High nutritional risk worsens COVID-19

Elderly coronavirus disease 2019 (COVID-19) patients with high nutritional risk appear to suffer worse outcomes, such as longer hospital stay and greater disease severity, according to a recent study.

“[O]ur findings will heighten clinicians’ awareness about the importance of nutritional screening in patients hospitalized with COVID-19, as well as spreading awareness that strengthening nutrition can improve disease outcomes,” researchers said.

The retrospective study included 141 COVID-19 patients (mean age, 71.688±5.851 years; 73 females). Most (n=73) had severe disease; 46 had common COVID-19 and 22 had extremely severe infections. Using four nutritional tools to group participants into those with normal nutrition vs those at risk, researchers found no baseline differences in terms of age, sex, and comorbidities. [Eur J Clin Nutr 2020;74:876-883]

The four nutritional tools used were the Nutrition Risk Screening 2002 (NRS 2002), Malnutrition Universal Screening Tool (MUST), Mini Nutrition Assessment Shortcut (MNA-sf), and the Nutrition Risk Index (NRI).

Multivariate analysis revealed that length of hospital stay (LOS) was significantly longer in patients who were at nutritional risk, as assessed by NRS 2002 (odds ratio [OR], 0.102, 95 percent confidence interval [CI], 0.042–0.250; p=0.000), MNA-sf (OR, 0.401, 95 percent CI, 0.198–0.813; p=0.0110), and NRI (OR, 0.261, 0.133–0.513; p=0.000).

Similarly, nutritional risk as assessed by these three tools corelated significantly with the patient’s change in appetite and change in weight. In terms of disease severity, only those at nutritional risk in the NRS 2002 (OR, 0.095, 95 percent CI, 0.031–0.292; p=0.000) and NRI (OR, 0.367, 0.173–0.776; p=0.009) were significantly more likely to experience worse outcomes.

The MUST score, in comparison, was only significantly associated with changes in appetite (OR, 2.866, 95 percent CI, 1.449–5.669; p=0.002) and weight (OR, 0.009, 95 percent CI, 0.003–0.026; p=0.000).

The findings from these logistic regression models were reflected in subsequent receiver operating characteristic (ROC) curve analyses. For example, NRS 2002 (area under the curve [AUC], 0.724, 95 percent CI, 0.640–0.808; p=0.000), MNA-sf (AUC, 0.602, 95 percent CI, 0.304–0.492; p=0.032), and NRI (AUC, 0.664, –0.579 to 0.741; p=0.000) were all strongly predictive of LOS >30 days.

In contrast, MUST (p=0.887) and body mass index (p=0.934) were not.

“Agreement was strong between the NRS 2002, MNA-sf, and NRI tools. Therefore, our findings suggest that the NRS 2002, MNA-sf, and NRI are useful and practical tools for identifying older adult patients with COVID-19 who are at nutritional risk,” the researchers said.

Limitation of the study included a small sample size; the use of body mass index as a measure, which is an accurate metric of body composition; the failure to assess for sarcopoenia, a strong marker of nutritional status in the elderly; and the lack of randomization. The researchers also did not conduct dynamic testing for nutritional status and were not able to account for potential differences between the acute and recovery phases of the disease.

“The purpose of nutritional screening is to identify patients at nutritional risk, aiming to prevent further declines in nutritional status during hospitalization and, in turn, improve clinical outcomes,” the researchers said. “Therefore, we recommend early intervention for patients with COVID-19 who are found to be at nutritional risk.”