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

Abstract

Patients with COVID‐19 disease are prone to develop significant weight loss and clinical cachexia. Three reports with altogether 589 patients that reported on weight loss and cachexia in COVID‐19 were identified. Disease severity of patients and the timing of the assessment during the disease course in these patients were variable—65 patients (11%) were intensive care treated at the time of assessment, and 183 (31%) were cared for in sub‐intensive or intermediate care structures. The frequency of weight loss ≥5% (that defines cachexia) was 37% (range 29–52%). Correlates of weight loss occurrence were reported to be raised C‐reactive protein levels, impaired renal function status, and longer duration of COVID‐19 disease. Underweight status by WHO criteria (BMI < 18.5 kg/m2) was only observed in 4% of patients analysing data from seven studies with 6661 patients. Cachexia assessment in COVID‐19 needs assessment of weight loss. COVID‐19 associated cachexia is understood to affect muscle and fat tissue as is also seen in many other chronic illness‐associated forms of cachexia. There are many factors that can contribute to body wasting in COVID‐19, and they include loss of appetite and taste, fever and inflammation, immobilization, as well as general malnutrition, catabolic–anabolic imbalance, endocrine dysfunction, and organ‐specific complications of COVID‐19 disease such as cardiac and renal dysfunction. Treatment of COVID‐19 patients should include a focus on nutritional support and rehabilitative exercise whenever possible. Specific anti‐cachectic therapies for COVID‐19 do not exist, but constitute a high medical need to prevent long‐term disability due to acute COVID‐19 disease.

Hyperactivated RAGE in Comorbidities as a Risk Factor for Severe COVID-19—The Role of RAGE-RAS Crosstalk

“…The deleterious crosstalk between RAGE and RAS might be active also in the muscles of severe COVID-19 patients who develop cachexia [108], a complex metabolic syndrome characterized by the loss of muscle mass and body weight, since both RAGE and RAS signals play crucial roles in inducing muscle protein breakdown [109]. Skeletal muscle tissue expresses a considerable amount of ACE2 [110], making muscles potential targets of SARS-CoV-2.…”

Nutrition risk prevalence and nutrition care recommendations for hospitalized and critically-ill patients with COVID-19

“…Hospitalized COVID-19 patients experience many of the factors that define cachexia, including significant weight loss, impaired functional status, loss of appetite, and inflammation [14e16,26]. A recent review of three papers including 589 patients reports 37% of hospitalized COVID-19 patients had cachexia which was correlated with elevated C-reactive protein, impaired renal function, and longer duration of illness [42]. Underweight status (defined as < 18 kg/m 2 ) was reported in only 4% of patients from 7 studies including 6661 patients indicating that initial weight status in this population alone may be insufficient; thus, monitoring of weight loss is important to identify nutritional risk.…”

COVID-19 and cytokine storm syndrome: can what we know about interleukin-6 in ovarian cancer be applied?

“…The actions of IL-6 on muscle wasting are dose-and time-dependent. Indeed, recent data showed that patients with COVID-19 develop weight loss and cachexia that correlated with high levels of inflammatory parameters (CRP), impaired renal function status, and longer duration of COVID-19 disease [113]. Therefore, the prolonged exposure to high IL-6 in patients with severe COVID-19 may lead to serious muscle wasting, which significantly worsens lung functional capacity and, through the associated negative energy balance, contributes to organ failure, including respiratory failure, as similarly reported in other severe viral infectious diseases [114,115].…”