Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations

Abstract

Although increased weight, and particularly obesity, has been associated with a more severe clinical course of COVID-19 and risk of fatality, the course of the illness can lead to prolonged length of stay. Changes in nutritional status and weight loss during hospitalization are largely reported in some populations, but still not explored in COVID-19 patients. Considering that patients with COVID-19 show an increased inflammatory response, other signs and symptoms, which can lead to weight and muscle loss should be monitored. The aim of this article was to establish possible connections between COVID-19, prolonged hospitalization and muscle wasting, as well as to propose nutritional recommendations for the prevention and treatment of cachexia, through a narrative review. Identification of risk and presence of malnutrition should be an early step in general assessment of all patients, with regard to more at-risk categories including older adults and individuals suffering from chronic and acute disease conditions, as COVID-19. The deterioration of nutritional status, and consequently cachexia, increase the risk of mortality, and need to be treated with attention as other complications. There is, however, little hard evidence of nutritional approaches in assisting COVID-19 treatment or its management including cachexia.

Evolution of the nutritional status of COVID-19 critically-ill patients: A prospective observational study from ICU admission to three months after ICU discharge

“…Yet the proportion of severe malnutrition, predominant at ICU discharge, decreased from M1 at the benefit of moderate malnutrition. Although the relatively small sample of patients precludes to draw definite conclusions, determinants of persistent malnutrition seemed to lie within the length of ICU stay and of organ support rather than related to preadmission characteristics or nutritional support during and after the ICU stay, as hypothesized by Virgens et al [17] and others [16]. Interestingly, only 32% of patients in whom undernutrition persisted at M3 had benefited from a nutritional support, suggesting that malnutrition was either underrecognized or undertreated in this population.…”

Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers

“…First of all, the SARS‐CoV‐2 infection can cause major inflammation, particularly pronounced in patients with severe and critical COVID‐19 disease 2 . Endothelial and epithelial cell death combined with vascular leakage can trigger production of chemokines and cytokines, and may result in a massive inflammatory reaction causing disturbed tissue homeostasis 1,3,4 . Acute phase proteins such as: TNFα, ferritin, C‐reactive protein (CRP), fibroblast growth factor, IL‐factors, NF‐κB, interferon‐γ are produced manifold and circulated, causing further dysregulation of metabolism and proteolysis 4 …”

COVID-19 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

“…A major clinical feature of cachexia in adults is weight loss, which has been linked to inflammation and loss of appetite [ 27 ]. COVID-19-induced gastrointestinal symptoms, anorexia, and cytokine storm are known to cause weight loss and to trigger cachexia [ 28 ]. While no measurements of skeletal muscle mass were conducted in the present study, weight loss during treatment for COVID-19 can be attributed to cachexia, which is believed to lead to a decrease in the strength of swallowing-related muscles and to have effects on swallowing function [ 29 ].…”