COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation: A post-hoc analysis of a prospective cohort study

Abstract

Background & aims Coronavirus disease 2019 (COVID-19) may associate with clinical manifestations, ranging from alterations in smell and taste to severe respiratory distress requiring intensive care, that might associate with weight loss and malnutrition. We aimed to assess the incidence of unintentional weight loss and malnutrition in COVID-19 survivors. Methods In this post-hoc analysis of a prospective observational cohort study, we enrolled all adult (age ≥18 years) patients with a confirmed diagnosis of COVID-19 who had been discharged home from either a medical ward or the Emergency Department of San Raffaele University Hospital, and were re-evaluated after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to May 11, 2020. Demographic, anthropometric, clinical and biochemical parameters upon admission were prospectively collected. At follow-up, anthropometrics, the mini nutritional assessment screening and a visual analogue scale for appetite were assessed. Results A total of 213 patients were included in the analysis (33% females, median age 59.0 [49.5–67.9] years, 70% overweight/obese upon initial assessment, 73% hospitalised). Sixty-one patients (29% of the total, and 31% of hospitalised patients vs . 21% of patients managed at home, p = 0.14) had lost >5% of initial body weight (median weight loss 6.5 [5.0–9.0] kg, or 8.1 [6.1–10.9]%). Patients who lost weight had greater systemic inflammation (C-reactive protein 62.9 [29.0–129.5] vs .48.7 [16.1–96.3] mg/dL; p = 0.02), impaired renal function (23.7% vs . 8.7% of patients; p = 0.003) and longer disease duration (32 [27–41] vs . 24 [21–30] days; p = 0.047) as compared with those who did not lose weight. At multivariate logistic regression analysis, only disease duration independently predicted weight loss (OR 1.05 [1.01–1.10] p = 0.022). Conclusions COVID-19 might negatively impact body weight and nutritional status. In COVID-19 patients, nutritional evaluation, counselling and treatment should be implemented at initial assessment, throughout the course of disease, and after clinical remission. Clinicaltrials.gov registration NCT04318366 .

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

“…Two studies, constituting 395 hospitalized COVID‐19 patients in total, studied malnutrition in COVID‐19 utilizing the Mini Nutritional Assessment score. They found that 42% of hospitalized patients with COVID‐19 were at risk of malnutrition and 28% of these patients were considered malnourished at the time of assessment 5,6 . Another study in 114 consecutive, hospitalized COVID‐19 patients found similar results using the Global Leadership Initiative on Malnutrition (GLIM) criteria with 42% (48/114 patients) being malnourished 7 …”

“…Secondly, malnutrition is frequently seen in COVID‐19 patients 5‐7 . Disease‐associated reductions in food intake and malnutrition can contribute to tissue wasting.…”

“…Until 12 December 2020, we have identified three peer‐reviewed publications investigating the occurrence of weight loss before, during, or after hospital treatment of in total 589 COVID‐19 patients (Table 1). One study 10 was performed at the time of hospital admission and reported on weight loss ≥5% before the index hospitalization, one study 11 investigated weight loss ≥5% until the examination date during hospitalization, and one study 6 assessed weight loss of patients in remission (i.e. after hospitalization).…”

COVID-19 im Alter – Die geriatrische Perspektive

“…Bei Anwendung der neuen Diagnosekriterien der Global Leadership Initiative on Malnutrition (GLIM) ist bei 42–50 % der COVID-19-Patienten eine Malnutrition zu diagnostizieren [ 3 , 50 ]. In einer italienischen Studie verloren 29 % der COVID-19-Patienten während des Krankheitsverlaufs mehr als 5 % ihres Körpergewichts [ 12 ]. Ein Gewichtsverlust war dabei mit einer längeren Erkrankungs- und Hospitalisierungsdauer assoziiert [ 12 ].…”

“…In einer italienischen Studie verloren 29 % der COVID-19-Patienten während des Krankheitsverlaufs mehr als 5 % ihres Körpergewichts [ 12 ]. Ein Gewichtsverlust war dabei mit einer längeren Erkrankungs- und Hospitalisierungsdauer assoziiert [ 12 ].…”