Association between malnutrition and post–acute COVID-19 sequelae: A retrospective cohort study, 2024, Ponce et al.

SNT Gatchaman

SNT Gatchaman

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Association between malnutrition and post–acute COVID-19 sequelae: A retrospective cohort study
Jana Ponce; A. Jerrod Anzalone; Makayla Schissel; Kristina Bailey; Harlan Sayles; Megan Timmerman; Mariah Jackson; Jonathan Tefft; Corrine Hanson;

BACKGROUND
Long coronavirus disease consists of health problems people experience after being infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). These can be severe and include respiratory, neurological, and gastrointestinal symptoms, with resulting detrimental impacts on quality of life. Although malnutrition has been shown to increase risk of severe disease and death during acute infection, less is known about its influence on post–acute COVID‐19 outcomes. We addressed this critical gap in knowledge by evaluating malnutrition's impact on post–COVID‐19 sequelae.

METHODS
This study leveraged the National COVID Cohort Collaborative to identify a cohort of patients who were at least 28 days post–acute COVID‐19 infection. Multivariable Cox proportional hazard models evaluated the impact of malnutrition on the following postacute sequelae of SARS‐CoV‐2: (1) death, (2) long COVID diagnosis, (3) COVID‐19 reinfection, and (4) other phenotypic abnormalities. A subgroup analysis evaluated these outcomes in a cohort of hospitalized patients with COVID‐19 with hospital‐acquired (HAC) malnutrition.

RESULTS
The final cohort included 4,372,722 individuals, 78,782 (1.8%) with a history of malnutrition. Individuals with malnutrition had a higher risk of death (adjusted hazard ratio [aHR]: 2.10; 95% CI: 2.04–2.17) and SARS‐CoV‐2 reinfection (aHR: 1.52; 95% CI: 1.43–1.61) in the postacute period than those without malnutrition. In the subgroup, those with HAC malnutrition had a higher risk of death and long COVID diagnosis.

CONCLUSIONS
Nutrition screening for individuals with acute SARS‐CoV‐2 infection may be a crucial step in mitigating life‐altering, negative postacute outcomes through early identification and intervention of patients with malnutrition.

Link | PDF (Journal of Parenteral and Enteral Nutrition) [Open Access]
 
See also —

Malnutrition and the Post-Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Multi-Institutional Population-Based Propensity Score-Matched Analysis (2024)
Lee, Cheng-Ya; Liang, Yung-Chun; Hsu, Wan-Hsuan; Tsai, Ya-Wen; Liu, Ting-Hui; Huang, Po-Yu; Chuang, Min-Hsiang; Hung, Kuo-Chuan; Lee, Mei-Chuan; Yu, Tsung; Lai, Chih-Cheng; Weng, Tzu-Chieh; Wu, Jheng-Yan

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global health crisis, exacerbating issues like malnutrition due to increased metabolic demands and reduced intake during illness. Malnutrition, a significant risk factor, is linked to worse outcomes in patients with COVID-19, such as increased mortality and extended hospital stays. This retrospective cohort study investigated the relationship between malnutrition and clinical outcomes within 90–180 days using data obtained from the TriNetX database.

Patients aged >18 years diagnosed with COVID-19 between 1 January 2022, and 31 March 2024 were enrolled in the study. The propensity score-matching (PSM) method was used to match patients with malnutrition (malnutrition group) and those without malnutrition (control group). The primary composite outcome was the cumulative hazard ratio (HR) for post-COVID-19 condition, all-cause hospitalization, and all-cause mortality between 90 days and 180 days after COVID-19 diagnosis. The secondary outcomes were the individual components of the primary outcomes. Two cohorts, each consisting of 15,004 patients with balanced baseline characteristics, were identified using PSM.

During the 90–180-day follow-up period, the malnutrition group exhibited a higher incidence of all-cause hospitalization, mortality, or post-COVID-19 condition (HR = 2.315, 95% confidence interval: 2.170–2.471, p < 0.0001). Compared with patients with COVID-19 without malnutrition, those with malnutrition may be associated with a higher risk of adverse clinical outcomes.

Link | PDF (Life) [Open Access]
 
The first one is frustrating.

Analysis with the large database - pre-Covid malnutrition events
Compared with those without malnutrition, individuals with malnutrition were older (median age: 64 vs 48 years), had a higher CCI (median CCI: 5 vs, 0) and had a higher severity of COVID-19 illness (P < 0.001 for all).
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Table 2 shows the univariate and multivariate analyses of the primary and secondary outcomes by malnutrition group. Following adjustment for confounders, individuals with malnutrition were 2.10 times (aHR: 2.10; 95% CI: 2.04–2.17) more likely to die in the postacute (days 28–180) period than those without malnutrition (Figure 1). Patients with malnutrition were also 1.52 times (aHR: 1.52; 95% CI: 1.43–1.61) more likely to have a SARS-CoV-2 reinfection >90 days after initial infection than individuals without malnutrition. The malnutrition group's risk of many other phenotypic abnormalities, including abnormality of the digestive system (aHR: 1.51; 95% CI: 1.48–1.54), abnormality of blood and blood forming tissues (aHR: 1.32; 95% CI: 1.30–1.35), and abnormality of the respiratory system (aHR: 1.16; 95% CI: 1.14–1.17) were likewise increased. There was slight protective association between malnutrition status and long COVID diagnosis (aHR: 0.92; 95% CI: 0.86–0.98).
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So, using the large sample, people with a history of malnutrition had a higher chance of death. The sentence at the end of that last quote says "There was slight protective association between [prior] malnutrition status and Long Covid diagnosis". Note, that finding didn't make it into the abstract.
The people with a history of malnutrition actually had twice the risk of the others of being diagnosed with Long Covid. But after adjustment for confounders, the people with a history of malnutrition had a risk that was 92% of the others. There's really not much we can take away from that given the likely difficulty of properly accounting for the confounders.


Analysis of the data for people with hospital acquired malnutrition
The subgroup analysis consisted of 163,098 acute COVID-19 survivors hospitalized within 14 days of original COVID-19 infection for a minimum of 5 days and a maximum of 27 days with no prior history of malnutrition. Of this subgroup, 4212 (2.6%) survivors were diagnosed with malnutrition between hospital days 5 and 27. ... Those with HAC malnutrition were again older (median age of 71 vs 66) with a higher median CCI (4 vs 3), more severe COVID-19 illness (P < 0.001 for all), and higher median numbers of healthcare visits before (number of visits: 28 vs 21) but not after (number of visits: 17 vs 17) SARS-CoV-2 infection (P < 0.001).
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In adjusted analyses, patients in the HAC malnutrition group were 2.31 times (aHR: 2.31; 95% CI: 2.15–2.49) more likely to die in the 28–180-day postacute period and 1.56 times (aHR: 1.56; 95% CI: 1.33–1.82) more likely to be diagnosed with long COVID (Table 3).
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It's "hospital acquired malnutrition" - I'm guessing the people didn't get it because they didn't like the hospital food. These people would have had all sorts of health issues going on. Really, until we have a biomarker, I can't see the point of these studies. Long Covid covers all sorts of issues - exhaustion, confusion, coughing, pain... and these people had plenty of reasons to have those various issues.

I am thinking that studies like this just fritter away the Long Covid research funds - there was never going to be any result that would move things forward.
 
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