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Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19

Published in Nutrients, November 2021

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Interested in long COVID? The post-acute effects of COVID-19 are diverse, with a range of symptoms and signs that persist for more than 12 weeks with prolonged multisystem involvement. Malnutrition and a variety of nutritional symptoms can manifest in this patient group.

This French study, just published in Nutrients, looked in depth at persistent symptoms, nutritional status, and changes in muscle strength and performance status (PS) 3 and 6 months after hospital discharge in COVID-19 survivors (March & April 2020). 

At home 30 days after discharge (288 patients, age 59.8 ± 16.6 y), nearly half (n 136) presented with persistent malnutrition, significant decline in muscle strength or a PS ≥ 2. 

These patients were receiving dietary counselling, nutritional supplementation, adapted physical activity guidance or physiotherapy assistance, or were in post-care facilities. 

At 6 months post-discharge (119 patients), 36.0% had persistent malnutrition, 14.3% complained of a significant reduction in their muscle strength and 15% had a performance status > 2. 

As the authors commented, malnutrition and functional decline occurred despite nutritional intervention:

At 6 months, 15% of the initial cohort remained malnourished despite nutritional counselling during hospitalization and ensuing dietary guidance, oral nutritional supplements, or relocation to rehabilitation centers, 6% complained of a significant decrease in muscle strength..’

However, notably, in this cohort, 21% of patients were already undernourished at admission and the investigators highlighted that malnutrition tended to have begun during the initial phases of the disease at home with patients being admitted to hospital with significant involuntary weight loss.

Interestingly, in patients with impairment, obesity was significantly more frequent than in those without impairment (52.8% vs. 31.0%), and these patients were admitted significantly more frequently to ICU (50.9% vs. 31.3%). 

The authors concluded that ‘Obese subjects as well as patients who have stayed in intensive care have a higher risk of functional loss or undernutrition 6 months after a severe COVID infection. Malnutrition and loss of muscle strength should be considered in the clinical assessment of these patients’.

However, critically, further research is warranted to understand what the optimal nutritional interventions are to manage both the early stages of COVID (pre-hospital admission) and long COVID, likely in conjunction with other strategies.