Body composition and risk factors associated with sarcopenia in post-COVID patients after moderate or severe COVID-19 infections

The Association between Body Composition Phenotype and Insulin Resistance in Post-COVID-19 Syndrome Patients without Diabetes: A Cross-Sectional, Single-Center Study

BACKGROUND

The most frequent body composition alterations in post-COVID-19 syndrome include low muscle mass, dynapenia, sarcopenia, and obesity. These conditions share interconnected pathophysiological mechanisms that exacerbate each other. The relationship between body composition phenotypes and metabolic abnormalities in post-COVID-19 syndrome remains unclear.

OBJECTIVE

To evaluate the association between body composition phenotypes and insulin resistance (IR) and metabolic abnormalities in non-diabetic individuals with post-COVID-19 syndrome.

METHODS

A cross-sectional, single-center study involving 483 subjects with post-COVID-19 syndrome following moderate to severe acute COVID-19 requiring hospitalization. Individuals with diabetes, those who declined to participate, or those who could not be contacted were excluded. Body composition phenotypes were classified as normal weight, dynapenia, sarcopenia, dynapenic obesity, and sarcopenic obesity (SO).

RESULTS

The average age was 52.69 ± 14.75 years; of note, 67.08% were male. The prevalence of body composition phenotypes was as follows: 13.25% were of normal weight, 9.52% had dynapenia, 9.94% had sarcopenia, 43.69% had obesity, 18.84% had dynapenic obesity, and 4.76% had SO. Additionally, 58.18% had IR. Obesity (OR: 2.98, CI95%; 1.64-5.41) and dynapenic obesity (OR: 4.98, CI95%; 1.46-6.88) were associated with IR.

CONCLUSION

The most common body composition phenotypes were obesity, dynapenic obesity, and dynapenia. Furthermore, obesity and dynapenic obesity were associated with IR in post-COVID-19 syndrome.

Telerehabilitation improves cardiorespiratory and muscular fitness and body composition in older people with post-COVID-19 syndrome

BACKGROUND

The effects of post-coronavirus disease 2019 (COVID-19) syndrome on the cardiorespiratory and muscular fitness in older people are of utmost relevance. This study aimed to evaluate the effects of a 12-week telerehabilitation programme on cardiorespiratory and muscular fitness and body composition in older patients with post-COVID-19 syndrome.

METHODS

One hundred twenty older patients with post-COVID-19 syndrome were randomly assigned to one of two groups: patients who carried out the telerehabilitation programme (n = 60; age: 65.0 ± 5.2; female: 14.2%) and a control group (n = 60; age: 64.3 ± 5.0; female: 24.5%). An incremental cardiopulmonary exercise testing, isokinetic strength test, and bioelectrical impedance analysis were performed to compare cardiorespiratory and muscle strength responses and body composition between telerehabilitation and control groups.

RESULTS

A significant increase in the cardiopulmonary exercise testing duration was found in the telerehabilitation group compared to the control group (mean difference = 88.9 s, P = 0.001). Peak oxygen uptake increased in the telerehabilitation group (mean difference = 3.0 mL·kg-1·min-1, P < 0.001) and control group (mean difference = 1.9 mL·kg-1·min-1, P < 0.001). Power output in cycle ergometer (mean difference = 25.9 watts, P < 0.001), fat free mass (mean difference = 2.1 kg, P = 0.004), soft lean mass (mean difference = 2.1 kg, P = 0.003), and skeletal muscle mass (mean difference = 1.4 kg, P = 0.003) only increased in the telerehabilitation group. A significant increase in the power output was observed in the telerehabilitation group compared with the control group in both lower limbs after isokinetic strength test of the leg extension at a speed of 60° (right: mean difference = 18.7 watts, P = 0.012; left: mean difference = 15.3 watts, P = 0.010). The peak torque of right leg extension increased only in the telerehabilitation group after isokinetic strength test at a speed of 60° (mean difference = 13.1 N·m, P < 0.001). A significant increase in the power output was observed in the telerehabilitation group compared with the control group in the left leg extension after isokinetic strength test at a speed of 180° (mean difference = 30.2 watts, P = 0.003).

CONCLUSIONS

The telerehabilitation programme improved cardiorespiratory and muscular fitness, and body composition in older patients with post-COVID-19 syndrome to a greater extent than a control group. The telerehabilitation programmes may be an alternative to improve the sequelae of post-COVID-19 syndrome in older patients.

Relationship between a body shape index and muscle strength index in Chinese university students: a cross-sectional survey

BACKGROUND

The problem of overweight obesity and decrease in muscle strength among university students has become an indisputable fact. In this study, a comprehensive index reflecting obesity degree a body shape index (ABSI) and a comprehensive index reflecting muscle strength muscle strength index (MSI) were studied to analyze the cross-sectional correlations existing between them.

METHODS

This study began recruiting participants and conducting the test survey in April 2022 and closed in July 2022. Basic condition, height, weight, waist circumference, grip strength, pull-up (boys), bent-leg sit-up (girls), and standing long jump were tested on 12,046 (boys: 6011, 49.90%) university students aged 19-22 years in China, and ABSI and MSI were calculated separately. ABSI was categorized into 5 groups according to age and sex, namely ABSI < 5th percentile (A), 5th ≤ ABSI < 25th percentile (B), 25th ≤ ABSI < 75th percentile (C), 75th ≤ ABSI < 95th percentile (D) and ABSI ≥ 95th percentile (E). The comparison of MSI between different ABSI groups was performed using effect size, and the association between them was performed by curve estimation analysis.

RESULTS

The association between ABSI and MSI of Chinese university students showed an inverted "U" curve. The effect of increased ABSI on MSI was greater in university girls compared to boys. The ABSI of boys was (0.080 ± 0.010) and MSI was (-0.005 ± 2.080); the ABSI of girls was (0.079 ± 0.008) and MSI was (-0.017 ± 1.867). Overall, university students ABSI was at a relatively high point for MSI between 0.050 and 0.100. The university students ABSI at 0.150 had an MSI of -1.229 for boys and - 2.779 for girls.

CONCLUSION

The ABSI of Chinese university students showed an inverted "U"-shaped curve relationship with MSI, and university students with low or high ABSI had lower MSI. The effect of increasing ABSI on the decrease of MSI was more obvious for girls than for boys.

Gender-Related Effectiveness of Personalized Post-COVID-19 Rehabilitation

Background: Post-COVID-19 syndrome (PCS) may affect a substantial proportion of patients who have had COVID-19. The rehabilitation program might improve the physical capacity, functioning of the cardiopulmonary system, and mental conditions of these patients. This study aimed to investigate the effectiveness of personalized rehabilitation in patients with PCS according to gender. Methods: Adults who underwent a 6-week personalized PCS rehabilitation program were enrolled in a prospective post-COVID-19 Rehabilitation (PCR-SIRIO 8) study. The initial visit and the final visit included the hand-grip strength test, the bioimpedance analysis of body composition, and the following scales: modified Borg's scale, Modified Fatigue Impact Scale (MFIS), Functioning in Chronic Illness Scale (FCIS), modified Medical Research Council (mMRC) dyspnea scale, and tests: 30 s chair stand test (30 CST), Six-Minute Walk Test (6MWT), Short Physical Performance Battery test (SPPB)e. Results: A total of 90 patients (54% female) underwent the rehabilitation program. Rehabilitation was associated with an increase in skeletal muscle mass (24.11 kg vs. 24.37 kg, p = 0.001) and phase angle (4.89° vs. 5.01°, p = 0.001) and with a reduction in abdominal fat tissue volume (3.03 L vs. 2.85 L, p = 0.01), waist circumference (0.96 m vs. 0.95 m, p = 0.001), and hydration level (83.54% vs. 82.72%, p = 0.001). A decrease in fat tissue volume and an increase in skeletal muscle mass were observed only in females, while an increase in grip strength was noticed selectively in males. Patients' fatigue (modified Borg's scale, MFIS), physical capacity (30 CST, 6MWT), balance (SPPB), dyspnea (mMRC), and functioning (FICS) were significantly improved after the rehabilitation regardless of gender. Conclusions: Personalized rehabilitation improved the body composition, muscle strength, and functioning of patients diagnosed with PCS. The beneficial effect of rehabilitation on body composition, hydration, and phase angle was observed regardless of gender.

Predictors of Post-COVID-19 Functional Status Scale in Hospitalized Patients Recovering From SARS-CoV-2 Infection

OBJECTIVE

The study aimed to investigate whether peripheral and inspiratory muscle strength and architecture, functional capacity, functional mobility, fatigue, and health-related quality of life are predictors of the Post-COVID-19 Functional Status Scale score in patients with post-COVID-19 syndrome who were hospitalized.

DESIGN

A cross-sectional study included 69 patients (53.3 ± 13.2 yrs, 36 men) with post-COVID-19 syndrome. The following outcomes were assessed: peripheral (dynamometry) and inspiratory (manovacuometry) muscle strength, muscle architecture (ultrasound), functional capacity (six-minute walk test), functional mobility (Timed Up and Go), fatigue (Functional Assessment of Chronic Illness Therapy), health-related quality of life (36-item Short-Form Health Survey), and functional status (Post-COVID-19 Functional Status scale).

RESULTS

Functional mobility (β = 0.573, P < 0.001), vastus intermedius echogenicity (β = -0.491, P = 0.001), length of stay (β = 0.349, P = 0.007), and female sex (β = 0.415, P = 0.003) influenced the Post-COVID-19 Functional Status Scale.

CONCLUSIONS

Functional mobility, muscle quality of the vastus intermedius, length of stay, and female sex influence the Post-COVID-19 Functional Status Scale score in this population. It is noteworthy that functional mobility is an independent predictor of Post-COVID-19 Functional Status Scale.

Association between muscle quality index and pulmonary function in post-COVID-19 subjects

BACKGROUND

The SARS-CoV2 pandemic impacted many critically ill patients, causing sequelae, affecting lung function, and involving the musculoskeletal system. We evaluated the association between lung function and muscle quality index in severely ill post-COVID-19 patients.

METHODS

A cross-sectional study was conducted on a post-COVID-19 cohort at a third-level center. The study included patients who had experienced severe-to-critical COVID-19. Anthropometric measurements, such as body mass index (BMI) and handgrip strength, were obtained to calculate the muscle quality index (MQI). Additionally, spirometry, measurements of expiratory and inspiratory pressure, and an assessment of DLCO in the lungs were performed. The MQI was categorized into two groups: low-MQI (below the 50th percentile) and high-MQI (above the 50th percentile), based on sex. Group differences were analyzed, and a multivariate linear regression analysis was performed to assess the association between respiratory function and MQI.

RESULTS

Among the 748 patients analyzed, 61.96% required mechanical ventilation, and the median hospital stay was 17 days. In patients with a low MQI, it was observed that both mechanical respiratory function and DLCO were lower. The multivariate analysis revealed significantly lower findings in mechanical respiratory function among patients with a low MQI.

CONCLUSION

The Low-MQI is an independent predictor associated with pulmonary function parameters in subjects with Post-COVID-19 syndrome.

COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia

(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.

Prognostic Impact of Myosteatosis on Mortality in Hospitalized Patients with COVID-19

Body composition, including sarcopenia, adipose tissue, and myosteatosis, is associated with unfavorable clinical outcomes in patients with coronavirus disease (COVID-19). However, few studies have identified the impact of body composition, including pre-existing risk factors, on COVID-19 mortality. Therefore, this study aimed to evaluate the effect of body composition, including pre-existing risk factors, on mortality in hospitalized patients with COVID-19. This two-center retrospective study included 127 hospitalized patients with COVID-19 who underwent unenhanced chest computed tomography (CT) between February and April 2020. Using the cross-sectional CT images at the L2 vertebra level, we analyzed the body composition, including skeletal muscle mass, visceral to subcutaneous adipose tissue ratio (VSR), and muscle density using the Hounsfield unit (HU). Of 127 patients with COVID-19, 16 (12.6%) died. Compared with survivors, non-survivors had low muscle density (41.9 vs. 32.2 HU, p < 0.001) and high proportion of myosteatosis (4.5 vs. 62.5%, p < 0.001). Cox regression analyses revealed diabetes (hazard ratio [HR], 3.587), myosteatosis (HR, 3.667), and a high fibrosis-4 index (HR, 1.213) as significant risk factors for mortality in patients with COVID-19. Myosteatosis was associated with mortality in hospitalized patients with COVID-19, independent of pre-existing prognostic factors.

[Coronavirus disease 2019 and frailty]

Der Verlauf der Coronavirus disease 2019 (COVID-19) ist individuell sehr unterschiedlich. Menschen höheren Lebensalters mit Komorbiditäten sind gefährdeter, schwer zu erkranken oder zu versterben. Gebrechlichkeit (Frailty) ist ein wesentlicher Risikofaktor. Ein Fünftel der Bevölkerung in Mitteleuropa ist älter als 65 Jahre, 10–15 % davon sind als „frail“ anzusehen. Die Pandemie bringt die Gesundheitssysteme vieler Länder an deren Grenzen. Die Entscheidung, welche Patienten noch intensivmedizinisch behandelt werden, führt zu ethischen Diskussionen. Die Clinical Frailty Scale von Rockwood (CFS; CMAJ 173:489–495, 2005) wird in manchen Ländern eingesetzt, diese Entscheidungen zu unterstützen.

Von COVID-19 betroffene 80-jährige Patienten haben ein fast 3,6faches Sterblichkeitsrisiko, verglichen mit der Altersgruppe von 18 bis 49 Jahren. Das Risiko gebrechlicher Patienten (CFS-Scores 6–9) ist mehr als 3fach höher als von robusten (CFS-Scores 1–3). Ein CFS-Cut-off-Wert ≥ 6 korreliert mit der Mortalität von COVID-19-Patienten über 65 Jahre. Das mittel- und längerfristige Überleben ist auch mit dem Ausmaß von „Frailty“ vor der Erkrankung und weniger mit dem Schweregrad der COVID-19 assoziiert.

Besonders Patienten über 60 Jahre sind gefährdet, bei moderaten und schweren COVID-19-Verläufen rasch Muskelmasse zu verlieren. Patienten auf Intensive Care Units (ICU) verlieren innerhalb von 10 Tagen 20–30 % der Oberschenkelstreckmuskulaturmasse. Das Ausmaß der COVID-19-assoziierten Sarkopenie bestimmt wesentlich den Verlauf der Erkrankung und macht individuelle Rehabilitationsprogrammen erforderlich. Bis zu 50 % der hospitalisierten Patienten benötigen weitere Rehabilitation nach der Entlassung. Aerobes Training mit niedriger Intensität, kombiniert mit Krafttraining, sowie die Sicherstellung einer ausreichenden Energie- und Eiweißzufuhr sind unerlässlich.