Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience

Abstract

Background & Aims The effect of the COVID-19 infection on nutritional status is not well established. Worldwide epidemiological studies have begun to investigate the incidence of malnutrition during hospitalization for COVID-19. The prevalence of malnutrition during follow-up after COVID-19 infection has not been investigated yet. The primary objective of the present study was to estimate the prevalence of the risk of malnutrition in hospitalized adult patients with COVID-19, re-evaluating their nutritional status during follow-up after discharge. The secondary objective was to identify factors that may contribute to the onset of malnutrition during hospitalization and after discharge. Methods We enrolled 142 COVID-19 patients admitted to Careggi University Hospital. Nutritional parameters were measured at three different timepoints for each patient: upon admission to hospital, at discharge from hospital and 3 months after discharge during follow-up. The prevalence of both the nutritional risk and malnutrition was assessed. During the follow-up, the presence of nutritional impact symptoms (NIS) was also investigated. An analysis of the association between demographic and clinical features and nutritional status was conducted. Results The mean unintended weight loss during hospitalization was 7.6% (p<0.001). A positive correlation between age and weight loss during hospitalization was observed (r=0.146, p=0.08). Moreover, for elderly patients (>61 years old), a statistically significant correlation between age and weight loss was found (r=0.288 p=0.05). Patients admitted to an Intensive Care Unit (ICU) or Intermediate Care Unit (IMCU) had a greater unintended weight loss than patients who stayed in a standard care ward (5.46% vs 1.19%; p<0.001). At discharge 12 patients were malnourished (8.4%) according to the ESPEN definition. On average, patients gained 4.36 kg (p<0.001) three months after discharge. Overall, we observed a weight reduction of 2.2% (p<0.001) from the habitual weight measured upon admission. Patients admitted to an ICU/IMCU showed a higher MUST score three months after discharge (Cramer’s V 0.218, p=0.035). With regard to the NIS score, only 7 patients (4.9%) reported one or more nutritional problems during follow-up. Conclusions The identification of groups of patients at a higher nutritional risk could be useful with a view to adopting measures to prevent worsening of nutritional status during hospitalization. Admission to an ICU/IMCU, age and length of the hospital stay seem to have a major impact on nutritional status. Nutritional follow-up should be guaranteed for patients who lose more than 10% of their habitual weight during their stay in hospital, especially after admission to an ICU/IMCU.

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

“…Contrary to our results, a study conducted in a cohort of severe COVID-19 patients assessing nutritional status 3 months after discharge from hospital [29] reported that only 8.4% of patients were malnourished at discharge and none at 3 months. Malnutrition was correlated with severity of the disease, indirectly inferable from an assessment of length of hospital stay and need for admission to ICU.…”

“…In our cohort, 20.7% of patients were already undernourished at admission. Malnutrition tended to have begun during the initial phases of the disease occurring at home since, upon admission, patients declared significant involuntary weight loss when compared to their habitual weight [29]. However, it is not excluded that malnutrition may precede the infection.…”

Factors Associated with Significant Weight Loss in Hospitalised Patients with COVID-19: A Retrospective Cohort Study in a Large Teaching Hospital

“…Furthermore, ≥10% weight loss during hospital admission was positively associated with the length of hospital stay. These results are consistent with previously published reports, showing the length of hospital stay to be a significant risk factor for malnutrition [ 24 , 27 ]. The length of stay does not precede weight loss and is likely to be a marker of disease severity; however, high CRP, SpO2/FiO2 ratio, and ICU admission (proxy markers of disease severity) did not remain significant in the multivariable analysis, suggesting that a longer length of stay may increase the risk of significant weight loss, independent of disease severity.…”

Malnutrition management of hospitalized patients with diabetes/hyperglycemia and COVID-19 infection

“…It has been shown that COVID-19 patients who lose more than 10% of their habitual weight during their hospital stay or are admitted to an ICU present a high nutritional risk during follow-up [46]. The group of experts and the panelists agreed on the necessity of a new nutritional assessment before hospital discharge and to maintain the diabetesspecific oral supplements if patients are still malnourished.…”