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The nutritional sequelae of COVID-19 have not been explored in a large cohort study.ObjectivesTo identify factors associated with the change in nutritional status between discharge and 30 days post-discharge (D30). Secondary objectives were to determine the prevalence of subjective functional loss and severe disability at D30 and their associated factors.MethodsCollected data included symptoms, nutritional status, self-evaluation of food intake, Performance Status (PS) Scale, Asthenia Scale, self-evaluation of strength (SES) for arms and legs at discharge and at D30. An SES <7 was used to determine subjective functional loss. A composite criteria for severe disability was elaborated combining malnutrition, subjective functional loss and PS >2. Patients were classified into three groups according to change in nutritional status between discharge and D30 (persistent malnutrition, correction of malnutrition and the absence of malnutrition).ResultsOf 549 consecutive patients hospitalised for COVID-19 between 1 March and 29 April 2020, 130 died including 17 after discharge (23.7%). At D30, 312 patients were at home, 288 (92.3%) of whom were interviewed. Of the latter, 33.3% were malnourished at discharge and still malnourished at D30, while 23.2% were malnourished at discharge but no longer malnourished at D30. The highest predictive factors of persistent malnutrition were intensive care unit (ICU) stay (OR=3.42, 95% CI: 2.04 to 5.75), subjective functional loss at discharge (OR=3.26, 95% CI: 1.75 to 6.08) and male sex (OR=2.39, 95% CI: 1.44 to 3.97). Subjective functional loss at discharge (76.8%) was the main predictive factor of subjective functional loss at D30 (26.3%) (OR=32.6, 95% CI: 4.36 to 244.0). Lastly, 8.3% had a severe disability, with a higher risk in patients requiring an ICU stay (OR=3.39, 95% CI: 1.43 to 8.06).ConclusionPatients who survived a severe form of COVID-19 had a high risk of persistent malnutrition, functional loss and severe disability at D30. We believe that nutritional support and rehabilitation should be strengthened, particularly for male patients who were admitted in ICU and had subjective functional loss at discharge.Trial registration numberNCT04451694.

NutriCoviD30 is a longitudinal multicenter cohort study that aimed to provide nutritional objective data of inpatients during COVID-19 infection. Food intake and weight trajectories, as well as clinical signs of the disease, pre-existing chronic diseases, and nutritional strategies were collected and analyzed during the course of the disease. Their association was estimated using mixed-effect regression modeling. Patients were recruited from French university hospitals from May until July 2020. For the 403 included patients (mean age 62.2 ± 14.2 years; 63% males), median [interquartile] hospitalization duration was 13 days [8; 20], and 30% of patients were admitted in intensive care unit. Patients declared a median 70% food intake decrease in the acute phase, and the disease resulted in an average loss of 8% of the pre-disease weight (corresponding to -6.5 kg). While most patients recovered their usual food intake one month after hospital discharge, they only regained half of their weight loss, such that malnutrition, which affected 67% of patients during their hospitalization, persisted in 41% of them. Patients with overweight, obesity and diabetes reported an additional weight loss of over 1.5% of their initial bodyweight during the hospitalization and recovery phase. In order to prevent malnutrition and its long-term effect, mainly combined with a rapid weight loss predominantly affecting lean body mass, implementation of nutritional support is needed for COVID-19 inpatients. It should start early in the course of the infection, and be extended up to the recovery phase.

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