ABSTRACT
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. CONCLUSION: 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.
ABSTRACT
Inflammation plays a key role in cancer development. As an important modulator of inflammation, the role of diet should be explored. The purpose of this study was to determine the association between diets with a higher inflammatory potential, as measured by the Dietary Inflammatory Index (DII®), and cancer development in a cohort of rural post-menopausal women. Dietary intake from a randomized controlled trial cohort of rural, post-menopausal women in Nebraska was used to compute energy-adjusted DII (E-DIITM) scores at baseline and four years later (visit 9). A linear mixed model analysis and multivariate logistic regression evaluated the association between E-DII scores (baseline, visit 9, change score) and cancer status. Of 1977 eligible participants, those who developed cancer (n = 91, 4.6%) had a significantly larger, pro-inflammatory change in E-DII scores (Non-cancer: Δ 0.19 ± 1.43 vs. Cancer: Δ 0.55 ± 1.43, p = 0.02). After adjustment, odds of cancer development were over 20% higher in those with a larger change (more pro-inflammatory) in E-DII scores than those with smaller E-DII changes (OR = 1.21, 95% CI [1.02, 1.42], p = 0.02). Shifting to a more pro-inflammatory diet pattern over four years was associated with increased odds of cancer development, but not with E-DII at baseline or visit 9 alone.
ABSTRACT
BACKGROUND: Coronavirus disease 2019 (COVID-19) is now the third leading cause of death in the United States. Malnutrition in hospitalized patients increases risk of complications. However, the effect of malnutrition on outcomes in patients infected is unclear. This study aims to identify the impact of malnutrition on mortality and adverse hospital events in patients hospitalized with COVID-19. METHODS: This study used data from the National COVID Cohort Collaborative (N3C), a COVID-19 repository containing harmonized, longitudinal electronic health record data from US health systems. Malnutrition was categorized into three groups based on condition diagnosis: (1) none documented, (2) history of malnutrition, and (3) hospital-acquired malnutrition. Multivariable logistic regression was performed to determine whether malnutrition was associated with mortality and adverse events, including mechanical ventilation, acute respiratory distress syndrome, extracorporeal membrane oxygenation, and hospital-acquired pressure injury, in hospitalized patients with COVID-19. RESULTS: Of 343,188 patients hospitalized with COVID-19, 11,206 had a history of malnutrition and 15,711 had hospital-acquired malnutrition. After adjustment for potential confounders, odds of mortality were significantly higher in patients with a history of malnutrition (odds ratio [OR], 1.71; 95% confidence interval [CI], 1.63-1.79; P < 0.001) and hospital-acquired malnutrition (OR, 2.5; 95% CI, 2.4-2.6; P < 0.001). Adjusted odds of adverse hospital events were also significantly elevated in both malnutrition groups. CONCLUSIONS: Results indicate the risk of mortality and adverse inpatient events in adults with COVID-19 is significantly higher in patients with malnutrition. Prevention, diagnosis, and treatment of malnutrition could be a key component in improving outcomes in these patients.
