Liver disorders in COVID-19, nutritional approaches and the use of phytochemicals

Table 1 Tools for malnutrition detection in patients with coronavirus disease 2019 and liver injury

Tool	Target patients	Criteria
MUST	Low weight	Objective criteria:
		Objective measures: weight and height to obtain BMI
		Other measures (optional): ulna length and mid upper arm circumference
		Weight loss in las 3-6 mo
	Obese patients	Subjective criteria:
		Reduced food intake in last 5 d: clinical management, psychological factors
		Weight loss appearance (clothes, jewelry)
NRS-2002	Hospitalized individuals	BMI
		Weight loss within 3 mo
		Reduced dietary intake in last week
NUTRIC score	Hospitalized patients at ICU	Age
		Days hospitalized or in the ICU
		Number of comorbidities
		IL-6 levels (optional)
		APACHE II score
		SOFA score
APACHE II score	Patients at ICU (predicting mortality)	Age
		Temperature
		Mean arterial pressure
		pH
		Heart rate/pulse
		Respiratory rate
		Sodium, potassium levels
		Creatinine
		Acute renal failure
SOFA score	Patients at ICU (estimation of mortality)	PaO2
		FiO2
		Medical ventilation
		Platelets level
		Glasgow Coma Scale
		Bilirubin levels
		Mean arterial pressure or administration of vasoactive agents required
		Creatinine levels
		Is a COVID-19 patient?
GLIM	Individuals at risk in general	Phenotypic criteria:
		Weight loss
		Low BMI
		Loss of muscle mass
		Etiologic criteria:
		Reduced food intake or assimilation
		Presence of disease or inflammation
NRF-NPT	Detection of malnutrition in liver patients disease	Unplanned weight loss in las 3-6 mo
		BMI
		Reduced dietary intake and uncompleted meals

BMI: Body mass index; GLIM: Global Leadership Initiative of Malnutrition; ICU: Intensive care unit; MUST: Malnutrition Universal Screening Tool; NRF-NPT: Royal Free Hospital-Nutritional Prioritizing Tool. NRS-2002: Nutrition Risk Screening-2002; NUTRIC: Nutrition risk in the critically ill; SOFA: Sequential Organ Failure Assessment.

Table 2 Energy and nutrient recommendations for patients with coronavirus disease 2019 with or without liver injury

Energy/Nutrient	Criteria	Recommendation
Estimation of REE	All individuals with COVID-19	Estimation by indirect calorimetry
		Prediction equations
Calories	Normal oral diets	1500-2000 kcals/d
		Increase 400-500 kcals in stress or infection crisis
	Polymorbid, old patients > 65 yr	27 kcals/kg Bw/day
	Low weight, older patients	30 kcals/kg Bw/day
	Malnourish chronic patients and muscle depletion	30-35 kcals/kg Bw/day
	-Patients with COVID-19 outside ICU	ONS with low oral intolerance:
		150-400 kcals/service
		70-100 g protein/service
		Carbohydrates, fiber, PUFAs, vitamins, minerals, probiotics
		Consuming for a month
Protein	Normal individuals (prevent loss and muscle mass)	1 g/kg Bw/day
		70-100 g/d
		Form animal (milk, yogurt, meat, fish, chicken, cheese) and vegetable sources (beans, soy, nuts, peas)
	Patients with liver cirrhosis sarcopenic	1.2-1.5 g/kg Bw/day
	Obese sarcopenic	Oral supplementation of BCAA 0.20-0.25 g/kg Bw/day or 30 g/d
		Glutamine and arginine supplementation
Carbohydrates/fat	Patients with COVID-19 without respiratory impairment	Ratio 70:30 carbohydrates/fat
		Medium and low glycemic
		Fiber 25-30 g/d
		PUFAs: DHA, EPA, ALA
	Patients with ventilator support	Ratio 50:50 carbohydrates/fat
Vitamins	All individuals with COVID-19	A, C, D, E, folate, B6 and B12 (monitoring in patients with liver abnormalities)
Minerals	All individuals with COVID-19	Zinc, copper, selenium (monitoring in patients with liver abnormalities)
	Critically ill patients	EN after 24-36 h. after ICU admission
		Initiate with trophic low-dose (10-20 mL/h.)
		Polymeric formula: 15-20 kcals/kg Bw and 1.2-2.0 g/kg Bw/day of protein vitamins, minerals, fiber, probiotics
		Provide 70%-80% needs in over 1 wk
	Sever obese patients BMI > 50	Energy 22-25 kcals/kg IBW
		Protein 2 g/kg per day (Class I, II) or 2.5 g/kg IBW/day of (Class III)
		Vitamins, minerals, fiber, probiotics
	Gastric intolerance individuals	Use prokinetics
		Post-pyloric feeding in persistence intolerance or at high risk of aspiration
	Patients with no GI feasible	PN recommended
	Poor nutrition status	Limit the use of omega-6 soy-based ILE during first week
	Prolonged stay at ICU	Mixture of lipids such as olive oil based ILE or SMOF (soy, medium chain triglycerides, olive oil, fish oil)

ALA: Alpha linoleic acid; BCAA: Branch chain amino acids; DHA: Docosahexaenoic acid; EN: Enteral nutrition; EPA: Eicosanoid acid; GI: Gastrointestinal; IBW: Ideal body weight; ICU: Intensive care unit; ILE: Intravenous lipid emulsion. ONS: Oral nutritional supplements; PN: Parenteral nutrition; PUFAs: Polyunsaturated fatty acids; REE: Resting energy expenditure.

Table 3 Curcumina, silibylin, sulfuraphane evaluation by Autodock 4.2

Ligand	Binding energy (kcal/mol)	kI µmol/L	Residue interactions
Curcumine	-4.6	428.13	Phe 23, Val 25, Leu 28, Phe 26, Thr 30, Val 26
Silybin	-5.73	62.57	Phe 23, Phe 26, Val 29
Sulforaphane	-3.75	1.79	Val 29, Phe 26, Val 25, Ala 22, Phe 23, Leu 27