Long-term effects of malnutrition on severity of COVID-19

Kurtz, Alec; Grant, Ken; Marano, Rachel; Arrieta, Antonio; Feaster, William; Steele, Caroline; Ehwerhemuepha, Louis

doi:10.1038/s41598-021-94138-z

Cited by 63 publications

(57 citation statements)

References 33 publications

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“…However, it is not excluded that malnutrition may precede the infection. A recent study showed that patients with a recent history of malnutrition could be at higher risk of severe COVID-19 [34]. The majority of our patients had comorbidities that could lead to malnutrition.…”

Section: Discussionmentioning

confidence: 77%

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

et al. 2021

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Post-acute consequences of COVID-19, also termed long COVID, include signs and symptoms persisting for more than 12 weeks with prolonged multisystem involvement; most often, however, malnutrition is ignored. Method: The objective was to analyze persistent symptoms, nutritional status, the evolution of muscle strength and performance status (PS) at 6 months post-discharge in a cohort of COVID-19 survivors. Results: Of 549 consecutive patients hospitalized for COVID-19 between 1 March and 29 April 2020, 23.7% died and 288 patients were at home at D30 post-discharge. At this date, 136 of them (47.2%) presented persistent malnutrition, a significant decrease in muscle strength or a PS ≥ 2. These patients received dietary counseling, nutritional supplementation, adapted physical activity guidance or physiotherapy assistance, or were admitted to post-care facilities. At 6 months post-discharge, 91.0% of the 136 patients (n = 119) were evaluated and 36.0% had persistent malnutrition, 14.3% complained of a significant decrease in muscle strength and 14.9% had a performance status > 2. Obesity was more frequent in patients with impairment than in those without (52.8% vs. 31.0%; p = 0.0071), with these patients being admitted more frequently to ICUs (50.9% vs. 31.3%; p = 0.010). Among those with persistent symptoms, 10% had psychiatric co-morbidities (mood disorders, anxiety, or post-traumatic stress syndrome), 7.6% had prolonged pneumological symptoms and 4.2% had neurological symptoms. Conclusions: Obese subjects as well as patients who have stayed in intensive care have a higher risk of functional loss or undernutrition 6 months after a severe COVID infection. Malnutrition and loss of muscle strength should be considered in the clinical assessment of these patients.

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Section: Discussionmentioning

confidence: 77%

Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

et al. 2021

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“…Interestingly, malnutrition is linked to higher serum HA levels [ 96 ]. Furthermore, the long‑term effects of malnutrition predispose patients to severe COVID‑19 in an age‑dependent manner [ 97 ], and are associated with hyperinflammation and immunosuppression [ 98 ]. How malnutrition affects glutamine levels remains to be determined.…”

Section: Consequences Of Glutamine Deficiency and Covid-19mentioning

confidence: 99%

Comorbidity-associated glutamine deficiency is a predisposition to severe COVID-19

Matsuyama

Yoshinaga²,

Shibue

et al. 2021

Cell Death Differ

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SARS-CoV-2 vaccinations have greatly reduced COVID-19 cases, but we must continue to develop our understanding of the nature of the disease and its effects on human immunity. Previously, we suggested that a dysregulated STAT3 pathway following SARS-Co-2 infection ultimately leads to PAI-1 activation and cascades of pathologies. The major COVID-19-associated metabolic risks (old age, hypertension, cardiovascular diseases, diabetes, and obesity) share high PAI-1 levels and could predispose certain groups to severe COVID-19 complications. In this review article, we describe the common metabolic profile that is shared between all of these high-risk groups and COVID-19. This profile not only involves high levels of PAI-1 and STAT3 as previously described, but also includes low levels of glutamine and NAD + , coupled with overproduction of hyaluronan (HA). SARS-CoV-2 infection exacerbates this metabolic imbalance and predisposes these patients to the severe pathophysiologies of COVID-19, including the involvement of NETs (neutrophil extracellular traps) and HA overproduction in the lung. While hyperinflammation due to proinflammatory cytokine overproduction has been frequently documented, it is recently recognized that the immune response is markedly suppressed in some cases by the expansion and activity of MDSCs (myeloid-derived suppressor cells) and FoxP3 + Tregs (regulatory T cells). The metabolomics profiles of severe COVID-19 patients and patients with advanced cancer are similar, and in high-risk patients, SARS-CoV-2 infection leads to aberrant STAT3 activation, which promotes a cancer-like metabolism. We propose that glutamine deficiency and overproduced HA is the central metabolic characteristic of COVID-19 and its high-risk groups. We suggest the usage of glutamine supplementation and the repurposing of cancer drugs to prevent the development of severe COVID-19 pneumonia.

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“… 32 On the other hand, as children age, the risk posed by a history of malnutrition to children with severe COVID-19 decreases only slightly and is highest in younger children (under 5 years of age). 29 At the same time, the length of hospital stay was significantly prolonged in children with other viral (such as adenovirus, rhinovirus, enterovirus, etc.) infections.…”

Section: Epidemiological Characteristics Of Covid-19 In Childrenmentioning

confidence: 99%