Malnutrition in COVID-19 survivors: prevalence and risk factors
Authors: Tosato Matteo , Calvani Riccardo , Ciciarello Francesca , Galluzzo Vincenzo , Martone Anna Maria , Zazzara Maria Beatrice , Pais Cristina , Savera Giulia , Robles Maria Camprubi , Ramirez Maria , Landi Francesco ,   Gemelli Against COVID-19 Post-Acute Care Team, Landi Francesco , Gremese Elisa , Bernabei Roberto , Fantoni Massimo , Gasbarrini Antonio , Tosato Matteo , Settanni Carlo Romano , Porcari Serena , Benvenuto Francesca , Bramato Giulia , Brandi Vincenzo , Carfì Angelo , Ciciarello Francesca , Lo Monaco Maria Rita , Martone Anna Maria , Marzetti Emanuele , Napolitano Carmen , Galluzzo Vincenzo , Pagano Francesco , Pais Cristina , Rocchi Sara , Rota Elisabetta , Salerno Andrea , Tosato Matteo , Tritto Marcello , Calvani Riccardo , Zazzara Maria Beatrice , Catalano Lucio , Picca Anna , Savera Giulia , D’Elia Mariaelena , Biscotti Damiano , Cauda Roberto , Murri Rita , Cingolani Antonella , Ventura Giulio , Taddei Eleonora , Moschese Davide , Ciccullo Arturo , Fantoni Massimo , Stella Leonardo , Addolorato Giovanni , Franceschi Francesco , Mingrone Gertrude , Zocco Maria Assunta , Sanguinetti Maurizio , Cattani Paola , Marchetti Simona , Posteraro Brunella , Sali Michela , Bizzarro Alessandra , Lauria Alessandra , Rizzo Stanislao , Savastano Maria Cristina , Gambini Gloria , Cozzupoli Grazia Maria , Culiersi Carola , Passali Giulio Cesare , Paludetti Gaetano , Galli Jacopo , Crudo Fabrizio , Di Cintio Giovanni , Longobardi Ylenia , Tricarico Laura , Santantonio Mariaconsiglia , Di Cesare Tiziana , Guarino Mariateresa , Corbò Marco , Settimi Stefano , Mele Dario , Brigato Francesca , Buonsenso Danilo , Valentini Piero , Sinatti Dario , De Rose Gabriella , Richeldi Luca , Lombardi Francesco , Calabrese Angelo , Varone Francesco , Leone Paolo Maria , Siciliano Matteo , Corbo Giuseppe Maria , Montemurro Giuliano , Calvello Mariarosaria , Intini Enrica , Simonetti Jacopo , Pasciuto Giuliana , Adiletta Veronica , Sofia Carmelo , Licata Maria Angela , Sani Gabriele , Janiri Delfina , Simonetti Alessio , Modica Marco , Silvia Montanari , Catinari Antonello , Terenzi Beatrice , Natale Luigi , Larici Anna Rita , Marano Riccardo , Pirronti Tommaso , Infante Amato , Paglionico Annamaria , Petricca Luca , Tolusso Barbara , Alivernini Stefano , Di Mario Clara , Santoliquido Angelo , Santoro Luca , Nesci Antonio , Di Giorgio Angela , D’Alessandro Alessia 
Published: September 2023

Abstract
Background
Nutritional status is a critical factor throughout COVID-19 disease course. Malnutrition is associated with poor outcomes in hospitalized COVID-19 patients.

Aim
To assess the prevalence of malnutrition and identify its associated factors in COVID-19 survivors.

Methods
Study cohort included 1230 COVID-19 survivors aged 18–86 attending a post-COVID-19 outpatient service. Data on clinical parameters, anthropometry, acute COVID-19 symptoms, lifestyle habits were collected through a comprehensive medical assessment. Malnutrition was assessed according to Global Leadership Initiative on Malnutrition (GLIM) criteria.

Results
Prevalence of malnutrition was 22% at 4–5 months after acute disease. Participants who were not hospitalized during acute COVID-19 showed a higher frequency of malnutrition compared to those who needed hospitalization (26% versus 19%, p < 0.01). Malnutrition was found in 25% COVID-19 survivors over 65 years of age compared to 21% younger participants (p < 0.01). After multivariable adjustment, the likelihood of being malnourished increased progressively and independently with advancing age (Odds ratio [OR] 1.02; 95% CI 1.01–1.03) and in male participants (OR 5.56; 95% CI 3.53–8.74). Malnutrition was associated with loss of appetite (OR 2.50; 95% CI 1.73–3.62), and dysgeusia (OR 4.05; 95% CI 2.30–7.21) during acute COVID-19.

Discussion
In the present investigation we showed that malnutrition was highly prevalent in a large cohort of COVID-19 survivors at 4–5 months from acute illness.

Conclusions
Our findings highlight the need to implement comprehensive nutritional assessment and therapy as an integral part of care for COVID-19 patients.