Persistent malnutrition after COVID-19 infection may worsen outcomes, including delayed recovery and increased risk of rehospitalization. This study aimed to determine dietary intakes and nutrient distribution patterns after acute COVID-19 illness. Findings were also compared to national standards for intake of energy, protein, fruit, and vegetables, as well as protein intake distribution recommendations. Participants (≥18 years old, n = 92) were enrolled after baseline visit at the Post-COVID Recovery Clinic. The broad screening battery included nutritional assessment and 24-h dietary recall. Participants were, on average, 53 years old, 63% female, 69% non-Hispanic White, and 59% obese/morbidly obese. Participants at risk for malnutrition (48%) experienced significantly greater symptoms, such as gastric intestinal issues, loss of smell, loss of taste, or shortness of breath; in addition, they consumed significantly fewer calories. Most participants did not meet recommendations for fruit or vegetables. Less than 39% met the 1.2 g/kg/day proposed optimal protein intake for recovery from illness. Protein distribution throughout the day was skewed; only 3% met the recommendation at all meals, while over 30% never met the threshold at any meal. Our findings highlight the need for nutritional education and support for patients to account for lingering symptoms and optimize recovery after COVID-19 infection.

Objectives Dietary proteins can be broadly characterized by their origin (animal-or plant-based) and amino acid composition (complete vs. incomplete). Meals containing > 20 g of high-quality, complete protein have repeatedly been shown to robustly stimulate skeletal muscle protein synthesis. However, breakfast in many Western countries is dominated by wheat-based products. Wheat and bread are considered a “lower-quality” incomplete source of protein, containing relatively low amounts of lysine and threonine. We hypothesized that a meal containing > 20 g of wheat-based protein would offer no anabolic advantage over a control meal containing only 5 g of plant-based protein. Methods In a subset of healthy, middle-aged women from our recently completed trial (n = 6/17, 53 ± 7 y, 27 ± 2 kg/m2), we measured post-prandial skeletal muscle protein synthesis,  blood glucose, insulin and appetite for 3 h following the ingestion of: i) a wheat-based protein meal (INCOMPLETE: 717 kcal,  23 g protein, 120 g carbohydrate, 16 g fat) or ii) a low protein, plant-based, control meal (CONTROL: 542 kcal,  5 g protein, 86 g carbohydrate and 23 g fat). Venous blood samples and vastus lateralis muscle biopsy samples were obtained during a primed (2.0 mmol/kg) constant infusion (0.08 mmol/(kg/min)) of L-[ring-13C6]phenylalanine. All analyses were performed using established, standard techniques. Results Preliminary results indicate post-prandial skeletal muscle protein synthesis was similar in both cohorts (INCOMPLETE: 0.050 ± 0.012%/h vs. CONTROL: 0.054 ± 0.025%/h; p = 0.83) and consistent with fasting values historically measured by our lab. Blood glucose area under the curve (AUC; p = 0.82), insulin AUC (p = 0.85) and hunger AUC were similar in both cohorts. Conclusions A moderate serving of incomplete protein failed to robustly stimulate skeletal muscle protein synthesis. Consumption of a higher-quality,  completeprotein meal is likely required to acutely increase muscle protein anabolism. Funding Sources National Cattlemen's Beef Association

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