Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19: A Major and Neglected Component of Long COVID-19

Nutrients. 2021 Nov 6;13(11):3964. doi: 10.3390/nu13113964.


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.

Keywords: cohort study; intensive care unit; long COVID-19; malnutrition; muscle strength; obesity; performance status; self-evaluation.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / physiopathology
  • COVID-19 / therapy
  • Female
  • Functional Status
  • Hospitalization
  • Humans
  • Length of Stay
  • Male
  • Malnutrition / diagnosis
  • Malnutrition / etiology*
  • Malnutrition / physiopathology
  • Malnutrition / therapy
  • Middle Aged
  • Muscle Strength*
  • Muscle Weakness / diagnosis
  • Muscle Weakness / etiology*
  • Muscle Weakness / physiopathology
  • Muscle Weakness / therapy
  • Muscle, Skeletal / physiopathology*
  • Nutritional Status*
  • Obesity / complications
  • Post-Acute COVID-19 Syndrome
  • Prognosis
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Time Factors