COVID-19 infection and 2-year mortality in nursing home residents who survived the first wave of the pandemic (preprint)

Background During the first COVID-19 pandemic wave (1stCoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents.Methods This was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food and hospitalization during lockdown. Nonadjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality.Results Among the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81–1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03–1.08], p < 0.01), severe disability vs moderate or no disability (HR = 1.35 [1.12–1.63], p < 0.01) and severe malnutrition vs no malnutrition (HR = 1.29 [1.04–1.60], p = 0.02).Conclusions Having survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs, suggesting that most of these residents recovered from the infection without COVID-19-related life-threatening sequelae.

Predictors factors of COVID-19-associated mortality in dialysis patients: Importance of nutritional status (preprint)

Background Patients with comorbidities, such as chronic renal disease, are susceptible to severe COVID-19 infection. Dialysis patients have a high prevalence of malnutrition, and it has been demonstrated association between nutritional status and several unfavorable outcomes in this population. The aim of this study was to assess nutritional status through Malnutrition-Inflammation Score (MIS) and phase angle (PhA), along with demographic and biochemical indicators and verify whether they are predictive variables of outcomes in dialysis patients with COVID-19 infection.Methods An observational, retrospective, cross sectional type study was undertaken in a Nephrology and Dialysis center in a tertiary hospital at São Paulo city. We evaluated data from EMR from 37 dialysis patients who had COVID-19 infection (RT-PCR) between march 2020 and december 2021. A Logistic regression was used in order to evaluate risk factors associated with mortality. Then we compared with a cohort of 31 dialysis patients infected with COVID-19 in the post-vaccionation period.Results Regarding MIS, age, and phase angle (PhA), we observed that for each unit increase in MIS previously to COVID-19 infection, there was a 30% increase in mortality risk (adj OR = 1.3, CI 1.0-1.8, p = 0.068) and that patients above 65 years had 8 times higher chance to die (adj OR = 8.8, CI 0.8–102, p = 0.082). Yet, for each unit increase in PhA, there was a 50% decrease in death risk (adj OR = 0.5, IC 0.2–1.1, p = 0.097), although no significance was found after logistic regression. After immunization, we found a attenuation of impact of nutritional status after COVID-19 infection, as demonstrated by a small, non-significant increase in MIS score, and with a low hospitalization need and no death.Conclusions The present study demonstrated a trend that age is the main variable determining outcomes of COVID-19 infection in dialysis patients. Besides that, we demonstrated the importance of nutritional status (MIS e PhA), since it appears to increase mortality risk when baseline nutritional status is worse and compromised after the COVID-19 infection, which was clearly abrogated with vaccination.

Impact of COVID-19 Lockdown Measures on Mother and Child Health – The case of Ghana (preprint)

Background  The lockdown measures in response to the coronavirus disease (COVID-19) have led to a wide range of unintended consequences for women and children. Until the outbreak of COVID-19, attention was on reducing maternal and infant mortality due to pregnancy and delivery complications. The aim of this study was to interrogate the impact of lockdown measures on women and children in two contrasting districts in Ghana – Krobo Odumase and Ayawaso West Wuogon. Methods This study adopted the mixed-method approach using both qualitative and quantitative data. The qualitative study relied on two data collection methods to explore the impacts of COVID-19 control measures on women and children in Ghana. These were: Focus Group Discussions (FGDs; n=12) and Key Informant Interviews (KIIs; n = 18).The study complemented the qualitative data with survey data - household surveys (n = 78) and policy data gathered from government websites consisting of government responses to COVID-19. Results  Engagements with participants in the study revealed that the lockdown measures implemented in Ghana had consequences on child and maternal health, and the health care system as a whole. Our study revealed, for example, that there was a decrease in antenatal and postnatal attendance in hospitals. Childhood vaccinations also came to a halt. Obesity and malnutrition were found to be common among children depending on the location of our study participants (urban and rural areas respectively). Our study also revealed that TB, Malaria and HIV treatment seeking reduced due to the fear of going to health facilities since those ailments manifest similar symptoms as COVID 19. Conclusion  Government responded to COVID-19 using different strategies however the policy response resulted in both intended and unintended consequences especially for women and children in Ghana.  It is recommended that national policy directions should ensure the continuous provision of child and maternal healthcare services which are essential health services during lockdowns.

Changes in the medical admissions and mortality amongst children in four South African hospitals following the COVID -19 pandemic: A five-year review. (preprint)

BackgroundVulnerable children from poor communities with high HIV and Tuberculosis(TB) burdens were impacted by COVID-19 lockdowns. Concern was raised about the extent of this impact and anticipated post-pandemic surges in mortality. MethodsInterrupted time series segmented regression analyses were done using routinely collected facility-level data of children admitted for medical conditions at four South African referral hospitals. Monthly admission and mortality data over a 60-month period from 01 April 2018 to 31 January 2023 was analysed using models which included dummy lockdown level variables, a dummy post-COVID period variable, Fourier terms to account for seasonality, and excess mortality as a proxy for healthcare burden. ResultsOf the 45 015 admissions analysed, 1237(2{middle dot}75%) demised with significant decreases in admissions during all the lockdown levels, with the most significant mean monthly decrease of 450(95%, CI=657{middle dot}3, -244{middle dot}3) p<0{middle dot}001 in level 5 (the most severe) lockdown. There was evidence of loss of seasonality on a six-month scale during the COVID periods for all admissions (p=0{middle dot}002), including under-one-year-olds (p=0{middle dot}034) and under-five-year-olds (p=0{middle dot}004). No decreases in mortality accompanied decreased admissions. Post-pandemic surges in admissions or mortality were not identified in children with acute gastroenteritis, acute pneumonia and severe acute malnutrition. ConclusionDuring the COVID-19 pandemic, paediatric admissions in 4 hospitals serving communities with high levels of HIV, TB and poverty decreased similar to global experiences however there was no change in in-hospital mortality. No post-pandemic surge in admissions or mortality were documented. Differences in the impact of pandemic control measures on transmission of childhood infections and access to health care may account for differing outcomes seen in our setting compared to the global experiences. Further studies are needed to understand the impact of pandemic control measures on healthcare provision and transmission dynamics and to better inform future responses amongst vulnerable child populations.

Unveiling Vulnerabilities in Maternal-Child Health amidst COVID-19: A Cross-Sectional Study on Food Insecurity and Socio-Demographic Disparities in the U.S. (preprint)

ObjectiveEarly infancy is a critical time of development when stresses, nutritional deficiencies, and other challenges have lifelong consequences. Social distancing regulations due to the COVID-19 pandemic in 2020 led to abrupt changes in work status, childcare accessibility, and food availability. DesignThis cross-sectional study assessed responses regarding experiences during the COVID-19 pandemic, including food insecurity (validated two-question screener), WIC use, and changes in childcare accessibility and work status. Data were assessed using logistic regressions while controlling for sociodemographic factors. SettingNational U.S. online survey in July-August 2020. ParticipantsU.S. mothers (n=1861) with infants [≤]12 months old. ResultsWe detected a 34% increase in perceived food insecurity during July-August 2020 compared to that before the pandemic. Hispanic mothers had 74% higher odds of becoming food insecure than non-Hispanic White mothers. Mothers with infants <9 weeks old had a 7% increase in WIC utilization, although no overall increase in WIC usage was detected. Most mothers (71%) reported moderate or extreme impacts from the pandemic, with higher odds associated with childcare interruptions, working from home, and identifying as Hispanic or non-Hispanic Black. ConclusionsOur findings reveal specific sociodemographic groups of mothers with infants who were especially vulnerable during the COVID-19 pandemic. These insights hold significant value for tailoring supportive programs, equipping these groups for potential socioeconomic upheavals, and aiding their transition into the post-pandemic world.

Dissecting Clinical Features of COVID-19 in a Cohort of 21,312 Acute Care Patients (preprint)

COVID-19 has resulted in over 645 million hospitalization and 7 million deaths globally. However, many questions still remain about clinical complications in COVID-19 and if these complications changed with different circulating SARS-CoV-2 strains. We analyzed a 2.5-year retrospective cohort of 47,063 encounters for 21,312 acute care patients at five Central Texas hospitals and define distinct trajectory groups (TGs) with latent class mixed modeling, based on the World Health Organization COVID-19 Ordinal Scale. Using this TG framework, we evaluated the association of demographics, diagnoses, vitals, labs, imaging, consultations, and medications with COVID-19 severity and broad clinical outcomes. Patients within 6 distinct TGs differed in manifestations of multi-organ disease and multiple clinical factors. The proportion of mild patients increased over time, particularly during Omicron waves. Age separated mild and fatal patients, though did not distinguish patients with severe versus critical disease. Male and Hispanic/Latino demographics were associated with more severe/critical TGs. More severe patients had a higher rate of neuropsychiatric diagnoses, consultations, and brain imaging, which did not change significantly in severe patients across SARS-CoV-2 variant waves. More severely affected patients also demonstrated an immunological signature of high neutrophils and immature granulocytes, and low lymphocytes and monocytes. Interestingly, low albumin was one of the best lab predictors of COVID-19 severity in association with higher malnutrition in severe/critical patients, raising concern of nutritional insufficiency influencing COVID-19 outcomes. Despite this, only a small fraction of severe/critical patients had nutritional labs checked (pre-albumin, thiamine, Vitamin D, B vitamins) or received targeted interventions to address nutritional deficiencies such as vitamin replacement. Our findings underscore the significant link between COVID-19 severity, neuropsychiatric complications, and nutritional insufficiency as key risk factors of COVID-19 outcomes and raise the question of the need for more widespread early assessment of patients neurological, psychiatric, and nutritional status in acute care settings to help identify those at risk of severe disease outcomes.

Cries of Hunger from Children: Who Should Care? (preprint)

Save the Children has warned that the world is facing the biggest global hunger crisis of the 21st century, as it is estimated that 5.7 million children under five are on the edge of starvation across the globe. (Save the Children 2021). The number of people affected by hunger globally rose to as many as 828 million in 2021, an increase of about 46 million since 2020 and 150 million since the outbreak of the COVID-19 pandemic. According to a United Nations report; the world is moving further away from its goal of ending hunger, food insecurity and malnutrition in all its forms by 2030 (FAO 2022). The threat is that the rate of the problem trends promptly, while the maximum rate of those who are affected being children. This article navigates on the situation through a descriptive analysis mode, in order to detect the basics of the situation of hunger globally, how hunger mostly distresses children, actions performed in battling the problematic state and calling every individual to participate to care for the suffering children.

Gut microbiota, malnutrition, and immunity: COVID-19's confounding triad.

The coronavirus disease has swept the world, bringing scientists from multiple disciplines together to work on a focused cause. In this forum, we discuss different roles that microbiota, malnutrition, and immunity have on severity of coronavirus disease and the importance of studying them from a gut-systemic perspective using multi-omics approaches.

Alignment of Global Leadership Initiative on Malnutrition (GLIM) and Mini Nutritional Assessment (MNA) in the evaluation of nutritional status and its association with clinical outcomes of hospitalized COVID-19 patients (preprint)

Background and aims: Considering that nutritional status is one of the influential factors in the process of infection and recovery of patients with covid-19, this study was conducted to determine the nutritional status of covid-19 patients and its relationship with clinical outcomes.Methods This cross-sectional study included 155 patients diagnosed with covid-19 disease (aged 18 to 80 years) with PCR tests and Chest CT scans. The nutritional status of participants was assessed using the Mini Nutritional Assessment (MNA) questionnaire, Global Leadership Initiative on Malnutrition (GLIM) criteria, and the NUTRIC score tool.Results The analysis performed on the collected data from 81 men (52.3%) and 74 women (47.7%) showed that, based on the results of the MNA tool, 30 participants (19.4%) and based on the GLIM criteria, 42 participants (27.1%) were suffering from malnutrition. Also, systolic and diastolic blood pressure (GLIM SBP, DBP p-value = 0.038, 0.008 and MNA: SBP, DBP p-value = 0.04, 0.01) and blood oxygen saturation (MNA p-value = 0.01 and GLIM p-value = 0.012) was significantly associated with nutritional status of the participants. In addition, the results from the MNA and GLIM questionnaires showed a relative agreement with a value of 0.35 and p-value < 0.0001.Conclusion This study revealed that nutritional status is a critical factor that affects the clinical condition of covid-19 patients, which can affect the recovery process. In addition, the GLIM criterion is a practical and reliable tool to measure the nutritional status for diagnosis and prognosis of patients with Covid-19.

Copper and zinc deficiency to the risk of preterm labor in pregnant women: a case-control study.

OBJECTIVE: The present study explored the relationship between maternal copper and zinc levels and preterm labor. DESIGN: The design of the present study was a case-control. Two groups were matched in terms of early-pregnancy body mass index (BMI), pregnancy and childbirth rating, education level, income, and employment status. Blood samples were taken from mothers after meeting the inclusion criteria when admitted to the maternity ward to check copper and zinc serum levels. Demographic and midwifery data were also collected using a questionnaire and patient records. The data were analyzed in SPSS26 using independent-samples T-test, chi-square, Fisher exact test, and regression analysis, and the p < 0.05 was considered statistically significant. SETTING: Bohloul Hospital in Gonabad, Iran. PARTICIPANTS: The subjects were 86 pregnant women visiting the hospital in two cases (preterm delivery) and control (term delivery) groups. RESULTS: The mean serum level of zinc in the case group (preterm delivery) (44.97 ± 13.06 µg/dl) was significantly lower than the control group (term) (52.63 ± 21.51 µg/dl), and the mean serum level of copper in the case group (149.82 ± 53.13 µg/dl) was significantly lower than the control group (183.97 ± 71.40 µg/dl). CONCLUSION: As the findings showed, copper and zinc serum levels in mothers with preterm delivery were significantly lower than mothers with term delivery, which shows the biological role of these elements in the pathogenesis of preterm delivery.

Expansion of national laboratory capacity in the Federal Republic of Somalia throughout the COVID-19 pandemic (preprint)

Abstract Introduction Somalia faced significant COVID-19 exposure due to limited lab capacity for pathogen detection. The country’s healthcare system is strained by poverty, conflict, malnutrition, and outbreaks. Urgent action was required to enhance COVID-19 detection, save lives, and support nationwide vaccination and healthcare efforts. Methods With WHO and other partners, the Ministry of Health formed the COVID-19 incident management committee to address infections. Testing was initiated at the National Public Health Laboratory, and through training and investment, expanded to 11 additional sites. Genomic surveillance was established to monitor circulating genotypes. A comprehensive data management system was implemented to track infections from patient to reporting, ensuring effective monitoring and response. Results The enhanced laboratory capacity identified 26,439 confirmed SARS-CoV-2 cases, resulting in 1,361 deaths and a case fatality rate (CFR) of 5.15%. A total of 344,002 suspected samples were tested within the country. Genomic surveillance was initiated in March, 2022, and the first results were reported in Agoust, 2022. The e-SPAR tool assessment demonstrated a significant improvement in laboratory capacity, rising from 27% in 2018 to 56% in 2021, marking an overall improvement of 210%. Discussion Somalia has made notable strides in enhancing and expanding in-country molecular diagnostic capacity, enabling swift COVID-19 diagnosis. This capacity is being expanded to encompass other pathogens as part of an integrated disease surveillance program. The objective is to enhance response capabilities to emerging pathogen outbreaks. The implementation of a data management system has improved data monitoring and evaluation, serving as a crucial foundation for Labs

Inadequate Energy Delivery Is Frequent among COVID-19 Patients Requiring ECMO Support and Associated with Increased ICU Mortality.

BACKGROUND: Patients receiving extracorporeal membrane oxygenation (ECMO) support are at high risk for malnutrition. There are currently no general nutrition guidelines for coronavirus disease 2019 (COVID-19) patients during ECMO therapy. METHODS: We conducted a retrospective analysis of COVID-19 patients requiring venovenous ECMO support at a large tertiary hospital center. Nutrition goals were calculated using 25 kcal/kg body weight (BW)/day. Associations between nutrition support and outcome were evaluated using Kaplan-Meier and multivariable Cox regression analyses. RESULTS: Overall, 102 patients accounted for a total of 2344 nutrition support days during ECMO therapy. On 40.6% of these days, nutrition goals were met. Undernutrition was found in 40.8%. Mean daily calorie delivery was 73.7% of calculated requirements, mean daily protein delivery was 0.7 g/kg BW/d. Mean energy intake of ≥70% of calculated targets was associated with significantly lower ICU mortality independently of age, disease severity at ECMO start and body mass index (adjusted hazard ratio: 0.372, p = 0.007). CONCLUSIONS: Patients with a mean energy delivery of ≥70% of calculated targets during ECMO therapy had a better ICU survival compared to patients with unmet energy goals. These results indicate that adequate nutritional support needs to be a major priority in the treatment of COVID-19 patients requiring ECMO support.

Food Insecurity and Nutritional Challenges in Adolescent and Young Adult Cancer Survivors in the U.S.A.: A Narrative Review and Call to Action.

Advancements in cancer treatments over the past several decades have led to improved cancer survival in adolescents and young adults (AYAs, ages 15-39 years). However, AYA cancer survivors are at an increased risk for "late effects", including cardiovascular, pulmonary and bone diseases as well as fatigue, infertility and secondary cancers. The treatments for cancer may also alter taste, lead to nutritional deficiencies and increase financial burdens that, when taken together, may increase the risk of food and nutrition security in AYA cancer survivors. Furthermore, although AYAs are often merged together in cancer survivorship studies, adolescents and young adults have distinct developmental, psychosocial and pathophysiological differences that may modify their risk of nutritional challenges. In this narrative review and "Call to Action", rationale is provided for why there is a need to better understand nutritional challenges and food insecurity in AYA cancer survivors as a special population. Then, recommendations for next steps to advance knowledge and policy in this field are provided. In particular, integrating screening for food and nutrition insecurity and enhancing awareness of existing resources (e.g., the Supplemental Nutrition Assistance Program, SNAP) might help AYA cancer survivors combat nutritional deficiencies and reduce late effects while improving their overall survival and quality of life.

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina.

INTRODUCTION: In 2020 the pandemic caused by SARS-COV-2 demanded an enormous number of healthcare resources in order to guarantee adequate treatment and support for those patients. This study aims to assess caloric and protein intake and evaluate its associations with relevant clinical outcomes in critically ill with coronavirus disease (COVID-19) patients. METHODS: A nationwide, multicentre prospective observational study including twelve Argentinian intensive care units (ICUs,) was conducted between March and October 2020. INCLUSION CRITERIA: Adult ICU patients>18 years admitted to the ICU with COVID-19 diagnosis and mechanical ventilation for at least 48h. Statistical analysis was carried out using IBM-SPSS© 24 programme. RESULTS: One hundred and eighty-five patients were included in the study. Those who died had lower protein intake (0.73g/kg/day (95% confidence interval (CI) 0.70-0.75 vs 0.97g/kg/day (CI 0.95-0.99), P<0.001), and lower caloric intake than those who survived (12.94kcal/kg/day (CI 12.48-13.39) vs 16.47kcal/kg/day (CI 16.09-16.8), P<0.001). A model was built, and logistic regression showed that factors associated with the probability of achieving caloric and protein intake, were the early start of nutritional support, modified NUTRIC score higher than five points, and undernutrition (Subjective Global Assessment B or C). The patients that underwent mechanical ventilation in a prone position present less caloric and protein intake, similar to those with APACHE II>18. CONCLUSIONS: Critically ill patients with COVID-19 associated respiratory failure requiring mechanical ventilation who died in ICU had less caloric and protein intake than those who survived. Early start on nutritional support and undernutrition increased the opportunity to achieve protein and caloric goals, whereas the severity of disease and mechanical ventilation in the prone position decreased the chance to reach caloric and protein targets.

Handgrip Strength Test and Bioelectrical Impedance Analysis in SARS-CoV-2 Patients Admitted to Sub-Intensive Unit.

Hospitalized patients with respiratory failure due to SARS-CoV-2 pneumonia are at increased risk of malnutrition and related mortality. The predictive value of the Mini-Nutritional Assessment short form (MNA-sf®), hand-grip strength (HGS), and bioelectrical impedance analysis (BIA) was determined with respect to in-hospital mortality or endotracheal intubation. The study included 101 patients admitted to a sub-intensive care unit from November 2021 to April 2022. The discriminative capacity of MNA-sf, HGS, and body composition parameters (skeletal mass index and phase angle) was assessed computing the area under the receiver operating characteristic curves (AUC). Analyses were stratified by age groups (<70/70+ years). The MNA-sf alone or in combination with HGS or BIA was not able to reliably predict our outcome. In younger participants, HGS showed a sensitivity of 0.87 and a specificity of 0.54 (AUC: 0.77). In older participants, phase angle (AUC: 0.72) was the best predictor and MNA-sf in combination with HGS had an AUC of 0.66. In our sample, MNA- sf alone, or in combination with HGS and BIA was not useful to predict our outcome in patients with COVID-19 pneumonia. Phase angle and HGS may be useful tools to predict worse outcomes in older and younger patients, respectively.

Nutritional Status, Refeeding Syndrome and Some Associated Factors of Patients at COVID-19 Hospital in Vietnam.

Multisystem inflammatory syndrome is associated with COVID-19 and can result in reduced food intake, increased muscle catabolism, and electrolyte imbalance. Therefore COVID-19 patients are at high risk of being malnourished and of refeeding syndrome. The present study aimed to determine the prevalence and correlates of malnutrition and refeeding syndrome (RS) among COVID-19 patients in Hanoi, Vietnam. This prospective cohort study analyzed data from 1207 patients who were treated at the COVID-19 hospital of Hanoi Medical University (HMUH COVID-19) between September 2021 and March 2022. Nutritional status was evaluated by the Global Leadership Initiative on Malnutrition (GLIM) and laboratory markers. GLIM-defined malnutrition was found in 614 (50.9%) patients. Among those with malnutrition, 380 (31.5%) and 234 (19.4%) had moderate and severe malnutrition, respectively. The prevalence of risk of RS was 346 (28.7%). Those with severe and critical COVID symptoms are more likely to be at risk of RS compared to those with mild or moderate COVID, and having severe and critical COVID-19 infection increased the incidence of RS by 2.47 times, compared to mild and moderate disease. There was an association between levels of COVID-19, older ages, comorbidities, the inability of eating independently, hypoalbuminemia and hyponatremia with malnutrition. The proportion of COVID-19 patients who suffered from malnutrition was high. These results underscore the importance of early nutritional screening and assessment in COVID-19 patients, especially those with severe and critical infection.

Malnutrition as a major related factor of frailty among older adults residing in long-term care facilities in Korea.

OBJECTIVES: The objectives of this study were 1) to investigate the prevalence and co-existence of frailty and malnutrition and 2) to identify factors related to frailty (including malnutrition) according to the level of frailty. METHODS: Data collection was conducted from July 11, 2021, to January 23, 2022, in 558 older adults residing in 16 long-term care facilities (LTCFs) in Korea. The FRAIL-NH and Mini-Nutritional Assessment short form were used to measure frailty and nutrition, respectively. The data analysis included descriptive statistics and a multivariate logistic regression. RESULTS: The mean age of the participants was 83.68 (± 7.39) years. Among 558 participants, 37 (6.6%), 274 (49.1%), and 247 (44.3%) were robust, prefrail, and frail, respectively. At the same time, 75.8% were categorized as having malnutrition status (malnourished: 18.1%; risk of malnutrition: 57.7%), and 40.9% had co-existing malnutrition and frailty. In the multivariate analysis, malnutrition was identified as the major frailty-related factor. Compared with a normal nutritional status, the incidence of frailty in the malnutrition group was 10.35 times (95% CI: 3.78-28.36) higher than the incidence of robustness and 4.80 times (95% CI: 2.69-8.59) higher than the incidence of prefrail. CONCLUSION: The prevalence of frailty and malnutrition, and their co-existence, among older adults residing in LTCFs was high. Malnutrition is a major factor that increases the incidence of frailty. Therefore, active interventions are needed to improve the nutritional status of this population.