may develop disease-related malnutrition (DRM) due to the catabolic situation, the symptoms that interfere with intake and prolonged hospital stay. One of the cardinal signs observed in severe COVID cases is a profound anorexia feeling which interferes with food intake, as we reported in a previous study.2 The European Society for Clinical Nutrition and Metabolism (ESPEN) and other medical societies devised expert statements and practical guidance for the nutritional management of patients with COVID-19 during the pandemic.3, 4, 5, 6, 7 These guidelines emphasize the importance of incorporating nutritional intervention and therapy as integral components of the comprehensive care approach for patients. Most expert guidelines recommend earlier assessment and diagnosis of the nutritional status of the patient, as well as the prescription of a medical nutrition therapy adapted to their needs, prioritizing enteral nutrition (EN) versus parenteral nutrition (PN), unless the first is contraindicated.

During the first wave of the pandemic, all COVID-19 patients admitted to our institution were at high nutritional risk (NR) given the acute inflammatory situation with high nutritional requirements. Consequently, we implemented an institutional protocol for nutritional support based on ESPEN recommendations.3 Nevertheless, we found that even the nutritional therapy, patients still presented malnutrition and sarcopenia at hospital discharge, with a very serious loss of weight of more than 10 kg in a substantial percentage of them. These findings suggested that these patients required an earlier nutritional assessment after admission for earlier detection of NR or DRM and its prevention and treatment through a prompt initiation and more intensive and prolonged nutritional support and monitoring.2

The future of health care is becoming increasingly performed under digital support strategies. During the COVID-19 pandemic, digital technologies have been harnessed to clinically monitor patients while maintaining social distancing and thus minimizing the risk of virus transmission to hospital health professionals. During the second and third waves, to improve early nutritional risk detection and monitoring, we developed jointly with the hospital Information Systems Department an automatized nutritional screening tool. This alarm was based on the daily quantification of food intake registered in the electronic medical record of every patient by the nurse in charge.

The objective of the present pilot study was to assess the usefulness and effectiveness of the electronic automatized NR screening tool in all non-critical COVID-19 patients admitted to our institution for the detection and treatment of DRM, taking this disease as a model of the catabolic situation that impairs nutritional status in severe illnesses.