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Garcia-Grimaldo A, Rodríguez-Moguel NC, Ríos-Ayala MA, Hernández-Cárdenas CM, Pensado-Piedra L, Osuna-Padilla IA. Muscle wasting in ICU-patients with COVID-19 - Descriptive analysis and risk factors identification. Med Intensiva 2024; 48:487-490. [PMID: 38697905 DOI: 10.1016/j.medine.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Affiliation(s)
- Alan Garcia-Grimaldo
- Coordinación de Nutrición Clínica, Departamento de Áreas Críticas. Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Nadia Carolina Rodríguez-Moguel
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | - Martín Armando Ríos-Ayala
- Coordinación de Nutrición Clínica, Departamento de Áreas Críticas. Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico
| | | | - Lya Pensado-Piedra
- Departamento de Imagenología, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Iván Armando Osuna-Padilla
- Coordinación de Nutrición Clínica, Departamento de Áreas Críticas. Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
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Wang Q, Shi P, Cao L, Li H, Chen X, Wang P, Zhang J. Unveiling the detrimental vicious cycle linking skeletal muscle and COVID-19: A systematic review and meta-analysis. J Evid Based Med 2024. [PMID: 38975690 DOI: 10.1111/jebm.12629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/18/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE Skeletal muscle catabolism supports multiple organs and systems during severe trauma and infection, but its role in COVID-19 remains unclear. This study investigates the interactions between skeletal muscle and COVID-19. METHODS The PubMed, EMbase, and The Cochrane Library databases were systematically searched from January 2020 to August 2023 for cohort studies focusing on the impact of skeletal muscle on COVID-19 prevalence and outcomes, and longitudinal studies examining skeletal muscle changes caused by COVID-19. Skeletal muscle quantity (SMQN) and quality (SMQL) were assessed separately. The random-effect model was predominantly utilized for statistical analysis. RESULTS Seventy studies with moderate to high quality were included. Low SMQN/SMQL was associated with an increased risk of COVID-19 infection (OR = 1.62, p < 0.001). Both the low SMQN and SMQL predicted COVID-19-related mortality (OR = 1.53, p = 0.016; OR = 2.18, p = 0.001, respectively). Mortality risk decreased with increasing SMQN (OR = 0.979, p = 0.009) and SMQL (OR = 0.972, p = 0.034). Low SMQN and SMQL were also linked to the need for intensive care unit/mechanical ventilation, increased COVID-19 severity, and longer hospital stays. Significant skeletal muscle wasting, characterized by reduced volume and strength, was observed during COVID-19 infection and the pandemic. CONCLUSIONS This study reveals a detrimental vicious circle between skeletal muscle and COVID-19. Effective management of skeletal muscle could be beneficial for treating COVID-19 infections and addressing the broader pandemic. These findings have important implications for the management of future virus pandemics. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023395476.
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Affiliation(s)
- Qin Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Peipei Shi
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lu Cao
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Haoran Li
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Xiankai Chen
- Department of Thoracic Surgical Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiyu Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Thoracic Surgery, Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Jianjiang Zhang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Casarin M, Silva FH, Pontes AFL, Lima BD, Pirih FQ, Muniz FWMG. Association between sequelae of COVID-19 with periodontal disease and obesity: A cross-sectional study. J Periodontol 2024; 95:688-698. [PMID: 37986698 DOI: 10.1002/jper.23-0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/04/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND To assess the sequelae of coronavirus disease 2019 (COVID-19) and associated factors, such as obesity and periodontitis in adults. METHODS The study included 128 individuals aged ≥35 years with a history of a diagnosis of COVID-19 through real-time polymerase chain reaction (RT-PCR), from Pelotas, Brazil. Self-report sequelae from COVID-19 were defined as the primary outcome. A questionnaire containing sociodemographic, medical, behavioral and self-report of sequelae of COVID-19 was applied. A complete periodontal clinical examination was performed. Weight and height were assessed. Uni-, bi- and multivariate analyses were performed using Poisson regression with robust variance. Additional analyses were performed considering obesity as a subgroup. RESULTS When considering the whole sample, no statistically significant associations between sequelae of COVID-19 with periodontitis (prevalence ratio [PR]:1.14;95% confidence interval [95%CI]: 0.80-1.61) and obesity (0.93 [0.68-1.26]) were identified. In the subgroup analysis, considering only individuals with obesity, those diagnosed with generalized periodontitis had 86% higher probability to have sequelae of COVID-19 when compared to individuals with periodontal health or localized periodontitis. However, when only those without obesity were considered, no significant association with periodontal status was detected (0.82 [0.55-1.23). No significant association with periodontal status were observed when the severity of sequelae (no sequelae, 1 sequela, and >1 sequela) were considered (p > 0.05). CONCLUSIONS Individuals diagnosed with obesity and periodontitis have a higher PR of reporting sequelae from COVID-19 compared to individuals with only obesity.
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Affiliation(s)
- Maísa Casarin
- Department of Periodontology, Post Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | | | | | | | - Flavia Q Pirih
- Section of Periodontics, School of Dentistry, University of California, Los Angeles, Los Angeles, USA
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Iturriaga T, Salazar-Pérez F, Casallo-Cerezo M, García-Pérez-de-Sevilla G, Sosa-Pedreschi A, Diez-Vega I, Supervia M, Arroyo O, Pérez-Ruiz M. Physical condition and perceived fatigue in post-covid patients: An observational descriptive study. SAO PAULO MED J 2024; 142:e2023167. [PMID: 38477734 PMCID: PMC10926933 DOI: 10.1590/1516-3180.2023.0167.r1.04122023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/23/2023] [Accepted: 12/04/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Patients with severe coronavirus disease 2019 (COVID-19) often require hospital admission and experience sequelae such as chronic fatigue or low muscle mass. OBJECTIVE To analyze the functional capacity of a cohort of patients with severe acute respiratory syndrome coronavirus 2 who required hospitalization. DESIGN AND SETTING An observational descriptive study was conducted on post-COVID-19 patients referred to the Rehabilitation Department of Gregorio Marañón Hospital (Madrid, SPAIN). METHODS Cardiorespiratory fitness, muscle strength, body composition, and perception of fatigue and dyspnea were analyzed. Furthermore, the existing correlations between clinical variables and physical conditions were analyzed. RESULTS Forty-two patients who required hospital admission (80 ± 22.45 days) or intensive care unit (ICU) admission (58 ± 10.52 days) were analyzed. They presented with decreased strength, respiratory capacity, and moderate-to-severe perceived fatigue. Additionally, an inverse correlation was found between right-handgrip strength and days in the ICU, as well as the 6-minute walk test for women. Similarly, strength and fitness were negatively associated with perceived fatigue. CONCLUSIONS Post-COVID-19 patients showed low muscle function and low levels of physical fitness associated with high perceived fatigue.
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Affiliation(s)
- Tamara Iturriaga
- Sport Sci, MSc, PhD. Professor, Department of Sports Sciences, Faculty of Sport Sciences, Universidad Europea de Madrid, Spain
| | - Fernanda Salazar-Pérez
- Sport Sci, MSc, Professor. Department of Physiotherapy, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona
| | - Marta Casallo-Cerezo
- MD, MSc, Physiatrist. Gregorio Marañón General University Hospital, Madrid, Spain
| | | | - Alicia Sosa-Pedreschi
- Nutr Diet, MS, Professor. Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Spain
| | - Ignacio Diez-Vega
- PT, MSc, PhD. Professor. Department of Nursing and Physiotherapy, Faculty of Health Science, Universidad de León, Ponferrada, Spain
| | - Marta Supervia
- MD, MSc, PhD. Physiatrist. Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain; Cardiologist. Division of Preventive Cardiology Department, Cardiovascular Medicine Mayo Clinic (MN), Madrid, Spain; Faculty of Physical Activity and Sport Sciences, Universidad Politécnica de Madrid, Madrid, Spain
| | - Olga Arroyo
- MD, MSc, PhD. Physiatrist. Gregorio Marañón General University Hospital, Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Margarita Pérez-Ruiz
- MD, MSc, PhD. Profesor Titular. Grupo ImFine. Departamento de Salud y Rendimiento Humano, Facultad de Ciencias de la Actividad Física y el Deporte (INEF), Universidad Politécnica de Madrid, Madrid, Spain
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de Paula Silva-Lalucci MP, Marques DCDS, Valdés-Badilla P, Andreato LV, Magnani Branco BH. Obesity as a Risk Factor for Complications and Mortality in Individuals with SARS-CoV-2: A Systematic Review. Nutrients 2024; 16:543. [PMID: 38398867 PMCID: PMC10892776 DOI: 10.3390/nu16040543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
This systematic review aimed to analyze the available studies that identified overweight and/or obesity as a risk factor for mortality, use of respiratory support, and changes in biochemical markers in adults hospitalized with SARS-CoV-2. The PubMed, Web of Science, and Scopus databases were searched using PRISMA guidelines until January 2024. The protocol was registered with PROSPERO (code: CRD42024501551). Of the 473 articles, only 8 met the inclusion criteria (e.g., adult individuals aged 18 or over diagnosed with COVID-19 individuals with overweight and/or obesity). In addition, the Downs and Black tool was used to assess the quality of the studies. The studies analyzed totaled 9782 adults hospitalized for COVID-19, indicating that overweight and obesity are present in more than half of adults. Diseases such as diabetes mellitus and hypertension are more prevalent in adults with obesity. The systematic review also highlighted that a higher incidence of respiratory support is related to a higher incidence of hospitalization in intensive care units and that adults with overweight and obesity have a higher risk of mortality from COVID-19. Biochemical markers such as procalcitinin, C-reactive protein, and interleukin-6 are associated with the severity of COVID-19 infection. This systematic review exposed overweight and/or obesity as a risk factor for worse COVID-19 disease, as well as for the need for intensive care, respiratory support, mortality, and changes in essential blood markers.
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Affiliation(s)
- Marielle Priscila de Paula Silva-Lalucci
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
| | - Déborah Cristina de Souza Marques
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca 3530000, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar 2520000, Chile
| | - Leonardo Vidal Andreato
- Higher School of Health Sciences, State University of Amazonas, Manaus 69065-001, Amazonas, Brazil;
| | - Braulio Henrique Magnani Branco
- Interdisciplinary Laboratory of Intervention in Health Promotion, Cesumar Institute of Science, Technology, and Innovation, Maringá 87050-390, Paraná, Brazil; (M.P.d.P.S.-L.); (D.C.d.S.M.)
- Graduate Program in Health Promotion, Cesumar University, Maringá 87050-390, Paraná, Brazil
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Peball M, Rass V, Valent D, Beer R, Schiefecker AJ, Limmert V, Putnina L, Heim B, Ellmerer P, Carbone F, Mahlknecht P, Kofler M, Lindner A, Kindl P, Sahanic S, Coen M, Pizzini A, Pfausler B, Kiechl S, Sonnweber T, Tancevski I, Löffler-Ragg J, Djamshidian A, Helbok R, Seppi K. Body Composition and Physical Performance 1 Year After COVID-19. Am J Phys Med Rehabil 2024; 103:124-133. [PMID: 37408132 DOI: 10.1097/phm.0000000000002314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
OBJECTIVE Long-term consequences after COVID-19 include physical complaints, which may impair physical recovery and quality of life. DESIGN We assessed body composition and physical ability in patients 12 months after COVID-19. Consecutively recruited patients recovering from mild to severe COVID-19 were assessed using bioelectrical impedance analysis, 6-min-walk test, additional scales for physical performance and health-related quality of life. RESULTS Overall physical recovery was good (i.e., Glasgow Outcome Scale-Extended ≥7 in 96%, Modified Rankin Scale ≤1 in 87%, Eastern Cooperative Oncology Group ≤1 in 99%). Forty-four percent of the 69 patients experienced a significant body mass index increase in the year after COVID-19 (≥1 kg/m 2 ), whereas skeletal muscle mass index was reduced in only 12%. Patients requiring intensive care treatment ( n = 15, 22%) during acute COVID-19 more often had a body mass index increase ( P = 0.002), worse 6-min-walk test-performance ( P = 0.044), and higher body fat mass ( P = 0.030) at the 1-yr follow-up when compared with patients with mild ( n = 22, 32%) and moderate ( n = 32, 46%) acute COVID-19. Body mass index increase was also more frequent in patients who had no professional rehabilitation ( P = 0.014). CONCLUSIONS Although patients with severe COVID-19 had increased body mass index and body fat and performed worse in physical outcome measures 1 yr after COVID-19, overall physical recovery was satisfying. Translating these findings to variants beyond the Alpha strain of severe acute respiratory syndrome coronavirus 2 virus needs further studies.
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Affiliation(s)
- Marina Peball
- From the Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria (MP, VR, DV, RB, AJS, VL, LP, BH, PE, FC, PM, MK, AL, PK, BP, SK, AD, KS); Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria (SS, MC, AP, TS, IT, JL-R); and Department of Neurology, Johannes Kepler University Linz, Linz, Austria (RH)
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Molz P, da Silva TG, da Silva Schlickmann D, Steffens JP, Colombelli RAW, Franke SIR. Re. "Influence of different categories of supplements on the body composition of resistance training practitioners". Nutrition 2024; 118:112288. [PMID: 38123368 DOI: 10.1016/j.nut.2023.112288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 10/29/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Patrícia Molz
- Graduate Program in Health Promotion, Department of Health Science, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil; Laboratory of Experimental Nutrition, Department of Health Science, University of Santa Cruz do SulSanta Cruz do Sul, Brazil; Graduate Program in Biosciences, Federal University of Health Sciences of Porto Alegre School of Medicine, Santa Cruz do Sul, Brazil
| | - Thalia Gama da Silva
- Laboratory of Experimental Nutrition, Department of Health Science, University of Santa Cruz do SulSanta Cruz do Sul, Brazil
| | - Diene da Silva Schlickmann
- Graduate Program in Health Promotion, Department of Health Science, University of Santa Cruz do Sul, Santa Cruz do SulBrazil; Laboratory of Experimental NutritionDepartment of Health Science, University of Santa Cruz do SulSanta Cruz do SulBrazil
| | - Juliana Priebe Steffens
- Laboratory of Experimental Nutrition, Department of Health Science, University of Santa Cruz do SulSanta Cruz do Sul, Brazil
| | - Renato Alberto Weber Colombelli
- Laboratory of Experimental Nutrition, Department of Health Science, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil
| | - Silvia Isabel Rech Franke
- Graduate Program in Health Promotion, Department of Health Science, University of Santa Cruz do Sul, Santa Cruz do Sul, Brazil; Laboratory of Experimental Nutrition, Department of Health Science, University of Santa Cruz do SulSanta Cruz do Sul, Brazil.
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Floro GC, Schwenger KJP, Ghorbani Y, Zidar DJ, Allard JP. In critically ill adult patients with COVID-19, lower energy and higher protein intake are associated with fewer mechanical ventilation and antibiotic days but not with ICU length of stay. Nutr Clin Pract 2023; 38:1368-1378. [PMID: 37302065 DOI: 10.1002/ncp.11019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/20/2023] [Accepted: 04/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) nutrition management guidelines recommend hypocaloric, high-protein feeding in the acute phase of critical illness. This study aimed to determine, among critically ill adults with COVID-19, whether nutrition support affects outcomes in nonobese patients when providing a mean energy intake of ≥20 kcal/kg/day vs <20 kcal/kg/day and protein intake of ≥1.2 g/kg/day vs <1.2 g/kg/day, using actual body weight, and in patients with obesity when providing ≥20 kcal/kg/day vs <20 kcal/kg/day and a protein intake of ≥2 g/kg/day vs <2 g/kg/day using ideal body weight. METHODS This retrospective study included adults with COVID-19 on mechanical ventilation (MV) admitted to the intensive care unit (ICU) from 2020 to 2021. Clinical and nutrition parameters were recorded the first 14 days of ICU stay. RESULTS One hundred four patients were included: 79 (75.96%) were male and had a median age of 51 years and body mass index of 29.65 kg/m2 . ICU length of stay (LOS) was not affected by nutrition intake, but patients receiving <20 kcal/kg/day had fewer MV days (P = 0.029). In a subgroup analysis, MV days were lower in the nonobese group receiving <20 kcal/kg/day (P = 0.012). In the obese group, those receiving higher protein intake had fewer antibiotic days (P = 0.013). CONCLUSION In critically ill patients with COVID-19, lower energy and higher protein intake were respectively associated with fewer MV days and, in patients with obesity, fewer antibiotic days, but they had no effect on ICU LOS.
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Affiliation(s)
- Geraldine C Floro
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | | | - Yasaman Ghorbani
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Deanna J Zidar
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
| | - Johane P Allard
- Department of Medicine, Toronto General Hospital, Toronto, ON, Canada
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das Virgens IPA, Sousa IM, Bezerra ADL, Fayh APT. Assessment of body composition in adults hospitalized with acute COVID-19: a scoping review. Front Nutr 2023; 10:1176441. [PMID: 37743922 PMCID: PMC10513420 DOI: 10.3389/fnut.2023.1176441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 07/07/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Body composition (BC) assessment can supply accurate information for in-hospital nutritional evaluation. The aim of this study was to explore in the literature how the studies assessed BC, for what purpose, and investigate the role of BC findings in COVID-19 hospitalized patients' outcomes. Methods A scoping review was conducted according to the methodology available on the Joanna Briggs Institute website. We used the PCC acronym for the systematic search (population: adults with COVID-19, concept: assessment of BC, context: hospital setting) and performed it on PubMed, Scopus, and the Web of Science on 16 September 2022. Eligibility criteria consisted of the utilization of BC assessment tools in COVID-19 patients. Studies in which BC was solely measured with anthropometry (perimeters and skinfolds) were excluded. No language restriction was applied. Results Fifty-five studies were eligible for the review. Out of the 55 studies, 36 used computed tomography (CT), 13 used bioelectrical impedance (BIA), and 6 used ultrasound (US). No studies with D3-creatinine, 24 h urine excretion, dual-energy X-ray absorptiometry, or magnetic resonance were retrieved. BC was mainly assessed to test associations with adverse outcomes such as disease severity and mortality. Discussion Studies assessing BC in hospitalized patients with COVID-19 used mainly CT and BIA and associated the parameters with severity and mortality. There is little evidence of BC being assessed by other methods, as well as studies on BC changes during hospitalization.
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Affiliation(s)
- Isabel Pinto Amorim das Virgens
- Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Center for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Iasmin Matias Sousa
- Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Agnes Denise Lima Bezerra
- Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Ana Paula Trussardi Fayh
- Graduation Program in Health Sciences, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Vogele D, Otto S, Sollmann N, Haggenmüller B, Wolf D, Beer M, Schmidt SA. Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. ROFO-FORTSCHR RONTG 2023; 195:393-405. [PMID: 36630983 DOI: 10.1055/a-1990-0201] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Sarcopenia is an age-related syndrome characterized by a loss of muscle mass and strength. As a result, the independence of the elderly is reduced and the hospitalization rate and mortality increase. The onset of sarcopenia often begins in middle age due to an unbalanced diet or malnutrition in association with a lack of physical activity. This effect is intensified by concomitant diseases such as obesity or metabolic diseases including diabetes mellitus. METHOD With effective preventative diagnostic procedures and specific therapeutic treatment of sarcopenia, the negative effects on the individual can be reduced and the negative impact on health as well as socioeconomic effects can be prevented. Various diagnostic options are available for this purpose. In addition to basic clinical methods such as measuring muscle strength, sarcopenia can also be detected using imaging techniques like dual X-ray absorptiometry (DXA), computed tomography (CT), magnetic resonance imaging (MRI), and sonography. DXA, as a simple and cost-effective method, offers a low-dose option for assessing body composition. With cross-sectional imaging techniques such as CT and MRI, further diagnostic possibilities are available, including MR spectroscopy (MRS) for noninvasive molecular analysis of muscle tissue. CT can also be used in the context of examinations performed for other indications to acquire additional parameters of the skeletal muscles (opportunistic secondary use of CT data), such as abdominal muscle mass (total abdominal muscle area - TAMA) or the psoas as well as the pectoralis muscle index. The importance of sarcopenia is already well studied for patients with various tumor entities and also infections such as SARS-COV2. RESULTS AND CONCLUSION Sarcopenia will become increasingly important, not least due to demographic changes in the population. In this review, the possibilities for the diagnosis of sarcopenia, the clinical significance, and therapeutic options are described. In particular, CT examinations, which are repeatedly performed on tumor patients, can be used for diagnostics. This opportunistic use can be supported by the use of artificial intelligence. KEY POINTS · Sarcopenia is an age-related syndrome with loss of muscle mass and strength.. · Early detection and therapy can prevent negative effects of sarcopenia.. · In addition to DEXA, cross-sectional imaging techniques (CT, MRI) are available for diagnostic purposes.. · The use of artificial intelligence (AI) offers further possibilities in sarcopenia diagnostics.. CITATION FORMAT · Vogele D, Otto S, Sollmann N et al. Sarcopenia - Definition, Radiological Diagnosis, Clinical Significance. Fortschr Röntgenstr 2023; DOI: 10.1055/a-1990-0201.
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Affiliation(s)
- Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Stephanie Otto
- Comprehensive Cancer Center (CCCU), University Hospital Ulm, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Benedikt Haggenmüller
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Daniel Wolf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
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Muacevic A, Adler JR, Osati S, Ehrampoush E, Davoodi SH, Homayounfar R. COVID-19 Induces Body Composition and Metabolic Alterations. Cureus 2023; 15:e34196. [PMID: 36843827 PMCID: PMC9953753 DOI: 10.7759/cureus.34196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
Background Individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are highly susceptible to disease-related metabolic dysregulation given the hyperinflammatory immune response of coronavirus disease 2019 (COVID-19). These changes are remarkably involved in multiple steps in adipogenesis and lipolysis. This study aimed to elaborate on the significant relations of COVID-19 infection with body fat distribution, changes in serum insulin, and homeostasis model assessment-estimated insulin resistance (HOMA-IR) levels before and after the infection. Methods In this follow-up study, from July 2021 to September 2021, persons referred to a university-affiliated Nutrition Counselling Clinic were randomly selected for the study samples. Validated food frequency (FFQ) and physical activity questionnaires were completed. Body composition was assessed in this investigation. On the second visit, those who reported mild to moderate COVID-19 infection (without hospitalization) were selected as the case group and the asymptomatic individuals as the control group. All measurements were re-measured in the second visit. Results In a total of 441 patients, the mean age was 38.82±4.63 years. There were 224 (50.79%) male subjects, and 217 (49.20%) were females. There was a statistically significant difference in the longitudinal change in total fat percentage between subjects with and without COVID-19. Also, the difference in HOMA-IR before and after COVID-19 in case groups (both males and females) was statistically significant (P-value < 0.001). Moreover, serum insulin levels were significantly increased in all cases (P-value < 0.001), while remaining stable in control groups. When compared to their initial visit, COVID-19 patients' total fat percentage rose significantly (almost 2%) following a hypocaloric diet. Participants who were not infected with COVID-19 had a lower total fat percentage than those who were. Serum insulin and HOMA-IR levels increased significantly after infection compared to the primary measurements. Conclusion Individuals with COVID-19 infection may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes such as muscle loss and fat accommodation.
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Gobbi M, Brunani A, Arreghini M, Baccalaro G, Dellepiane D, La Vela V, Lucchetti E, Barbaglia M, Cova A, Fornara E, Galli S, Cimolin V, Brugliera L, Capodaglio P. Nutritional status in post SARS-Cov2 rehabilitation patients. Clin Nutr 2022; 41:3055-3060. [PMID: 34049750 PMCID: PMC8056781 DOI: 10.1016/j.clnu.2021.04.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/22/2020] [Accepted: 04/07/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS After prolonged hospitalization, the assessment of nutritional status and the identification of adequate nutritional support is of paramount importance. In this observational study, we aimed at assessing the presence of a malnutrition condition in SARS-Cov2 patients after the acute phase and the effects of a multidisciplinary rehabilitation program on nutritional and functional status. METHODS We recruited 48 patients (26 males/22 females) admitted to our Rehabilitation Unit after discharge from acute Covid Hospitals in northern Italy with negative swab for SARS-Cov2. We used the Global Leadership Initiative on Malnutrition (GLIM) criteria to identify patients with different degrees of malnutrition. Patients underwent a 3 to 4-week individual multidisciplinary rehabilitation program consisting of nutritional intervention (energy intake 27to30 kcal/die/kg and protein intake 1-1.3 g/die/kg), exercise for total body conditioning and progressive aerobic exercise with cycle- and arm-ergometer (45 min, 5 days/week). At admission and discharge from our Rehabilitation Unit, body composition and phase angle (PhA) (BIA101 Akern), muscle strength (handgrip, HG) and physical performance (Timed-Up-and-Go, TUG) were assessed. RESULTS At admission in all patients the mean weight loss, as compared to the habitual weight, was -12.1 (7.6)%, mean BMI was 25.9 (7.9) kg/m2, mean Appendicular Skeletal Muscle Index (ASMI) was 6.6 (1.7) kg/m2 for males and 5.4 (1.4) kg/m2 for females, mean phase angle was 2.9 (0.9)°, mean muscle strength (HG) was 21.1 (7.8) kg for males and 16.4 (5.9) kg for females, mean TUG value was 23.7 (19.2) s. Based on GLIM criteria 29 patients (60% of the total) showed a malnutrition condition. 7 out of those 29 patients (24%) presented a mild/moderate grade and 22 patients (76%) a severe grade. After a rehabilitation program of an average duration of 25 days (range 13-46) ASMI increased, with statistically significant differences only in females (p = 0.001) and HG improved only in males (p = 0.0014). In all of the patients, body weight did not change, CRP/albumin (p < 0.05) and TUG (p < 0.001) were reduced and PhA increased (p < 0.01). CONCLUSIONS We diagnosed a malnutrition condition in 60% of our post SARS-Cov2 patients. An individualized nutritional intervention with adequate energy and protein intake combined with tailored aerobic and strengthening exercise improved nutritional and functional status.
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Affiliation(s)
- M Gobbi
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy.
| | - A Brunani
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - M Arreghini
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - G Baccalaro
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - D Dellepiane
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - V La Vela
- Department of Clinical Nutrition and Eating Disorder, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - E Lucchetti
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - M Barbaglia
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - A Cova
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - E Fornara
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - S Galli
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy
| | - V Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico of Milano, Milan, Italy
| | - L Brugliera
- Department of Rehabilitation and Functional Recovery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - P Capodaglio
- Istituto Auxologico Italiano, IRCCS, Ospedale San Giuseppe, Piancavallo, Verbania, Italy; Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Turin, Turin, Italy
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13
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Osuna-Padilla IA, Rodríguez-Moguel NC, Rodríguez-Llamazares S, Orsso CE, Prado CM, Ríos-Ayala MA, Villanueva-Camacho O, Aguilar-Vargas A, Pensado-Piedra LE, Juárez-Hernández F, Hernández-Cárdenas CM. Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment. Clin Nutr 2022; 41:2910-2917. [PMID: 35282986 PMCID: PMC8886683 DOI: 10.1016/j.clnu.2022.02.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 02/25/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Low muscle mass is a common condition in the critically ill population and is associated with adverse clinical outcomes. The primary aim of this study was to analyze the prognostic significance of low muscle mass using computed tomography (CT) scans in COVID-19 critically ill patients. A second objective was to determine the accuracy and agreement in low muscle mass identification using diverse markers compared to CT as the gold standard. METHODS This was a prospective cohort study of COVID-19 critically ill patients. Skeletal muscle area at the third lumbar vertebra was measured. Clinical outcomes (intensive care unit [ICU] and hospital length of stay [LOS], tracheostomy, days on mechanical ventilation [MV], and in-hospital mortality) were assessed. Phase angle, estimated fat-free mass index, calf circumference, and mid-upper arm circumference were measured as surrogate markers of muscle mass. RESULTS Eighty-six patients were included (mean age ± SD: 48.6 ± 12.9; 74% males). Patients with low muscle mass (48%) had a higher rate of tracheostomy (50 vs 20%, p = 0.01), prolonged ICU (adjusted HR 0.53, 95%CI 0.30-0.92, p = 0.024) and hospital LOS (adjusted HR 0.50, 95% CI 0.29-0.86, p = 0.014). Bedside markers of muscle mass showed poor to fair agreement and accuracy compared to CT-assessed low muscle mass. CONCLUSION Low muscle mass at admission was associated with prolonged length of ICU and hospital stays. Further studies are needed to establish targeted nutritional interventions to halt and correct the catabolic impact of COVID-19 in critically ill patients, based on standardized and reliable measurements of body composition.
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Affiliation(s)
- I A Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico; Departamento de Áreas Críticas Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - N C Rodríguez-Moguel
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - S Rodríguez-Llamazares
- Departamento de Investigación en Tabaquismo y EPOC Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - C E Orsso
- Human Nutrition Research Unit Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - C M Prado
- Human Nutrition Research Unit Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - M A Ríos-Ayala
- Departamento de Áreas Críticas Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - O Villanueva-Camacho
- Departamento de Alimentación y Nutrición Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - A Aguilar-Vargas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - L E Pensado-Piedra
- Departamento de Imagenología Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - F Juárez-Hernández
- Departamento de Imagenología Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - C M Hernández-Cárdenas
- Departamento de Áreas Críticas Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
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Guaraldi G, Milic J, Cesari M, Leibovici L, Mandreoli F, Missier P, Rozzini R, Cattelan AM, Motta F, Mussini C, Cossarizza A. The interplay of post-acute COVID-19 syndrome and aging: a biological, clinical and public health approach. Ageing Res Rev 2022; 81:101686. [PMID: 35820609 PMCID: PMC9270773 DOI: 10.1016/j.arr.2022.101686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/07/2022] [Indexed: 01/31/2023]
Abstract
The post-acute COVID-19 syndrome (PACS) is characterized by the persistence of fluctuating symptoms over three months from the onset of the possible or confirmed COVID-19 acute phase. Current data suggests that at least 10% of people with previously documented infection may develop PACS, and up to 50-80% of prevalence is reported among survivors after hospital discharge. This viewpoint will discuss various aspects of PACS, particularly in older adults, with a specific hypothesis to describe PACS as the expression of a modified aging trajectory induced by SARS CoV-2. This hypothesis will be argued from biological, clinical and public health view, addressing three main questions: (i) does SARS-CoV-2-induced alterations in aging trajectories play a role in PACS?; (ii) do people with PACS face immuno-metabolic derangements that lead to increased susceptibility to age-related diseases?; (iii) is it possible to restore the healthy aging trajectory followed by the individual before pre-COVID?. A particular focus will be given to the well-being of people with PACS that could be assessed by the intrinsic capacity model and support the definition of the healthy aging trajectory.
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Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy,Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy,Correspondence to: Department of Surgical, Medical, Dental and Morphological Sciences University of Modena and Reggio Emilia, Largo del Pozzo, 71, 41124 Modena, Italy
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Federica Mandreoli
- Department of Physical, Computer and Mathematical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Missier
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Renzo Rozzini
- Geriatric Department, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Federico Motta
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Mussini
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Modena, Italy,Department of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico of Modena, Modena, Italy
| | - Andrea Cossarizza
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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15
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Saseedharan S, Chada RR, Kadam V, Chiluka A, Nagalla B. Energy expenditure in COVID-19 mechanically ventilated patients: A comparison of three methods of energy estimation. JPEN J Parenter Enteral Nutr 2022; 46:1875-1882. [PMID: 35526145 PMCID: PMC9348140 DOI: 10.1002/jpen.2393] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure. Energy expenditure (EE) estimated by ventilator-derived carbon dioxide consumption (EEVCO2 ) has also been proposed. In the absence of IC, predictive weight-based equations have been recommended to estimate daily energy requirements. This study aims to compare simple predictive weight-based equations with those estimated by EEVCO2 and IC in mechanically ventilated patients of COVID-19. METHODS Retrospective study of a cohort of critically ill adult patients with COVID-19 requiring mechanical ventilation and artificial nutrition to compare energy estimations by three methods through the calculation of bias and precision agreement, reliability, and accuracy rates. RESULTS In 58 mechanically ventilated patients, a total of 117 paired measurements were obtained. The mean estimated energy derived from weight-based calculations was 2576 ± 469 kcal/24 h, as compared with 1507 ± 499 kcal/24 h when EE was estimated by IC, resulting in a significant bias of 1069 kcal/day (95% CI [-2158 to 18.7 kcal]; P < 0.001). Similarly, estimated mean EEVCO2 was 1388 ± 467 kcal/24 h when compared with estimation of EE from IC. A significant bias of only 118 kcal/day (95% CI [-187 to 422 kcal]; P < 0.001), compared by the Bland-Altman plot, was noted. CONCLUSION The energy estimated with EEVCO2 correlated better with IC values than energy derived from weight-based calculations. Our data suggest that the use of simple predictive equations may potentially lead to overfeeding in mechanically ventilated patients with COVID-19.
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Affiliation(s)
- Sanjith Saseedharan
- Department of Intensive CareS L Raheja Hospital‐A Fortis AssociateMumbaiMaharashtraIndia
| | - Radha Reddy Chada
- Department of Clinical Nutrition and DieteticsAIG HospitalsHyderabadTelanganaIndia
| | - Vaijayanti Kadam
- Department of Intensive CareS L Raheja Hospital‐A Fortis AssociateMumbaiMaharashtraIndia
| | - Annapurna Chiluka
- Department of Intensive CareS L Raheja Hospital‐A Fortis AssociateMumbaiMaharashtraIndia
| | - Balakrishna Nagalla
- Department of StatisticsApollo Hospitals Educational And Research FoundationHyderabadTelanganaIndia
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16
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Alghamdi F, Owen R, Ashton REM, Obotiba AD, Meertens RM, Hyde E, Faghy MA, Knapp KM, Rogers P, Strain WD. Post-acute COVID syndrome (long COVID): What should radiographers know and the potential impact for imaging services. Radiography (Lond) 2022; 28 Suppl 1:S93-S99. [PMID: 36109264 PMCID: PMC9468096 DOI: 10.1016/j.radi.2022.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/30/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The COVID-19 pandemic caused an unprecedented health crisis resulting in over 6 million deaths worldwide, a figure, which continues to grow. In addition to the excess mortality, there are individuals who recovered from the acute stages, but suffered long-term changes in their health post COVID-19, commonly referred to as long COVID. It is estimated there are currently 1.8 million long COVID sufferers by May 2022 in the UK alone. The aim of this narrative literature review is to explore the signs, symptoms and diagnosis of long COVID and the potential impact on imaging services. KEY FINDINGS Long COVID is estimated to occur in 9.5% of those with two doses of vaccination and 14.6% if those with a single dose or no vaccination. Long COVID is defined by ongoing symptoms lasting for 12 or more weeks post acute infection. Symptoms are associated with reductions in the quality of daily life and may involve multisystem manifestations or present as a single symptom. CONCLUSION The full impact of long COVID on imaging services is yet to be realised, but there is likely to be significant increased demand for imaging, particularly in CT for the assessment of lung disease. Educators will need to include aspects related to long COVID pathophysiology and imaging presentations in curricula, underpinned by the rapidly evolving evidence base. IMPLICATIONS FOR PRACTICE Symptoms relating to long COVID are likely to become a common reason for imaging, with a particular burden on Computed Tomography services. Planning, education and updating protocols in line with a rapidly emerging evidence base is going to be essential.
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Affiliation(s)
- F Alghamdi
- College of Medicine and Health, University of Exeter, Exeter, UK.
| | - R Owen
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - R E M Ashton
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - A D Obotiba
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - R M Meertens
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - E Hyde
- College of Health, Psychology and Social Care, University of Derby, Derby, UK
| | - M A Faghy
- Human Sciences Research Centre, University of Derby, Derby, UK
| | - K M Knapp
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - P Rogers
- Medical Imaging, Royal Devon and Exeter NHS Foundation Trust, UK
| | - W D Strain
- College of Medicine and Health, University of Exeter, Exeter, UK
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17
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Besutti G, Pellegrini M, Ottone M, Bonelli E, Monelli F, Farì R, Milic J, Dolci G, Fasano T, Canovi S, Costi S, Fugazzaro S, Massari M, Ligabue G, Croci S, Salvarani C, Pattacini P, Guaraldi G, Giorgi Rossi P. Modifications of Chest CT Body Composition Parameters at Three and Six Months after Severe COVID-19 Pneumonia: A Retrospective Cohort Study. Nutrients 2022; 14:3764. [PMID: 36145141 PMCID: PMC9501258 DOI: 10.3390/nu14183764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/16/2022] Open
Abstract
We aimed to describe body composition changes up to 6-7 months after severe COVID-19 and to evaluate their association with COVID-19 inflammatory burden, described by the integral of the C-reactive protein (CRP) curve. The pectoral muscle area (PMA) and density (PMD), liver-to-spleen (L/S) ratio, and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, and IMAT) were measured at baseline (T0), 2-3 months (T1), and 6-7 months (T2) follow-up CT scans of severe COVID-19 pneumonia survivors. Among the 208 included patients (mean age 65.6 ± 11 years, 31.3% females), decreases in PMA [mean (95%CI) -1.11 (-1.72; -0.51) cm2] and in body fat areas were observed [-3.13 (-10.79; +4.52) cm2 for TAT], larger from T0 to T1 than from T1 to T2. PMD increased only from T1 to T2 [+3.07 (+2.08; +4.06) HU]. Mean decreases were more evident for VAT [-3.55 (-4.94; -2.17) cm2] and steatosis [L/S ratio increase +0.17 (+0.13; +0.20)] than for TAT. In multivariable models adjusted by age, sex, and baseline TAT, increasing the CRP interval was associated with greater PMA reductions, smaller PMD increases, and greater VAT and steatosis decreases, but it was not associated with TAT decreases. In conclusion, muscle loss and fat loss (more apparent in visceral compartments) continue until 6-7 months after COVID-19. The inflammatory burden is associated with skeletal muscle loss and visceral/liver fat loss.
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Affiliation(s)
- Giulia Besutti
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Massimo Pellegrini
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Marta Ottone
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Efrem Bonelli
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Filippo Monelli
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Clinical and Experimental PhD Program, University of Reggio Emilia, 41124 Modena, Italy
| | - Roberto Farì
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Jovana Milic
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Giovanni Dolci
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Tommaso Fasano
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Simone Canovi
- Clinical Chemistry and Endocrinology Laboratory, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Stefania Costi
- Scientific Directorate Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Stefania Fugazzaro
- Physical Medicine and Rehabilitation Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Marco Massari
- Infectious Diseases Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Guido Ligabue
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Stefania Croci
- Clinical Immunology, Allergy and Advanced Biotechnologies Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Carlo Salvarani
- Department of Surgery, Medicine, Dentistry and Morphological Sciences with Interest in Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41124 Modena, Italy
- Rheumatology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
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Morrow A, Gray SR, Bayes HK, Sykes R, McGarry E, Anderson D, Boiskin D, Burke C, Cleland JGF, Goodyear C, Ibbotson T, Lang CC, McConnachie, Mair F, Mangion K, Patel M, Sattar N, Taggart D, Taylor R, Dawkes S, Berry C. Prevention and early treatment of the long-term physical effects of COVID-19 in adults: design of a randomised controlled trial of resistance exercise-CISCO-21. Trials 2022; 23:660. [PMID: 35971155 PMCID: PMC9376905 DOI: 10.1186/s13063-022-06632-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/04/2022] [Indexed: 11/11/2022] Open
Abstract
Background Coronavirus disease-19 (COVID-19) infection causes persistent health problems such as breathlessness, chest pain and fatigue, and therapies for the prevention and early treatment of post-COVID-19 syndromes are needed. Accordingly, we are investigating the effect of a resistance exercise intervention on exercise capacity and health status following COVID-19 infection. Methods A two-arm randomised, controlled clinical trial including 220 adults with a diagnosis of COVID-19 in the preceding 6 months. Participants will be classified according to clinical presentation: Group A, not hospitalised due to COVID but persisting symptoms for at least 4 weeks leading to medical review; Group B, discharged after an admission for COVID and with persistent symptoms for at least 4 weeks; or Group C, convalescing in hospital after an admission for COVID. Participants will be randomised to usual care or usual care plus a personalised and pragmatic resistance exercise intervention for 12 weeks. The primary outcome is the incremental shuttle walks test (ISWT) 3 months after randomisation with secondary outcomes including spirometry, grip strength, short performance physical battery (SPPB), frailty status, contacts with healthcare professionals, hospitalisation and questionnaires assessing health-related quality of life, physical activity, fatigue and dyspnoea. Discussion Ethical approval has been granted by the National Health Service (NHS) West of Scotland Research Ethics Committee (REC) (reference: GN20CA537) and recruitment is ongoing. Trial findings will be disseminated through patient and public forums, scientific conferences and journals. Trial registration ClinicialTrials.gov NCT04900961. Prospectively registered on 25 May 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06632-y.
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Affiliation(s)
- A Morrow
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stuart R Gray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - H K Bayes
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Sykes
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - E McGarry
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Anderson
- Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - D Boiskin
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - C Burke
- Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - J G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C Goodyear
- Institute of Inflammation, Infection and Immunity, University of Glasgow, Glasgow, UK
| | - T Ibbotson
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C C Lang
- School of Medicine, University of Dundee, Dundee, UK
| | - McConnachie
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - F Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - K Mangion
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - M Patel
- University Hospital Wishaw, NHS Lanarkshire, Wishaw, UK
| | - N Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - D Taggart
- NHS Project Management Unit, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R Taylor
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - S Dawkes
- School for Nursing Midwifery and Paramedic Practice, Robert Gordon University, Aberdeen, UK
| | - C Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
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19
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Orendáčová M, Kvašňák E. Effects of vaccination, new SARS-CoV-2 variants and reinfections on post-COVID-19 complications. Front Public Health 2022; 10:903568. [PMID: 35968477 PMCID: PMC9372538 DOI: 10.3389/fpubh.2022.903568] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Post-COVID-19 complications involve a variety of long-lasting health complications emerging in various body systems. Since the prevalence of post-COVID-19 complications ranges from 8-47% in COVID-19 survivors, it represents a formidable challenge to COVID-19 survivors and the health care system. Post-COVID-19 complications have already been studied in the connection to risk factors linked to their higher probability of occurrence and higher severity, potential mechanisms underlying the pathogenesis of post-COVID-19 complications, and their functional and structural correlates. Vaccination status has been recently revealed to represent efficient prevention from long-term and severe post-COVID-19 complications. However, the exact mechanisms responsible for vaccine-induced protection against severe and long-lasting post-COVID-19 complications remain elusive. Also, to the best of our knowledge, the effects of new SARS-CoV-2 variants and SARS-CoV-2 reinfections on post-COVID-19 complications and their underlying pathogenesis remain to be investigated. This hypothesis article will be dedicated to the potential effects of vaccination status, SARS-CoV-2 reinfections, and new SARS-CoV-2 variants on post-COVID-19 complications and their underlying mechanisms Also, potential prevention strategies against post-COVID complications will be discussed.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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20
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Gomez-Perez SL, Zhang Y, Byrne C, Wakefield C, Geesey T, Sclamberg J, Peterson S. Concordance of Computed Tomography Regional Body Composition Analysis Using a Fully Automated Open-Source Neural Network versus a Reference Semi-Automated Program with Manual Correction. SENSORS 2022; 22:s22093357. [PMID: 35591047 PMCID: PMC9101564 DOI: 10.3390/s22093357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Quick, efficient, fully automated open-source programs to segment muscle and adipose tissues from computed tomography (CT) images would be a great contribution to body composition research. This study examined the concordance of cross-sectional areas (CSA) and densities for muscle, visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and intramuscular adipose tissue (IMAT) from CT images at the third lumbar (L3) between an automated neural network (test method) and a semi-automatic human-based program (reference method). Concordance was further evaluated by disease status, sex, race/ethnicity, BMI categories. Agreement statistics applied included Lin’s Concordance (CCC), Spearman correlation coefficient (SCC), Sorensen dice-similarity coefficient (DSC), and Bland−Altman plots with limits of agreement (LOA) within 1.96 standard deviation. A total of 420 images from a diverse cohort of patients (60.35 ± 10.92 years; body mass index (BMI) of 28.77 ± 7.04 kg/m2; 55% female; 53% Black) were included in this study. About 30% of patients were healthy (i.e., received a CT scan for acute illness or pre-surgical donor work-up), while another 30% had a diagnosis of colorectal cancer. The CCC, SCC, and DSC estimates for muscle, VAT, SAT were all greater than 0.80 (>0.80 indicates good performance). Agreement analysis by diagnosis showed good performance for the test method except for critical illness (DSC 0.65−0.87). Bland−Altman plots revealed narrow LOA suggestive of good agreement despite minimal proportional bias around the zero-bias line for muscle, SAT, and IMAT CSA. The test method shows good performance and almost perfect concordance for L3 muscle, VAT, SAT, and IMAT per DSC estimates, and Bland−Altman plots even after stratification by sex, race/ethnicity, and BMI categories. Care must be taken to assess the density of the CT images from critically ill patients before applying the automated neural network (test method).
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Affiliation(s)
- Sandra L. Gomez-Perez
- Department of Clinical Nutrition, Rush University, Chicago, IL 60612, USA;
- Correspondence:
| | - Yanyu Zhang
- Rush Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL 60612, USA;
| | - Cecily Byrne
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Connor Wakefield
- Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA;
| | - Thomas Geesey
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL 60612, USA; (T.G.); (J.S.)
| | - Joy Sclamberg
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL 60612, USA; (T.G.); (J.S.)
| | - Sarah Peterson
- Department of Clinical Nutrition, Rush University, Chicago, IL 60612, USA;
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21
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Prediction of abdominal CT body composition parameters by thoracic measurements as a new approach to detect sarcopenia in a COVID-19 cohort. Sci Rep 2022; 12:6443. [PMID: 35440794 PMCID: PMC9017415 DOI: 10.1038/s41598-022-10266-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/30/2022] [Indexed: 12/11/2022] Open
Abstract
As most COVID-19 patients only receive thoracic CT scans, but body composition, which is relevant to detect sarcopenia, is determined in abdominal scans, this study aimed to investigate the relationship between thoracic and abdominal CT body composition parameters in a cohort of COVID-19 patients. This retrospective study included n = 46 SARS-CoV-2-positive patients who received CT scans of the thorax and abdomen due to severe disease progression. The subcutaneous fat area (SF), the skeletal muscle area (SMA), and the muscle radiodensity attenuation (MRA) were measured at the level of the twelfth thoracic (T12) and the third lumbar (L3) vertebra. Necessity of invasive mechanical ventilation (IMV), length of stay, or time to death (TTD) were noted. For statistics correlation, multivariable linear, logistic, and Cox regression analyses were employed. Correlation was excellent for the SF (r = 0.96) between T12 and L3, and good for the respective SMA (r = 0.80) and MRA (r = 0.82) values. With adjustment (adj.) for sex, age, and body-mass-index the variability of SF (adj. r2 = 0.93; adj. mean difference = 1.24 [95% confidence interval (95% CI) 1.02–1.45]), of the SMA (adj. r2 = 0.76; 2.59 [95% CI 1.92–3.26]), and of the MRA (adj. r2 = 0.67; 0.67 [95% CI 0.45–0.88]) at L3 was well explained by the respective values at T12. There was no relevant influence of the SF, MRA, or SMA on the clinical outcome. If only thoracic CT scans are available, CT body composition values at T12 can be used to predict abdominal fat and muscle parameters, by which sarcopenia and obesity can be assessed.
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22
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Overweight subjects have a higher risk of malnutrition and loss of function after severe COVID infection. Clin Nutr ESPEN 2022; 49:669-670. [PMID: 35623871 PMCID: PMC9015947 DOI: 10.1016/j.clnesp.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
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23
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shabanpur M, Pourmahmoudi A, Nicolau J, Veronese N, Roustaei N, Jahromi AJ, Hosseinikia M. The importance of nutritional status on clinical outcomes among both ICU and Non-ICU patients with COVID-19. Clin Nutr ESPEN 2022; 49:225-231. [PMID: 35623817 PMCID: PMC9021035 DOI: 10.1016/j.clnesp.2022.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/22/2022] [Accepted: 04/15/2022] [Indexed: 12/19/2022]
Abstract
Background and aims Methods Results Conclusion
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24
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Ahmadi Hekmatikar AH, Ferreira Júnior JB, Shahrbanian S, Suzuki K. Functional and Psychological Changes after Exercise Training in Post-COVID-19 Patients Discharged from the Hospital: A PRISMA-Compliant Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2290. [PMID: 35206483 PMCID: PMC8871540 DOI: 10.3390/ijerph19042290] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 02/04/2023]
Abstract
Millions of people worldwide are infected with COVID-19, and COVID-19 survivors have been found to suffer from functional disabilities and mental disorders such as depression and anxiety. This is a matter of concern because COVID-19 is still not over. Because reinfection is still possible in COVID-19 survivors, decreased physical function and increased stress and anxiety can lower immune function. However, the optimal exercise intensity and volume appear to remain unknown. Therefore, the current systematic review aimed to evaluate the effect of resistance or aerobic exercises in post-COVID-19 patients after hospital discharge. We conducted searches in the Scopus, SciELO, PubMed, Web of Science, Science Direct, and Google Scholar databases. Studies that met the following criteria were included: (i) English language, (ii) patients with COVID-19 involved with resistance or aerobic exercise programs after hospital discharge. Out of 381 studies reviewed, seven studies met the inclusion criteria. Evidence shows that exercise programs composed of resistance exercise (e.g., 1-2 sets of 8-10 repetitions at 30-80% of 1RM) along with aerobic exercise (e.g., 5 to 30 min at moderate intensity) may improve the functional capacity and quality of life (reduce stress and mental disorders) in post-COVID-19 patients. In addition, only one study reported reinfection of three subjects involved with the exercise program, suggesting that exercise programs may be feasible for the rehabilitation of the patients. A meta-analysis was not conducted because the included studies have methodological heterogeneities, and they did not examine a control group. Consequently, the results should be generalized with caution.
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Affiliation(s)
| | | | - Shahnaz Shahrbanian
- Department of Sport Science, Faculty of Humanities, Tarbiat Modares University, Tehran 14117-13116, Iran;
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Saitama, Japan
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25
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Di Girolamo FG, Fiotti N, Sisto UG, Nunnari A, Colla S, Mearelli F, Vinci P, Schincariol P, Biolo G. Skeletal Muscle in Hypoxia and Inflammation: Insights on the COVID-19 Pandemic. Front Nutr 2022; 9:865402. [PMID: 35529457 PMCID: PMC9072827 DOI: 10.3389/fnut.2022.865402] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/09/2022] [Indexed: 12/23/2022] Open
Abstract
SARS-CoV-2 infection is often associated with severe inflammation, oxidative stress, hypoxia and impaired physical activity. These factors all together contribute to muscle wasting and fatigue. In addition, there is evidence of a direct SARS-CoV-2 viral infiltration into skeletal muscle. Aging is often characterized by sarcopenia or sarcopenic obesity These conditions are risk factors for severe acute COVID-19 and long-COVID-19 syndrome. From these observations we may predict a strong association between COVID-19 and decreased muscle mass and functions. While the relationship between physical inactivity, chronic inflammation, oxidative stress and muscle dysfunction is well-known, the effects on muscle mass of COVID-19-related hypoxemia are inadequately investigated. The aim of this review is to highlight metabolic, immunity-related and redox biomarkers potentially affected by reduced oxygen availability and/or muscle fatigue in order to shed light on the negative impact of COVID-19 on muscle mass and function. Possible countermeasures are also reviewed.
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Affiliation(s)
- Filippo G. Di Girolamo
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- *Correspondence: Filippo G. Di Girolamo
| | - Nicola Fiotti
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Ugo G. Sisto
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Alessio Nunnari
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Stefano Colla
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Filippo Mearelli
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Pierandrea Vinci
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Paolo Schincariol
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianni Biolo
- Department of Medical Surgical ad Health Science, Clinica Medica, Cattinara Hospital, University of Trieste, Trieste, Italy
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26
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Kunal S, Madan M, Tarke C, Gautam DK, Kinkar JS, Gupta K, Agarwal R, Mittal S, Sharma SM. Emerging spectrum of post-COVID-19 syndrome. Postgrad Med J 2021; 98:633-643. [PMID: 34880080 DOI: 10.1136/postgradmedj-2020-139585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 11/13/2021] [Indexed: 12/16/2022]
Abstract
'Post-COVID-19 syndrome' refers to symptoms in the convalescent phase following initial COVID-19 infection. This term encompasses a wide array of presentation involving lungs, heart and the neuromuscular system. Pulmonary manifestations include post-COVID-19 fibrosis, which is akin to post acute respiratory distress syndrome fibrosis and may reflect the permanent damage to the lungs following an initial bout of infection. Cardiovascular system is often involved, and the presentation can be in terms of acute coronary syndrome, myocarditis and heart failure. Clinical manifestations are often varied and non-specific, which entails a detailed workup and a multidisciplinary approach. Post-COVID-19 syndrome adds to the overall disease morbidity and leads to a prolonged hospital stay, greater healthcare utilisation and loss of productivity marring the country's dwindling economy. Thus, it is imperative that post-COVID-19 syndrome be prevented and identified early followed by a prompt treatment.
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Affiliation(s)
- Shekhar Kunal
- Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Manu Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Chandrakant Tarke
- Department of Pulmonology, Apollo Hospital, Hyderabad, Telangana, India
| | - Dinesh Kumar Gautam
- Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Jiwan Shriram Kinkar
- Department of Neurology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Kashish Gupta
- Department of Medicine, SG Diabetes Centre, Delhi, India
| | - Ritu Agarwal
- Department of Radiodiagnosis, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Shruti Mittal
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Shashi Mohan Sharma
- Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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27
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Gobbi M, Bezzoli E, Ismelli F, Trotti G, Cortellezzi S, Meneguzzo F, Arreghini M, Seitanidis I, Brunani A, Aspesi V, Cimolin V, Fanari P, Capodaglio P. Skeletal Muscle Mass, Sarcopenia and Rehabilitation Outcomes in Post-Acute COVID-19 Patients. J Clin Med 2021; 10:jcm10235623. [PMID: 34884325 PMCID: PMC8658326 DOI: 10.3390/jcm10235623] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 12/28/2022] Open
Abstract
The relationship between skeletal muscle mass at the beginning of the post-acute rehabilitation phase and rehabilitation outcomes has been scarcely investigated. The aim of this study was to investigate the impact of the existence of sarcopenia upon admission to a post-acute COVID-19 patient rehabilitation unit on body composition and functional and respiratory capacity at discharge. Thirty-four post-acute COVID-19 patients were referred to our Rehabilitation Unit from different COVID Hospitals in northern Italy. Body weight loss, body composition, handgrip strength, functional parameters, oxygen saturation and related perception of dyspnea in several positions were measured before and after a 28-day multidisciplinary rehabilitation program. Spirometry was performed only upon admission. The intervention included psychiatric support, cognitive behavioral therapy, nutritional therapy and physiotherapy, including aerobic and resistance training. Training volume was 45 min/session, 6 sessions/week. Upon admission, the prevalence of sarcopenia among our patients was 58%. In all of the 34 patients, we observed a trend of improvement in all of the respiratory, body composition, muscle strength and functional parameters considered. Monitoring muscle mass and strength in post-acute COVID-19 patients appears to be a key predictor of rehabilitation outcomes. Early diagnosis of sarcopenia therefore appears to be of paramount importance in the management of post-acute COVID-19 patients.
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Affiliation(s)
- Michele Gobbi
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
- Correspondence:
| | - Emanuela Bezzoli
- Respiratory Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (E.B.); (P.F.)
| | - Francesco Ismelli
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Giulia Trotti
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Stefano Cortellezzi
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Francesca Meneguzzo
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Marco Arreghini
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Ionathan Seitanidis
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Amelia Brunani
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Valentina Aspesi
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milano, Italy;
| | - Paolo Fanari
- Respiratory Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (E.B.); (P.F.)
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics and Rehabilitation, Istituto Auxologico Italiano, IRCCS, 28824 Piancavallo, Italy; (F.I.); (G.T.); (S.C.); (F.M.); (M.A.); (I.S.); (A.B.); (V.A.); (P.C.)
- Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Torino, 10126 Torino, Italy
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28
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Gérard M, Mahmutovic M, Malgras A, Michot N, Scheyer N, Jaussaud R, Nguyen-Thi PL, Quilliot D. Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19. Nutrients 2021; 13:3964. [PMID: 34836219 PMCID: PMC8618979 DOI: 10.3390/nu13113964] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 01/21/2023] Open
Abstract
Post-acute consequences of COVID-19, also termed long COVID, include signs and symptoms persisting for more than 12 weeks with prolonged multisystem involvement; most often, however, malnutrition is ignored. METHOD The objective was to analyze persistent symptoms, nutritional status, the evolution of muscle strength and performance status (PS) at 6 months post-discharge in a cohort of COVID-19 survivors. RESULTS Of 549 consecutive patients hospitalized for COVID-19 between 1 March and 29 April 2020, 23.7% died and 288 patients were at home at D30 post-discharge. At this date, 136 of them (47.2%) presented persistent malnutrition, a significant decrease in muscle strength or a PS ≥ 2. These patients received dietary counseling, nutritional supplementation, adapted physical activity guidance or physiotherapy assistance, or were admitted to post-care facilities. At 6 months post-discharge, 91.0% of the 136 patients (n = 119) were evaluated and 36.0% had persistent malnutrition, 14.3% complained of a significant decrease in muscle strength and 14.9% had a performance status > 2. Obesity was more frequent in patients with impairment than in those without (52.8% vs. 31.0%; p = 0.0071), with these patients being admitted more frequently to ICUs (50.9% vs. 31.3%; p = 0.010). Among those with persistent symptoms, 10% had psychiatric co-morbidities (mood disorders, anxiety, or post-traumatic stress syndrome), 7.6% had prolonged pneumological symptoms and 4.2% had neurological symptoms. CONCLUSIONS Obese subjects as well as patients who have stayed in intensive care have a higher risk of functional loss or undernutrition 6 months after a severe COVID infection. Malnutrition and loss of muscle strength should be considered in the clinical assessment of these patients.
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Affiliation(s)
- Marine Gérard
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France; (M.G.); (M.M.); (A.M.); (N.M.); (N.S.)
| | - Meliha Mahmutovic
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France; (M.G.); (M.M.); (A.M.); (N.M.); (N.S.)
| | - Aurélie Malgras
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France; (M.G.); (M.M.); (A.M.); (N.M.); (N.S.)
| | - Niasha Michot
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France; (M.G.); (M.M.); (A.M.); (N.M.); (N.S.)
| | - Nicolas Scheyer
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France; (M.G.); (M.M.); (A.M.); (N.M.); (N.S.)
| | - Roland Jaussaud
- Internal Medicine and Clinical Immunology Department, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France;
| | - Phi-Linh Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France;
| | - Didier Quilliot
- Transversal Nutrition Unit, University of Lorraine, Nancy University Hospital, 54500 Vandoeuvre-les-Nancy, France; (M.G.); (M.M.); (A.M.); (N.M.); (N.S.)
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van der Meij BS, Ligthart-Melis GC, de van der Schueren MAE. Malnutrition in patients with COVID-19: assessment and consequences. Curr Opin Clin Nutr Metab Care 2021; 24:543-554. [PMID: 34419971 DOI: 10.1097/mco.0000000000000783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW COVID-19 disease often presents with malnutrition and nutrition impact symptoms, such as reduced appetite, nausea and loss of taste. This review summarizes the most up-to-date research on nutritional assessment in relation to mortality and morbidity risk in patients with COVID-19. RECENT FINDINGS Numerous studies have been published on malnutrition, muscle wasting, obesity, and nutrition impact symptoms associated with COVID-19, mostly observational and in hospitalized patients. These studies have shown a high prevalence of symptoms (loss of appetite, nausea, vomiting, diarrhea, dysphagia, fatigue, and loss of smell and taste), malnutrition, micronutrient deficiencies and obesity in patients with COVID-19, all of which were associated with increased mortality and morbidity risks. SUMMARY Early screening and assessment of malnutrition, muscle wasting, obesity, nutrition impact symptoms and micronutrient status in patients with COVID-19, followed by pro-active nutrition support is warranted, and expected to contribute to improved recovery. There is limited research on nutritional status or nutrition impact symptoms in patients living at home or in residential care. RCTs studying the effects of nutrition intervention on clinical outcomes are lacking. Future research should focus on these evidence gaps.
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Affiliation(s)
- Barbara S van der Meij
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands
- Bond University Nutrition and Dietetics Research Group, Faculty of Health Sciences and Medicine, Gold Coast, Australia
| | - Gerdien C Ligthart-Melis
- Center for Translational Research in Aging & Longevity, Department Health & Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Marian A E de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Division of Human Nutrition, Wageningen University and Research, Wageningen, The Netherlands
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Guaraldi G, Milic J, Sebastiani G, Raggi P. Sarcopenic obesity at the crossroad of pathogenesis of cardiometabolic diseases. Atherosclerosis 2021; 335:84-86. [PMID: 34563339 DOI: 10.1016/j.atherosclerosis.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Giovanni Guaraldi
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy.
| | - Jovana Milic
- Department of Surgical, Medical, Dental and Morphological Sciences, University of Modena and Reggio Emilia, Italy.
| | - Giada Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
| | - Paolo Raggi
- Department of Medicine, Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
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Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19. Nutrients 2021; 13:nu13093293. [PMID: 34579171 PMCID: PMC8472175 DOI: 10.3390/nu13093293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
Targeted nutritional therapy should be started early in severe illness and sustained through to recovery if clinical and patient-centred outcomes are to be optimised. The coronavirus disease 2019 (COVID-19) pandemic has shone a light on this need. The literature on nutrition and COVID-19 mainly focuses on the importance of nutrition to preserve life and prevent clinical deterioration during the acute phase of illness. However, there is a lack of information guiding practice across the whole patient journey (e.g., hospital to home) with a focus on targeting recovery (e.g., long COVID). This review paper is of relevance to doctors and other healthcare professionals in acute care and primary care worldwide, since it addresses early, multi-modal individualised nutrition interventions across the continuum of care to improve COVID-19 patient outcomes. It is of relevance to nutrition experts and non-nutrition experts and can be used to promote inter-professional and inter-organisational knowledge transfer on the topic. The primary goal is to prevent complications and support recovery to enable COVID-19 patients to achieve the best possible nutritional, physical, functional and mental health status and to apply the learning to date from the COVID-19 pandemic to other patient groups experiencing acute severe illness.
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Virgens IPA, Santana NM, Lima SCVC, Fayh APT. Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations. Br J Nutr 2021; 126:552-560. [PMID: 33261670 PMCID: PMC7711335 DOI: 10.1017/s0007114520004420] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 01/08/2023]
Abstract
Although increased weight, and particularly obesity, has been associated with a more severe clinical course of COVID-19 and risk of fatality, the course of the illness can lead to prolonged length of stay. Changes in nutritional status and weight loss during hospitalisation are largely reported in some populations, but still not explored in COVID-19 patients. Considering that patients with COVID-19 show an increased inflammatory response, other signs and symptoms, which can lead to weight and muscle loss, should be monitored. The aim of this article was to establish possible connections between COVID-19, prolonged hospitalisation and muscle wasting, as well as to propose nutritional recommendations for the prevention and treatment of cachexia, through a narrative review. Identification of risk and presence of malnutrition should be an early step in general assessment of all patients, with regard to more at-risk categories including older adults and individuals suffering from chronic and acute disease conditions, such as COVID-19. The deterioration of nutritional status, and consequently cachexia, increases the risk of mortality and needs to be treated with attention as other complications. There is, however, little hard evidence of nutritional approaches in assisting COVID-19 treatment or its management including cachexia.
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Affiliation(s)
- Isabel P. A. Virgens
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte59078-970, Brazil
| | - Natália M. Santana
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte59078-970, Brazil
| | - Severina C. V. C. Lima
- Graduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte59078-970, Brazil
| | - Ana P. T. Fayh
- Graduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte59078-970, Brazil
- Graduate Program in Nutrition, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte59078-970, Brazil
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Singer P. Nutritional and metabolic management of COVID-19 intensive care patients. JOURNAL OF INTENSIVE MEDICINE 2021; 1:31-34. [PMID: 36943801 PMCID: PMC7919505 DOI: 10.1016/j.jointm.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 04/15/2023]
Abstract
Nutritional and metabolic disturbances are observed in patients critically ill with Coronavirus disease 19 (COVID-19) patients. The aim of this review is to describe these disturbances during the progression of the disease, from the pre-intubation phase through the ventilated condition to the post extubation phase. The analysis of new data describing the prevalence of malnutrition, the modifications in energy expenditure and body composition are guiding medical nutritional therapy to prevent patients from experiencing severe energy deficit and muscle loss. Rehabilitation may be extremely prolonged and therefore, nutrition is mandatory to decrease this recondition period. This review also comments on the European Society of Parenteral and Enteral Nutrition (ESPEN) nutritional statements.
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Wierdsma NJ, Kruizenga HM, Konings LA, Krebbers D, Jorissen JR, Joosten MHI, van Aken LH, Tan FM, van Bodegraven AA, Soeters MR, Weijs PJ. Poor nutritional status, risk of sarcopenia and nutrition related complaints are prevalent in COVID-19 patients during and after hospital admission. Clin Nutr ESPEN 2021; 43:369-376. [PMID: 34024542 PMCID: PMC8056328 DOI: 10.1016/j.clnesp.2021.03.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Patients with COVID-19 infection presents with a broad clinical spectrum of symptoms and complications. As a consequence nutritional requirements are not met, resulting in weight- and muscle loss, and malnutrition. The aim of the present study is to delineate nutritional complaints, the (course of the) nutritional status and risk of sarcopenia of COVID-19 patients, during hospitalisation and after discharge. METHODS In this prospective observational study in 407 hospital admitted COVID-19 patients in four university and peripheral hospitals, data were collected during dietetic consultations. Presence of nutrition related complaints (decreased appetite, loss of smell, changed taste, loss of taste, chewing and swallowing problems, nausea, vomiting, feeling of being full, stool frequency and consistency, gastric retention, need for help with food intake due to weakness and shortness of breath and nutritional status (weight loss, BMI, risk of sarcopenia with SARC-F ≥4 points) before, during hospital stay and after discharge were, where possible, collected. RESULTS Included patients were most men (69%), median age of 64.8 ± 12.4 years, 60% were admitted to ICU at any time point during hospitalisation with a median LOS of 15 days and an in-hospital mortality rate of 21%. The most commonly reported complaints were: decreased appetite (58%), feeling of being full (49%) and shortness of breath (43%). One in three patients experienced changed taste, loss of taste and/or loss of smell. Prior to hospital admission, 67% of the patients was overweight (BMI >25 kg/m2), 35% of the patients was characterised as malnourished, mainly caused by considerable weight loss. Serious acute weight loss (>5 kg) was showed in 22% of the patents during the hospital stay; most of these patients (85%) were admitted to the ICU at any point in time. A high risk of sarcopenia (SARC-F ≥ 4 points) was scored in 73% of the patients during hospital admission. CONCLUSION In conclusion, one in five hospital admitted COVID-19 patients suffered from serious acute weight loss and 73% had a high risk of sarcopenia. Moreover, almost all patients had one or more nutritional complaints. Of these complaints, decreased appetite, feeling of being full, shortness of breath and changed taste and loss of taste were the most predominant nutrition related complaints. These symptoms have serious repercussions on nutritional status. Although nutritional complaints persisted a long time after discharge, only a small group of patients received dietetic treatment after hospital discharge in recovery phase. Clinicians should consider the risks of acute malnutrition and sarcopenia in COVID-19 patients and investigate multidisciplinary treatment including dietetics during hospital stay and after discharge.
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Affiliation(s)
- Nicolette J Wierdsma
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Hinke M Kruizenga
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Lotte Aml Konings
- Wageningen University and Research Center, Wageningen, the Netherlands.
| | - Daphne Krebbers
- Department of Dietetics, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
| | - Jolein Rmc Jorissen
- Department of Dietetics, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands.
| | - Marie-Helene I Joosten
- Department of Dietetics, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands.
| | - Loes H van Aken
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Flora M Tan
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Ad A van Bodegraven
- Department of Gastroenterology, Zuyderland Medical Center, Heerlen, Sittard-Geleen, the Netherlands.
| | - Maarten R Soeters
- Department of Endocrinology & Metabolism, Internal Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Peter Jm Weijs
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, AMS Research Institute, VU University, Amsterdam, the Netherlands.
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Ali AM, Kunugi H. Screening for Sarcopenia (Physical Frailty) in the COVID-19 Era. Int J Endocrinol 2021; 2021:5563960. [PMID: 34113379 PMCID: PMC8152925 DOI: 10.1155/2021/5563960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/22/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Although the numbers of aged populations have risen considerably in the last few decades, the current coronavirus disease 2019 (COVID-19) has revealed an extensive vulnerability among these populations. Sarcopenia is an age-related disorder that increases hospitalization, dependencies, and mortality in older adults. It starts to develop in midlife or even earlier as a result of unbalanced diet/poor nutrition and low levels of physical activity, in addition to chronic disorders such as obesity and diabetes mellitus. Given that social isolation is adopted as the most protective measure against COVID-19, the level of physical activity and the intake of adequate diet have considerably declined, especially among older adults-denoting an increased possibility for developing sarcopenia. Research also shows a higher vulnerability of sarcopenic people to COVID-19 as well as the development of wasting disorders such as sarcopenia and cachexia in a considerable proportion of symptomatic and recovering COVID-19 patients. Muscular wasting in COVID-19 is associated with poor prognosis. Accordingly, early detection and proper management of sarcopenia and wasting conditions in older adults and COVID-19 patients may minimize morbidity and mortality during the current COVID-19 crisis. This review explored different aspects of screening for sarcopenia, stressing their relevance to the detection of altered muscular structure and performance in patients with COVID-19. Current guidelines recommend prior evaluation of muscle strength by simple measures such as grip strength to identify individuals with proven weakness who then would be screened for muscle mass loss. The latter is best measured by MRI and CT. However, due to the high cost and radiation risk entailed by these techniques, other simpler and cheaper techniques such as DXA and ultrasound are given preference. Muscle loss in COVID-19 patients was measured during the acute phase by CT scanning of the pectoralis muscle simultaneously during a routine check for lung fibrosis, which seems to be an efficient evaluation of sarcopenia among those patients with no additional cost. In recovering patients, muscle strength and physical performance have been evaluated by electromyography and traditional tests such as the six-minute walk test. Effective preventive and therapeutic interventions are necessary in order to prevent muscle loss and associated physical decline in COVID-19 patients.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Hiroshi Kunugi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
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Besutti G, Pellegrini M, Ottone M, Cantini M, Milic J, Bonelli E, Dolci G, Cassone G, Ligabue G, Spaggiari L, Pattacini P, Fasano T, Canovi S, Massari M, Salvarani C, Guaraldi G, Rossi PG. The impact of chest CT body composition parameters on clinical outcomes in COVID-19 patients. PLoS One 2021; 16:e0251768. [PMID: 33989341 PMCID: PMC8121324 DOI: 10.1371/journal.pone.0251768] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/02/2021] [Indexed: 01/08/2023] Open
Abstract
We assessed the impact of chest CT body composition parameters on outcomes and disease severity at hospital presentation of COVID-19 patients, focusing also on the possible mediation of body composition in the relationship between age and death in these patients. Chest CT scans performed at hospital presentation by consecutive COVID-19 patients (02/27/2020-03/13/2020) were retrospectively reviewed to obtain pectoralis muscle density and total, visceral, and intermuscular adipose tissue areas (TAT, VAT, IMAT) at the level of T7-T8 vertebrae. Primary outcomes were: hospitalization, mechanical ventilation (MV) and/or death, death alone. Secondary outcomes were: C-reactive protein (CRP), oxygen saturation (SO2), CT disease extension at hospital presentation. The mediation of body composition in the effect of age on death was explored. Of the 318 patients included in the study (median age 65.7 years, females 37.7%), 205 (64.5%) were hospitalized, 68 (21.4%) needed MV, and 58 (18.2%) died. Increased muscle density was a protective factor while increased TAT, VAT, and IMAT were risk factors for hospitalization and MV/death. All these parameters except TAT had borderline effects on death alone. All parameters were associated with SO2 and extension of lung parenchymal involvement at CT; VAT was associated with CRP. Approximately 3% of the effect of age on death was mediated by decreased muscle density. In conclusion, low muscle quality and ectopic fat accumulation were associated with COVID-19 outcomes, VAT was associated with baseline inflammation. Low muscle quality partly mediated the effect of age on mortality.
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Affiliation(s)
- Giulia Besutti
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Pellegrini
- Clinical Nutrition Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- * E-mail:
| | - Marta Ottone
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Michele Cantini
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Jovana Milic
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Efrem Bonelli
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Diagnostic Imaging and Laboratory Medicine, Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Dolci
- Infectious Disease Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Cassone
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Rheumatology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Guido Ligabue
- Radiology Unit, Azienda Ospedaliero-Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Spaggiari
- Radiology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Tommaso Fasano
- Department of Diagnostic Imaging and Laboratory Medicine, Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simone Canovi
- Department of Diagnostic Imaging and Laboratory Medicine, Clinical Chemistry and Endocrinology Laboratory, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marco Massari
- Infectious Disease Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL–IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Abstract
PURPOSE OF REVIEW This manuscript reviews evidence collected during COVID-19 pandemic and provides information on the impact of body composition on severity and outcomes of the disease, analysing methods used for body composition assessment. Malnutrition-screening tools will also be discussed to screen and diagnose the patients at higher risk of COVID-19 severity and related worse outcomes. RECENT FINDINGS COVID-19 can occur in a wide range of presentation, from asymptomatic to severe forms. Among the major risk factors for worse severity, overnutrition, undernutrition and body composition play a role in the ability to respond to SARS-CoV-2 infection. Excess fat accumulation (i.e. obesity) or lean mass loss and functionality (i.e. sarcopenia) or a combination of both (i.e. sarcopenic obesity) can affect whole-body functioning. These body composition alterations in the short-term can influence susceptibility and immunological responses to the virus, inflammatory reaction, metabolic and respiratory distress, while in the long-term can modulate disease outcomes, namely length of stay, time required for recovery, risk of ICU-acquired weakness and long-term disabilities, and potentially increase the risk of death. SUMMARY Individuals with malnutrition, sarcopenia, obesity, sarcopenic obesity and older adults with abnormal body composition or malnutrition risk may require tailored medical nutrition therapy to improve short and long-term COVID-19 outcomes.
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Affiliation(s)
- Edda Cava
- Unit of Dietetic and Clinical Nutrition, University Hospital "Maggiore della Carità", Novara, Italy
| | - Salvatore Carbone
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA, United States of America; VCU Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University, Richmond, VA, United States of America
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Ali AM, Kunugi H. Skeletal Muscle Damage in COVID-19: A Call for Action. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:372. [PMID: 33921429 PMCID: PMC8069858 DOI: 10.3390/medicina57040372] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary.
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Affiliation(s)
- Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Hiroshi Kunugi
- Department of Psychiatry, School of Medicine, Teikyo University, Tokyo 173-8605, Japan;
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo 187-8551, Japan
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Caracciolo M, Correale P, Mangano C, Foti G, Falcone C, Macheda S, Cuzzola M, Conte M, Falzea AC, Iuliano E, Morabito A, Caraglia M, Polimeni N, Ferrarelli A, Labate D, Tescione M, Di Renzo L, Chiricolo G, Romano L, De Lorenzo A. Efficacy and Effect of Inhaled Adenosine Treatment in Hospitalized COVID-19 Patients. Front Immunol 2021; 12:613070. [PMID: 33815368 PMCID: PMC8012541 DOI: 10.3389/fimmu.2021.613070] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 02/24/2021] [Indexed: 01/08/2023] Open
Abstract
Lack of specific antiviral treatment for COVID-19 has resulted in long hospitalizations and high mortality rate. By harnessing the regulatory effects of adenosine on inflammatory mediators, we have instituted a new therapeutic treatment with inhaled adenosine in COVID-19 patients, with the aim of reducing inflammation, the onset of cytokine storm, and therefore to improve prognosis. The use of inhaled adenosine in COVID19 patients has allowed reduction of length of stay, on average 6 days. This result is strengthened by the decrease in SARS-CoV-2 positive days. In treated patients compared to control, a clear improvement in PaO2/FiO2 was observed together with a reduction in inflammation parameters, such as the decrease of CRP level. Furthermore, the efficacy of inhaled exogenous adenosine led to an improvement of the prognosis indices, NLR and PLR. The treatment seems to be safe and modulates the immune system, allowing an effective response against the viral infection progression, reducing length of stay and inflammation parameters.
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Affiliation(s)
- Massimo Caracciolo
- Unit of Post-Surgery Intensive Therapy (USDO), Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Pierpaolo Correale
- Medical Oncology Unit, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Carmelo Mangano
- Unit of Infectious Disease, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Giuseppe Foti
- Unit of Infectious Disease, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Carmela Falcone
- Unit of Radiology, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Sebastiano Macheda
- Unit of Intensive Care Medicine and Anaesthesia, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Maria Cuzzola
- Microbiology Unit, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Marco Conte
- Microbiology Unit, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Eleonora Iuliano
- Medical Oncology Unit, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | | | - Michele Caraglia
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Biogem Scarl, Institute of Genetic Research, Laboratory of Precision and Molecular Oncology, Ariano Irpino, Italy
| | - Nicola Polimeni
- Unit of Intensive Care Medicine and Anaesthesia, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Anna Ferrarelli
- Unit of Radiology, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Demetrio Labate
- Unit of Intensive Care Medicine and Anaesthesia, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Marco Tescione
- Unit of Intensive Care Medicine and Anaesthesia, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Laura Di Renzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gaetano Chiricolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Lorenzo Romano
- PhD School of Applied Medical, Surgical Sciences, University of Rome Tor Vergata, Rome, Italy
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Ali AM, Kunugi H. Approaches to Nutritional Screening in Patients with Coronavirus Disease 2019 (COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2772. [PMID: 33803339 PMCID: PMC7967488 DOI: 10.3390/ijerph18052772] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023]
Abstract
Malnutrition is common among severe patients with coronavirus disease 2019 (COVID-19), mainly elderly adults and patients with comorbidities. It is also associated with atypical presentation of the disease. Despite the possible contribution of malnutrition to the acquisition and severity of COVID-19, it is not clear which nutritional screening measures may best diagnose malnutrition in these patients at early stages. This is of crucial importance given the urgency and rapid progression of the disease in vulnerable groups. Accordingly, this review examines the available literature for different nutritional screening approaches implemented among COVID-19 patients, with a special focus on elderly adults. After a literature search, we selected and scrutinized 14 studies assessing malnutrition among COVID-19 patients. The Nutrition Risk Screening 2002 (NRS-2002) has demonstrated superior sensitivity to other traditional screening measures. The controlling nutritional status (CONUT) score, which comprises serum albumin level, cholesterol level, and lymphocytes count, as well as a combined CONUT-lactate dehydrogenase-C-reactive protein score expressed a predictive capacity even superior to that of NRS-2002 (0.81% and 0.92% vs. 0.79%) in midlife and elder COVID-19 patients. Therefore, simple measures based on routinely conducted laboratory investigations such as the CONUT score may be timely, cheap, and valuable alternatives for identifying COVID-19 patients with high nutritional risk. Mini Nutritional Assessment (MNA) was the only measure used to detect residual malnutrition and high malnutrition risk in remitting patients-MNA scores correlated with hypoalbuminemia, hypercytokinemia, and weight loss. Older males with severe inflammation, gastrointestinal symptoms, and pre-existing comorbidities (diabetes, obesity, or hypertension) are more prone to malnutrition and subsequently poor COVID-19 prognosis both during the acute phase and during convalescence. Thus, they are in need of frequent nutritional monitoring and support while detecting and treating malnutrition in the general public might be necessary to increase resilience against COVID-19.
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Affiliation(s)
- Amira Mohammed Ali
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria 21527, Egypt
| | - Hiroshi Kunugi
- National Center of Neurology and Psychiatry, Department of Mental Disorder Research, National Institute of Neuroscience, Tokyo 187-0031, Japan;
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo 173-8605, Japan
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Földi M, Farkas N, Kiss S, Dembrovszky F, Szakács Z, Balaskó M, Erőss B, Hegyi P, Szentesi A. Visceral Adiposity Elevates the Risk of Critical Condition in COVID-19: A Systematic Review and Meta-Analysis. Obesity (Silver Spring) 2021; 29:521-528. [PMID: 33263191 PMCID: PMC7753720 DOI: 10.1002/oby.23096] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/22/2020] [Accepted: 11/24/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A higher BMI has become acknowledged as one of the important risk factors for developing critical condition in coronavirus disease 2019 (COVID-19). In addition to BMI, body composition, and particularly visceral adiposity, might be an even more accurate measure to stratify patients. Therefore, the aim of this study was to evaluate the association between the distributions of computed-tomography-quantified fat mass and critical condition of patients with COVID-19. METHODS A systematic search was conducted in five databases for studies published until November 17, 2020. In the meta-analysis, pooled mean difference (standardized mean difference [SMD]) of visceral fat area (VFA; in square centimeters) was calculated between patients in the intensive care unit and those in general ward and between patients with the requirement for invasive mechanical ventilation (IMV) and those without the IMV requirement. RESULTS The quantitative synthesis revealed that patients requiring intensive care had higher VFA values (SMD = 0.46, 95% CI: 0.20-0.71, P < 0.001) compared with patients on the general ward. Similarly, patients requiring IMV had higher VFA values (SMD = 0.38, 95% CI: 0.05-0.71, P = 0.026) compared with patients without the IMV requirement. CONCLUSIONS VFA values were found to be significantly higher in patients with critical condition. Therefore, abdominal adiposity seems to be a risk factor in COVID-19, and patients with central obesity might need special attention.
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Affiliation(s)
- Mária Földi
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
- Centre for Translational MedicineDepartment of MedicineUniversity of SzegedSzegedHungary
| | - Nelli Farkas
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Institute of BioanalysisMedical SchoolUniversity of PécsPécsHungary
| | - Szabolcs Kiss
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
- Centre for Translational MedicineDepartment of MedicineUniversity of SzegedSzegedHungary
| | - Fanni Dembrovszky
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
| | - Zsolt Szakács
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
| | - Márta Balaskó
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
| | - Bálint Erőss
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
| | - Péter Hegyi
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
- Centre for Translational MedicineDepartment of MedicineUniversity of SzegedSzegedHungary
| | - Andrea Szentesi
- Institute for Translational MedicineMedical SchoolUniversity of PécsPécsHungary
- Szentágothai Research CentreUniversity of PécsPécsHungary
- Centre for Translational MedicineDepartment of MedicineUniversity of SzegedSzegedHungary
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Meunier N, Briand L, Jacquin-Piques A, Brondel L, Pénicaud L. COVID 19-Induced Smell and Taste Impairments: Putative Impact on Physiology. Front Physiol 2021; 11:625110. [PMID: 33574768 PMCID: PMC7870487 DOI: 10.3389/fphys.2020.625110] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/31/2020] [Indexed: 12/18/2022] Open
Abstract
Smell and taste impairments are recognized as common symptoms in COVID 19 patients even in an asymptomatic phase. Indeed, depending on the country, in up to 85-90% of cases anosmia and dysgeusia are reported. We will review briefly the main mechanisms involved in the physiology of olfaction and taste focusing on receptors and transduction as well as the main neuroanatomical pathways. Then we will examine the current evidences, even if still fragmented and unsystematic, explaining the disturbances and mode of action of the virus at the level of the nasal and oral cavities. We will focus on its impact on the peripheral and central nervous system. Finally, considering the role of smell and taste in numerous physiological functions, especially in ingestive behavior, we will discuss the consequences on the physiology of the patients as well as management regarding food intake.
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Affiliation(s)
- Nicolas Meunier
- Université Paris-Saclay, INRAE, UVSQ, VIM, Jouy-en-Josas, France
| | - Loïc Briand
- Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS UMR6265, INRAE UMR 1324, Université de Bourgogne Franche Comté, Dijon, France
| | - Agnès Jacquin-Piques
- Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS UMR6265, INRAE UMR 1324, Université de Bourgogne Franche Comté, Dijon, France
- Department of Clinical Neurophysiology, University Hospital, Dijon, France
| | - Laurent Brondel
- Centre des Sciences du Goût et de l’Alimentation, AgroSup Dijon, CNRS UMR6265, INRAE UMR 1324, Université de Bourgogne Franche Comté, Dijon, France
| | - Luc Pénicaud
- STROMALab, Université de Toulouse, CNRS ERL 5311, Inserm U1031, Université Paul Sabatier (UPS), Toulouse, France
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Brende A, Stacer RJ, Jhaveri S, Darlington A, Soto Abarca A, Paracha A, Suleman S, Rainey B, Wendel J, Huerta D. We Need to Know: A Call for Interdisciplinary Education on COVID-19. J Nutr Health Aging 2021; 25:675-678. [PMID: 33949636 PMCID: PMC7905425 DOI: 10.1007/s12603-021-1608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
COVID-19 disrupted numerous disciplines which led to widespread misinformation on the virus. Thirteen students from across the USA designed a web-based conference, or "webinar," to minimize the misinformation among student populations. Professionals presented the current and possible future impacts of COVID-19 in their respective fields. Pre- and post-conference surveys were administered to the attendees to gauge the impact of the conference. Survey results demonstrated increased knowledge and a lower degree of feeling overwhelmed by COVID-19 information overall, indicating a niche use for webinars during the COVID-19 pandemic and beyond.
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Affiliation(s)
- A Brende
- Anna Brende, MSW Candidate, School of Social Work, Saint Louis University, 1 N. Grand Blvd., St. Louis, MO 63103,
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Di Filippo L, De Lorenzo R, Cinel E, Falbo E, Ferrante M, Cilla M, Martinenghi S, Vitali G, Bosi E, Giustina A, Rovere-Querini P, Conte C. Weight trajectories and abdominal adiposity in COVID-19 survivors with overweight/obesity. Int J Obes (Lond) 2021; 45:1986-1994. [PMID: 34002039 PMCID: PMC8127478 DOI: 10.1038/s41366-021-00861-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND COVID-19 is associated with unintentional weight loss. Little is known on whether and how patients regain the lost weight. We assessed changes in weight and abdominal adiposity over a three-month follow-up after discharge in COVID-19 survivors. METHODS In this sub-study of a large prospective observational investigation, we collected data from individuals who had been hospitalized for COVID-19 and re-evaluated at one (V1) and three (V2) months after discharge. Patient characteristics upon admission and anthropometrics, waist circumference and hunger levels assessed during follow-up were analyzed across BMI categories. RESULTS One-hundred-eighty-five COVID-19 survivors (71% male, median age 62.1 [54.3; 72.1] years, 80% with overweight/obesity) were included. Median BMI did not change from admission to V1 in normal weight subjects (-0.5 [-1.2; 0.6] kg/m2, p = 0.08), but significantly decreased in subjects with overweight (-0.8 [-1.8; 0.3] kg/m2, p < 0.001) or obesity (-1.38 [-3.4; -0.3] kg/m2, p < 0.001; p < 0.05 vs. normal weight or obesity). Median BMI did not change from V1 to V2 in normal weight individuals (+0.26 [-0.34; 1.15] kg/m2, p = 0.12), but significantly increased in subjects with overweight (+0.4 [0.0; 1.0] kg/m2, p < 0.001) or obesity (+0.89 [0.0; 1.6] kg/m2, p < 0.001; p = 0.01 vs. normal weight). Waist circumference significantly increased from V1 to V2 in the whole group (p < 0.001), driven by the groups with overweight or obesity. At multivariable regression analyses, male sex, hunger at V1 and initial weight loss predicted weight gain at V2. CONCLUSIONS Patients with overweight or obesity hospitalized for COVID-19 exhibit rapid, wide weight fluctuations that may worsen body composition (abdominal adiposity). CLINICALTRIALS. GOV REGISTRATION NCT04318366.
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Affiliation(s)
- Luigi Di Filippo
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Institute of Endocrine and Metabolic Sciences, IRCCS San Raffaele Hospital, Milan, Italy
| | - Rebecca De Lorenzo
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elena Cinel
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elisabetta Falbo
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marica Ferrante
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Marta Cilla
- grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Sabina Martinenghi
- grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giordano Vitali
- grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Emanuele Bosi
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Andrea Giustina
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Institute of Endocrine and Metabolic Sciences, IRCCS San Raffaele Hospital, Milan, Italy
| | - Patrizia Rovere-Querini
- grid.15496.3fVita-Salute San Raffaele University, Milan, Italy ,grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy
| | - Caterina Conte
- grid.18887.3e0000000417581884Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Hospital, Milan, Italy ,Present Address: Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open, University, Rome, Italy
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Del Giorno R, Quarenghi M, Stefanelli K, Capelli S, Giagulli A, Quarleri L, Stehrenberger D, Ossola N, Monotti R, Gabutti L. Nutritional Risk Screening and Body Composition in COVID-19 Patients Hospitalized in an Internal Medicine Ward. Int J Gen Med 2020; 13:1643-1651. [PMID: 33380822 PMCID: PMC7767704 DOI: 10.2147/ijgm.s286484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Malnutrition in patients hospitalized in internal medicine wards is highly prevalent and represents a prognostic factor of worse outcomes. Previous evidence suggested the prognostic role of the nutritional status in patients affected by the coronavirus disease 2019 (COVID-19). We aim to investigate the nutritional risk in patients with COVID-19 hospitalized in an internal medicine ward and their clinical outcomes using the Nutritional Risk Screening 2002 (NRS-2002) and parameters derived from bioelectrical impedance analysis (BIA). METHODS Retrospective analysis of patients with COVID-19 aimed at exploring: 1) the prevalence of nutritional risk with NRS-2002 and BIA; 2) the relationship between NRS-2002, BIA parameters and selected outcomes: length of hospital stay (LOS); death and need of intensive care unit (ICU); prolonged LOS; and loss of appetite. RESULTS Data of 90 patients were analyzed. Patients at nutritional risk were 92% with NRS-2002, with BIA-derived parameters: 88% by phase angle; 86% by body cell mass; 84% by fat-free mass and 84% by fat mass (p-value ≤0.001). In ROC analysis, NRS had the maximum sensitivity in predicting the risk of death and need of ICU and a prolonged hospitalization showing moderate-low specificity; phase angle showed a good predictive power in terms of AUC. NRS-2002 was significantly associated with LOS (β 12.62, SE 5.79). In a multivariate analysis, blood glucose level and the early warning score are independent predictors of death and need of ICU (OR 2.79, p ≤0.001; 1.59, p-0.029, respectively). CONCLUSION Present findings confirm the clinical utility of NRS-2002 to assess nutritional risk in patients with COVID-19 at hospital admission and in predicting LOS, and that bioimpedance does not seem to add further predictive value. An early detection of nutritional risk has to be systematically included in the management of COVID-19 patients hospitalized in internal medicine wards.
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Affiliation(s)
- Rosaria Del Giorno
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
| | - Massimo Quarenghi
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Kevyn Stefanelli
- Department of Social Sciences and Economics, Sapienza University of Rome, Rome, Italy
| | - Silvia Capelli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Antonella Giagulli
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Lara Quarleri
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Daniela Stehrenberger
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Locarno, Switzerland
| | - Nicola Ossola
- Section of Clinical Nutrition and Dietetics, Department of Internal Medicine, Ente Ospedaliero Cantonale, Mendrisio, Switzerland
| | - Rita Monotti
- Department of Internal Medicine, Ospedale La Carità, Locarno, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Clinical Research Unit, Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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Souza LFDF, Silva ICL, Marques AG, Silva FHDS, Nunes VX, Hassan MM, de Albuquerque VHC, Filho PPR. Internet of Medical Things: An Effective and Fully Automatic IoT Approach Using Deep Learning and Fine-Tuning to Lung CT Segmentation. SENSORS 2020; 20:s20236711. [PMID: 33255308 PMCID: PMC7727680 DOI: 10.3390/s20236711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022]
Abstract
Several pathologies have a direct impact on society, causing public health problems. Pulmonary diseases such as Chronic obstructive pulmonary disease (COPD) are already the third leading cause of death in the world, leaving tuberculosis at ninth with 1.7 million deaths and over 10.4 million new occurrences. The detection of lung regions in images is a classic medical challenge. Studies show that computational methods contribute significantly to the medical diagnosis of lung pathologies by Computerized Tomography (CT), as well as through Internet of Things (IoT) methods based in the context on the health of things. The present work proposes a new model based on IoT for classification and segmentation of pulmonary CT images, applying the transfer learning technique in deep learning methods combined with Parzen’s probability density. The proposed model uses an Application Programming Interface (API) based on the Internet of Medical Things to classify lung images. The approach was very effective, with results above 98% accuracy for classification in pulmonary images. Then the model proceeds to the lung segmentation stage using the Mask R-CNN network to create a pulmonary map and use fine-tuning to find the pulmonary borders on the CT image. The experiment was a success, the proposed method performed better than other works in the literature, reaching high segmentation metrics values such as accuracy of 98.34%. Besides reaching 5.43 s in segmentation time and overcoming other transfer learning models, our methodology stands out among the others because it is fully automatic. The proposed approach has simplified the segmentation process using transfer learning. It has introduced a faster and more effective method for better-performing lung segmentation, making our model fully automatic and robust.
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Affiliation(s)
- Luís Fabrício de Freitas Souza
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza CE 60020-181, Brazil
| | - Iágson Carlos Lima Silva
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Adriell Gomes Marques
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Francisco Hércules dos S. Silva
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Virgínia Xavier Nunes
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
| | - Mohammad Mehedi Hassan
- Information Systems Department, College of Computer and Information Sciences, King Saud University, Riyadh 11543, Saudi Arabia
- Correspondence:
| | - Victor Hugo C. de Albuquerque
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza CE 60020-181, Brazil
| | - Pedro P. Rebouças Filho
- Department of Computer Science, Federal Institute of Education, Science and Technology of Ceará, Fortaleza CE 60040-215, Brazil; (L.F.d.F.S.); (I.C.L.S.); (A.G.M.); (F.H.d.S.S.); (V.X.N.); (V.H.C.d.A.); (P.P.R.F.)
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza CE 60020-181, Brazil
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Muhanna D, Arnipalli SR, Kumar SB, Ziouzenkova O. Osmotic Adaptation by Na +-Dependent Transporters and ACE2: Correlation with Hemostatic Crisis in COVID-19. Biomedicines 2020; 8:E460. [PMID: 33142989 PMCID: PMC7693583 DOI: 10.3390/biomedicines8110460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
COVID-19 symptoms, including hypokalemia, hypoalbuminemia, ageusia, neurological dysfunctions, D-dimer production, and multi-organ microthrombosis reach beyond effects attributed to impaired angiotensin-converting enzyme 2 (ACE2) signaling and elevated concentrations of angiotensin II (Ang II). Although both SARS-CoV (Severe Acute Respiratory Syndrome Coronavirus) and SARS-CoV-2 utilize ACE2 for host entry, distinct COVID-19 pathogenesis coincides with the acquisition of a new sequence, which is homologous to the furin cleavage site of the human epithelial Na+ channel (ENaC). This review provides a comprehensive summary of the role of ACE2 in the assembly of Na+-dependent transporters of glucose, imino and neutral amino acids, as well as the functions of ENaC. Data support an osmotic adaptation mechanism in which osmotic and hemostatic instability induced by Ang II-activated ENaC is counterbalanced by an influx of organic osmolytes and Na+ through the ACE2 complex. We propose a paradigm for the two-site attack of SARS-CoV-2 leading to ENaC hyperactivation and inactivation of the ACE2 complex, which collapses cell osmolality and leads to rupture and/or necrotic death of swollen pulmonary, endothelial, and cardiac cells, thrombosis in infected and non-infected tissues, and aberrant sensory and neurological perception in COVID-19 patients. This dual mechanism employed by SARS-CoV-2 calls for combinatorial treatment strategies to address and prevent severe complications of COVID-19.
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Affiliation(s)
| | | | | | - Ouliana Ziouzenkova
- Department of Human Sciences, The Ohio State University, Columbus, OH 43210, USA; (D.M.); (S.R.A.); (S.B.K.)
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Correale P, Caracciolo M, Bilotta F, Conte M, Cuzzola M, Falcone C, Mangano C, Falzea AC, Iuliano E, Morabito A, Foti G, Armentano A, Caraglia M, De Lorenzo A, Sitkovsky M, Macheda S. Therapeutic effects of adenosine in high flow 21% oxygen aereosol in patients with Covid19-pneumonia. PLoS One 2020; 15:e0239692. [PMID: 33031409 PMCID: PMC7544127 DOI: 10.1371/journal.pone.0239692] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/13/2020] [Indexed: 01/08/2023] Open
Abstract
Background SARS-Cov2 infection may trigger lung inflammation and acute-respiratory-distress-syndrome (ARDS) that requires active ventilation and may have fatal outcome. Considering the severity of the disease and the lack of active treatments, 14 patients with Covid-19 and severe lung inflammation received inhaled adenosine in the attempt to therapeutically compensate for the oxygen-related loss of the endogenous adenosine→A2A adenosine receptor (A2AR)-mediated mitigation of the lung-destructing inflammatory damage. This off label-treatment was based on preclinical studies in mice with LPS-induced ARDS, where inhaled adenosine/A2AR agonists protected oxygenated lungs from the deadly inflammatory damage. The treatment was allowed, considering that adenosine has several clinical applications. Patients and treatment Fourteen consecutively enrolled patients with Covid19-related interstitial pneumonitis and PaO2/FiO2 ratio<300 received off-label-treatment with 9 mg inhaled adenosine every 12 hours in the first 24 hours and subsequently, every 24 days for the next 4 days. Fifty-two patients with analogue features and hospitalized between February and April 2020, who did not receive adenosine, were considered as a historical control group. Patients monitoring also included hemodynamic/hematochemical studies, CTscans, and SARS-CoV2-tests. Results The treatment was well tolerated with no hemodynamic change and one case of moderate bronchospasm. A significant increase (> 30%) in the PaO2/FiO2-ratio was reported in 13 out of 14 patients treated with adenosine compared with that observed in 7 out of52 patients in the control within 15 days. Additionally, we recorded a mean PaO2/FiO2-ratio increase (215 ± 45 vs. 464 ± 136, P = 0.0002) in patients receiving adenosine and no change in the control group (210±75 vs. 250±85 at 120 hours, P>0.05). A radiological response was demonstrated in 7 patients who received adenosine, while SARS-CoV-2 RNA load rapidly decreased in 13 cases within 7 days while no changes were recorded in the control group within 15 days. There was one Covid-19 related death in the experimental group and 11in the control group. Conclusion Our short-term analysis suggests the overall safety and beneficial therapeutic effect of inhaled adenosine in patients with Covid-19-inflammatory lung disease suggesting further investigation in controlled clinical trials.
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Affiliation(s)
- Pierpaolo Correale
- Medical Oncology Unit, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Massimo Caracciolo
- Unit of Post Surgery Intensive Therapy (USDO), Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Marco Conte
- Microbiology Unit, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Maria Cuzzola
- Microbiology Unit, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Carmela Falcone
- Unit of Radiology, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Carmelo Mangano
- Unit of Infectious Disease, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Antonella Consuelo Falzea
- Medical Oncology Unit, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Eleonora Iuliano
- Medical Oncology Unit, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Antonella Morabito
- Unit of Pharmacy, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Giuseppe Foti
- Unit of Infectious Disease, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Antonio Armentano
- Unit of Neuro-radiology, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Michele Caraglia
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy.,Laboratory of Precision and Molecular Oncology, BiogemScarl, Institute of Genetic Research, Ariano Irpino, Italy
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomic, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Michail Sitkovsky
- New England Inflammation and Tissue Protection Institute, Northeastern University, Boston, Massachusetts, United States of America
| | - Sebastiano Macheda
- Unit of Intensive Therapy and Resuscitation, Covid19 Scientific Task Force, Grand Metropolitan Hospital, Reggio Calabria, Italy
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Falcone C, Caracciolo M, Correale P, Macheda S, Vadalà EG, La Scala S, Tescione M, Danieli R, Ferrarelli A, Tarsitano MG, Romano L, De Lorenzo A. Can Adenosine Fight COVID-19 Acute Respiratory Distress Syndrome? J Clin Med 2020; 9:E3045. [PMID: 32967358 PMCID: PMC7564484 DOI: 10.3390/jcm9093045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) patients can develop interstitial pneumonia, which, in turn, can evolve into acute respiratory distress syndrome (ARDS). This is accompanied by an inflammatory cytokine storm. severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has proteins capable of promoting the cytokine storm, especially in patients with comorbidities, including obesity. Since currently no resolutive therapy for ARDS has been found and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Through its receptors, adenosine is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier, and reduce the damage due to an overactivation of the immune system, such as that occurring in cytokine storms. These features are known in ischemia/reperfusion models and could also be exploited in acute lung injury with hypoxia. Considering these hypotheses, a COVID-19 patient with unresponsive respiratory failure was treated with adenosine for compassionate use. The results showed a rapid improvement of clinical conditions, with negativity of SARS-CoV2 detection.
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Affiliation(s)
- Carmela Falcone
- Unit of Radiology, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (C.F.); (A.F.)
| | - Massimo Caracciolo
- Unit of Intensive Postoperative Therapy, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy;
| | - Pierpaolo Correale
- Medical Oncology Unit, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy;
| | - Sebastiano Macheda
- Unit of Intensive Care Medicine and Anesthesia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (S.M.); (E.G.V.); (S.L.S.); (M.T.)
| | - Eugenio Giuseppe Vadalà
- Unit of Intensive Care Medicine and Anesthesia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (S.M.); (E.G.V.); (S.L.S.); (M.T.)
| | - Stefano La Scala
- Unit of Intensive Care Medicine and Anesthesia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (S.M.); (E.G.V.); (S.L.S.); (M.T.)
| | - Marco Tescione
- Unit of Intensive Care Medicine and Anesthesia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (S.M.); (E.G.V.); (S.L.S.); (M.T.)
| | - Roberta Danieli
- Department of Human Sciences and Promotion of the Quality of Life, University San Raffaele, 00166 Rome, Italy;
| | - Anna Ferrarelli
- Unit of Radiology, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, 89124 Reggio Calabria, Italy; (C.F.); (A.F.)
| | | | - Lorenzo Romano
- School of Specialization in Food Science, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
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Negrini F, de Sire A, Andrenelli E, Lazzarini SG, Patrini M, Ceravolo MG. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of July 31st, 2020. Eur J Phys Rehabil Med 2020; 56:652-657. [PMID: 32869962 DOI: 10.23736/s1973-9087.20.06539-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION This paper is the first update of the second edition of the rapid living systematic review on the latest scientific literature informing rehabilitation of patients with COVID-19 and/or describing consequences of the disease and its treatment, as they relate to limitations in functioning of rehabilitation interest. The aim of this study was to report data of a systematic search performed on papers published in July 2020. EVIDENCE ACQUISITION The methodology described in the second edition of the rapid living systematic review was applied to search eligible papers included in the databases between July 1, 2020 and July 31, 2020. EVIDENCE SYNTHESIS Eight-hundred-ninety-two papers were identified through database searching (after removal of duplicates); of these, only 23 studies were included. According to OCEBM 2011 Levels of Evidence Table, they were level 3 in 30.5% cases and level 4 in 69.5%. No RCT was found. Nineteen papers studied COVID-19 patients, assessed in the acute (10 studies), post-acute (8 studies) and chronic phase (one study). Four studies reported data on the impact of COVID-19 on subjects with pre-existing health conditions. CONCLUSIONS The current literature production still focuses more on describing all the possible aspects and complications of the pathology than on interventions or new organization models to deal with it. Albeit evidence on handling COVID-19 from a rehabilitative point of view is improving each month, further studies are still mandatory to report the role of rehabilitation in this scenario.
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Affiliation(s)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, "Politecnica delle Marche" University, Ancona, Italy -
| | - Stefano G Lazzarini
- IRCCS Fondazione Don Gnocchi, Milan, Italy, Update of: https://www.doi.org/10.23736/S1973-9087.20.06501-6
| | - Michele Patrini
- IRCCS Fondazione Don Gnocchi, Milan, Italy, Update of: https://www.doi.org/10.23736/S1973-9087.20.06501-6
| | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, "Politecnica delle Marche" University, Ancona, Italy
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