Nutritional Reports

Specializing in the diagnosis, treatment and monitoring of heart disorders

The 2020 Global Nutrition Report in the context of Covid-19


As the world’s leading report on the state of global nutrition, the Global Nutrition Report sheds light on where progress has been made and where challenges remain. New analysis shows that global and national patterns hide significant inequalities within countries and populations, with the most vulnerable groups being most affected. The 2020 Global Nutrition Report therefore examines the critical role of addressing inequity to end malnutrition in all its forms. Inequity is a cause of malnutrition – both undernutrition and overweight, obesity and other diet-related chronic diseases. Inequities in food and health systems exacerbate inequalities in nutrition outcomes that in turn can lead to more inequity, perpetuating a vicious cycle.

Although the 2020 Global Nutrition Report was written before the current coronavirus pandemic, its emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.

Introduction

At present, many studies have indicated the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) (1–4). However, there are many diseases that may affect the immune system, such as AIDS, cirrhosis, and advanced malignant tumors, which may affect the removal of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), further affecting the treatment of COVID-19 patients. A nationwide analysis in China analyzed the major strategies for patients with cancer in this COVID-19 crisis (5). The process of advanced cirrhosis is complicated with cirrhosis-associated immune dysfunction. Cirrhosis has the potential to injure the homeostatic role of the liver in the immune system (6, 7). In this case study, we report a case of a COVID-19 patient with cirrhosis. We describe the symptoms, diagnosis, treatment, and management of this patient, which may provide more information for the treatment of COVID-19 patients with cirrhosis.

Case Report

On February 11, 2020, a 73-year-old woman came to the Fever Clinic of the First Hospital of Changsha, China. Ten minutes later, she was taken to the examination room and evaluated by a clinic doctor. The chief complaint of the patient was a fever—her body temperature peaked at 39°C—with cough, expectoration, shortness of breath, and general weakness that started prior 5 days. She developed mild diarrhea (3–4 stools/day) 2 days prior to coming to the hospital. Her daughter was diagnosed with COVID-19. Given her symptoms and recent close contact with a COVID-19-positive patient, she decided to go to a healthcare provider. The patient had a history of cirrhosis and type 2 diabetes, but no history of smoking or drinking. Physical examination indicated a body temperature of 38.8°C, a pulse of 100 beats/min, a respiratory rate of 22 breaths/min, an oxygen saturation of 85%, and bowel sounds at four times/min. She presented with a characteristic feature of chronic liver disease, hepatic facies, and liver palms, but no spider nevus. In addition, she had thick breathing sounds on both sides of the lungs and audible wet murmurs in both the lungs. The abdomen of the patient was soft and had no lumps. No pain was found in the liver without mobile dullness.

Considering the possibility of SARS-COV-2 infection, we performed a chest CT examination and found bilateral pneumonia (Figure 1). The results of a nucleic acid amplification test (NAAT) for influenza A and B were negative. Her blood tests demonstrated simultaneous reduction of the ternary systems (red blood cells: 2.83 × 1012 cells/l; peripheral blood hemoglobin: 83 g/l; white blood cells: 0.78 × 109 cells/l; lymphocytes: 0.11 × 109 cells/l; lym%: 14.5%; platelets: 41 × 109 cells/l) and an elevated percentage of neutrophils (0.65 × 109/L; n%: 82.8%), C-reactive protein (62.5 mg/l), and erythrocyte sedimentation rate (129 mm/h) (Table 1). In view of the close contact history and clinical examination results of the patient, we carried out COVID-19 test for the patient. Specimens were collected following the Chinese Center for Disease Control and Prevention (CCDC) guidance. The results showed that she tested positive for SARS-COV-2. Therefore, she was admitted to the isolation ward for further treatment.