Malnutrition: Percentage and Association with Prognosis in Patients Hospitalized for Coronavirus Disease 2019

Abstract

Previous studies have found a correlation between malnutrition and prognosis in respiratory infections. Our objectives were to determine (i) the percentage of malnutrition, and (ii) its prognosis in patients admitted for coronavirus disease 2019 (COVID-19). In this monocentric retrospective study, we consecutively included all adult patients presenting with acute COVID-19 between 9 April and 29 May 2020. Malnutrition was diagnosed on low body mass index (BMI) and weight loss ≥ 5% in the previous month and/or ≥ 10% in the previous six months. The Nutritional Risk Index (NRI) defined nutritional risk. Severe COVID-19 was defined as a need for nasal oxygen ≥ 6 L/min. We enrolled 108 patients (64 men, 62 ± 16 years, BMI 28.8 ± 6.2 kg/m2), including 34 (31.5%) with severe COVID-19. Malnutrition was found in 42 (38.9%) patients, and moderate or severe nutritional risk in 83 (84.7%) patients. Malnutrition was not associated with COVID-19 severity. Nutritional risk was associated with severe COVID-19 (p < 0.01; p < 0.01 after adjustment for C reactive protein), as were lower plasma proteins, albumin, prealbumin, and zinc levels (p < 0.01). The main cause of malnutrition was inflammation. The high percentage of malnutrition and the association between nutritional risk and COVID-19 prognosis supports international guidelines advising regular screening and nutritional support when necessary.

Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19)

“…Three studies used both traditional measures and calculated indices [ 34 , 45 , 55 ]. COVID-19 related outcomes addressed in these studies included disease severity [ 34 ], COVID-19 complications (such as renal/hepatic injury [ 45 ] and muscle dystrophy [ 41 ]), admission to the ICU [ 47 ], need for oxygen therapy [ 56 ], and in-hospital mortality [ 41 , 43 , 45 , 47 , 54 , 55 ]. One study evaluated the length of hospital stay (LOS), hospital expenses, loss of appetite, and weight loss [ 34 ] while many studies evaluated the association between malnutrition and markers of inflammation [ 28 , 41 , 45 , 53 , 54 , 55 ].…”

“…Compared with severely ill patients, critically ill patients express significantly lower levels of total protein, serum albumin, and prealbumin as well as significantly higher levels of serum urea nitrogen, creatinine, glucose, and total bilirubin [ 28 , 37 ]. Nutritional markers in severe/critical COVID-19 patients correlated with NRS-2002 [ 28 ] and NRI [ 56 ]. Likewise, among remitting patients, MNA scores correlated with nutritional markers [ 52 ].…”

“…Male gender is associated with increased occurrence of nutritional deficiency and adverse effects of COVID-19 [ 41 , 47 ]. According to Table 1 , most nutritional biomarkers/measures correlated with biomarkers of inflammation [ 28 , 41 , 55 , 56 ], weight loss [ 34 , 51 , 52 , 56 ], disease severity, prolonged LOS [ 28 , 34 ], preexisting comorbidities (e.g., diabetes [ 41 , 47 , 48 , 50 ], obesity [ 50 , 52 , 56 ], and hypertension [ 41 , 47 , 48 ]), acute myocardial injury [ 41 , 43 ], ICU admission [ 53 ], poor appetite [ 34 ], old age [ 47 ], incidence of ARDS, secondary infection, shock, and use of vasopressors [ 43 ]. Antibiotics, antiviral drugs, and bowel invasion by SARS-CoV-2 induce GI symptoms such as diarrhea, vomiting, and anorexia [ 33 , 34 , 35 , 54 , 61 ].…”

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

“…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 Infection-Related Weight Loss Decreases Eating/Swallowing Function in Schizophrenic Patients

“…Subjects who had a ≥10% weight loss showed a significant association with decreased eating function and transition to parenteral feeding. Allard et al [ 23 ] reported that a large number of patients admitted due to COVID-19 had malnutrition. COVID-19 is also known to cause gastrointestinal symptoms, diarrhea, mild abdominal pain, nausea, vomiting, and loss of appetite, making it a potential cause of nutritional disorders [ 24 ].…”