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

Abstract

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.

Effects of Rehabilitation on Long-COVID-19 Patient’s Autonomy, Symptoms and Nutritional Observance

“…Concerning weight changes, the majority of our population was overweight before the COVID-19 pandemic started. This is consistent with previous data [ 4 ] showing a high rate of people with obesity being infected and placed in intensive care, and that might explain why patients did not reach their pre-hospitalization weight after rehabilitation. Indeed, nutritional recommendations systematically provided to the patients aimed to help them normalize their BMI.…”

“…Accordingly, we observed that sarcopenia—defined as reduced muscle mass and strength—was related to the duration of hospitalization after COVID-19 infection [ 21 ], and a common hypothesis is that hospitalization and/or a SARS-CoV2-related increase in muscle weakness likely causes, in turn, a decrease in the GIR [ 22 , 23 ]. From this perspective, pre-existing comorbidities are also likely involved since they are associated not only with the need for hospitalization but also likely with persistent alteration [ 4 , 24 ].…”

“…As the SARS-CoV-2 pandemic has spread throughout the world, research has allowed us to increase our knowledge of this virus and to optimize COVID-19 infection prevention and treatment [ 1 ]. However, to date, studies concerning the nutritional status of patients after a COVID-19 hospitalization, in the long term, are relatively few and those concerning their autonomy are even fewer [ 2 , 3 , 4 ].…”

Impact of COVID-19 Infection and Persistent Lingering Symptoms on Patient Reported Indicators of Nutritional Risk and Malnutrition

“…A study by Gerard et al followed 288 COVID-19 patients discharged from the hospital at 30 days post-discharge and six months post-discharge to evaluate the presence of malnutrition. At 30 days, 47.2% of patients evaluated were malnourished, and at 6 months, 36% of the patients previously identified with malnutrition still had malnutrition based on GLIM criteria [ 23 ].…”

COVID-19 Disease and Outcomes among Critically Ill Patients: The Case of Medical Nutritional Therapy

“…This finding supports the hypothesis that these patients obviously do not receive optimal nutritional care. Additionally, disease symptoms and de-arrangement of the nutritional status persists until 6 months after hospital discharge, as an interesting French study published in this SI informed us [ 6 ]. The authors supported the hypothesis that COVID-19 patients had a much higher risk of developing muscle weakness, malnutrition and functional loss.…”