Relationship between nutritional status, lifestyle and prognosis in patients diagnosed with COVID-19 hospitalized in the state of Pernambuco
Main Article Content
Abstract
Objective: To analyze the relationship between nutritional status and lifestyle habits and the prognosis of hospitalized patients with COVID-19 in Pernambuco. Methods: Multicenter, cross-sectional study, associated with prospective analysis variables, involving patients with COVID-19 and admitted to 8 hospitals. Individuals aged ≥ 18 years of both sexes, hospitalized from June 2020 to June 2021, were included. Socioeconomic, clinical, anthropometric, lifestyle and prognostic variables were collected. Results: The sample consisted of 263 individuals with a mean age of 62.9 ± 16.6 years and homogeneous distribution between genders. It was observed that 8.2% were smokers, 20.9% reported alcohol consumption, and 80.1% were sedentary. The anthropometric profile indicated that 49.5% were overweight and 7.0% were underweight. Malnutrition and excess weight were associated with more extended hospital stays (66.7% weight loss and 64.5% weight gain vs. 30.0% eutrophy; p = 0.021), smoking with death (tab 65 .0% vs. non-tab 33.7%; p = 0.006) and need for admission to the intensive care unit (yes 64.3%, no 31.5%; p = 0.014). The frequency of dyspnea was higher in patients who reported drinking alcohol (yes 69.6% vs. no 48.1%; p = 0.007). Physical activity was not associated with any prognostic factor. Conclusion: Nutritional extremes and bad lifestyle habits, such as smoking and alcohol consumption, are risk factors for a poor prognosis in individuals with COVID-19.
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References
World Health Organization (WHO). WHO Coronavirus (COVID-19) Dashboard. Situation by Region, Country, Territory & Area. [cited 17 Nov 2021]. Available from: https://covid19.who.int/table
Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.
https://doi.org/10.1016/j.ijantimicag.2020.105924
Azevedo RB, Botelho BG, Hollanda JVG, Ferreira LVL, Andrade LZJ, Oei SSML, et al. Covid-19 and the cardiovascular system: a comprehensive review. J Hum Hypertens. 2020;35:4-11. https://doi.org/10.1038/s41371-020-0387-4
Sobrado MM, Mateo-Abad M, Vrotsou K, Vergara I. Health Status and Lifestyle Habits of Vulnerable, Community-Dwelling Older People During the COVID-19 Lockdown. J Frailty Aging. 2021;10(3):286-9. https://doi.org/10.14283/jfa.2021.12
Zabetakis I, Lordan R, Norton C, Tsoupras, A. The Inflammation Link and the Role of Nutrition in Potential Mitigation. Nutrients. 2020;12(5):1466. https://doi.org/10.3390/nu12051466
Anker MS, Landmesser U, Haehling SV, Butler J, Coats AJS, Anker SD. Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers. J Cachexia Sarcopenia Muscle. 2021;12(1):9-13. https://doi.org/10.1002/jcsm.12674
Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL, et al. Depression, Anxiety and Stress during COVID-19: Associations with changes in physical activity, sleep, tobacco and alcohol use in australian adults. Int J Environ Res Public Health. 2020;17(11):4065. https://doi.org/10.3390/ijerph17114065
Engin AB, Engin ED, Engin A. Two important controversial risk factors in SARS-CoV-2 infection: Obesity and smoking. Environ Res. 2020;78:103411. https://doi.org/10.1016/j.etap.2020.103411
Beserra EA, Rodrigues PA, Lisboa AQ. Validação de métodos subjetivos para estimativa do índice de massa corporal em pacientes acamados. Com Ciências Saúde [Internet]. 2011[cited 21 Nov 2022];22(1):19-26. Available from: http://bit.ly/3GBunsE
World Health Organization (WHO). Physical status: the use and interpretation of anthropometry: Report of a WHO Expert Committee. Technical Report Series nº 854. Geneva: World Health Organization; 1995.
Lipschitz DA. Screening for nutritional status in the elderly. Primary Care. 1994; 21(1):55-67. https://doi.org/10.1016/S0095-4543(21)00452-8
Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, et al. A Physical activity and public health: updated recommendation for adults from the American Collegeof Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423-34. https://doi.org/10.1249/mss.0b013e3180616b27
Simonnet A, Chetboun M, Poissy J, Raverdy V, Noulette J, Duhamel A, et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) requiring invasive mechanical ventilation. Obesity. 2020;28(7):1195-9. https://doi.org/10.1002/oby.22831
Hamer M, Gale, CR, Kivimaki M, Batty GD. Overweight, obesity, and risk of hospitalization for COVID-19: A community-based cohort study of adults in the United Kingdom. Proc Natl Acad Sci U S A. 2020;117(35):21011-3. https://doi.org/10.1073/pnas.2011086117
Li T, Zhang Y, Gong C, Wang J, Liu B, Shi L, et al. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr. 2020;74:871-5. https://doi.org/10.1038/s41430-020-0642-3
Pironi L, Sasdelli AS, Ravaiolli F, Leoni L, Mari GA. Malnutrition and nutritional therapy in patients with SARS-CoV-2 disease. Clin Nutr. 2021;40(3):1330-7.
https://doi.org/10.1016/j.clnu.2020.08.021
Fresán U, Guevara M, Elía F, Albéniz E, Burgui C, Castilla J, et al. Independent Role of Severe Obesity as a Risk Factor for COVID-19 Hospitalization: A Spanish Population-Based Cohort Study. Obesity. 2021;29(1):29-37. https://doi.org/10.1002/oby.23029
Nicolau J, Ayala L, Sanchís P, Olivares J, Dotres K, Soler AG, et al. Influence of nutritional status on clinical outcomes among hospitalized patients with COVID-19. Clin Nutr ESPEN. 2021;43:223-9. https://doi.org/10.1016/j.clnesp.2021.04.013
Mariconi D, Mais S, Rebelos E, Virdis A, Manca ML, Marco S, et al. Obesity prolongs the hospital stay in patients affected by COVID-19, and may impact on SARS-COV-2 shedding. Obes Res Clin Pract. 2020;14(3):205-9. https://doi.org/10.1016/j.orcp.2020.05.009
Al-Salameh A, Lanoix JP, Bennis Y, Andrejak C, Brochot E, Deschasse G, et al. The association between body mass index class and coronavirus disease 2019 outcomes. Int J Obes. 2021;45(3):700-5. https://doi.org/10.1038/s41366-020-00721-1
Cordova E, Mykietiuk A, Sued O, Vedia L, Pacifico N, Matias H, et al. Clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 infection in a Latin American country: Results from the ECCOVID multicenter prospective study. Plos One. 2020;16(10):e0258260. https://doi.org/10.1371/journal.pone.0258260
Petrova D, Fernández ES, Barranco MR, Pérez PN, Moleón JJJ, Sánchez MJ. La obesidad como factor de riesgo en personas con COVID-19: posibles mecanismos e implicaciones. Aten Primaria. 2020; 52(7):496-500. https://doi.org/10.1016/j.aprim.2020.05.003
Fiorindi C, Campani F, Rosero L, Campani C, Livi L, Giovannoni L, et al. Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience. Clin Nutr ESPEN. 2021;45:351-5. https://doi.org/10.1016/j.clnesp.2021.07.020
Fedele D, Francesco A, Riso S, Collo A. Obesity, malnutrition, and trace element deficiency in the coronavirus disease (COVID-19) pandemic: An overview. Nutrition. 2021;81:111016. https://doi.org/10.1016/j.nut.2020.111016
Zhang J, Dong X, Cao Y, Yuan Y, Yang Y, Yan Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75:1730-41. https://doi.org/10.1111/all.14238
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382:1708-20. https://doi.org/10.1056/NEJMoa2002032
27 - Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3
Liu W, Tao Z, Wanh L, Yuan M, Liu K, Zhou L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl). 2020;133(9):1032-8. https://doi.org/10.1097/CM9.0000000000000775
Patanavanich R, Glantz AS. Smoking Is Associated With COVID-19 Progression: A Meta-analysis. Nicotine Tob Res. 2020;22(9):1653-6. https://doi.org/10.1093/ntr/ntaa082
Berlin I, Thomas D, Faou AL, Cornuz J. COVID-19 and Smoking. Nicotine Tob Res. 2020;22(9):1650-2. https://doi.org/10.1093/ntr/ntaa059
Saurabh S, Verma MK, Gautam V, Kumar N, Jain V, Goel AD, et al. Tobacco, alcohol use and other risk factors for developing symptomatic COVID-19 vs asymptomatic SARS-CoV-2 infection: a case-control study from western Rajasthan, India. Trans R Soc Trop Med Hyg. 2021;115(7):820-31. https://doi.org/10.1093/trstmh/traa172
Fan X, Liu Z, Poulsen KL, Wu X, Miyata T, Dasarathy S, et al. Alcohol Consumption Is Associated with Poor Prognosis in Obese Patients with COVID-19: A Mendelian Randomization Study Using UK Biobank. Nutrients. 2021;13(5):1592. https://doi.org/10.3390/nu13051592
Feng Y, Ling Y, Bai T, Xie Y, Huang J, Li J, et al. COVID-19 with Different Severities: A Multicenter Study of Clinical Features. Am J Respir Crit Care Med. 2020; 201(11):1380-8. https://doi.org/10.1164/rccm.202002-0445OC
Ojo AS, Balagun AS, Williams O, Ojo OS. Pulmonary Fibrosis in COVID-19 Survivors: Predictive Factors and Risk Reduction Strategies. Pulm Med. 2020; 2020:6175964. https://doi.org/10.1155/2020/6175964
Yuan Q, Huang H, Chen X, Chen R, Zhang Y, Pan X, et al. Does pre-existent physical inactivity have a role in the severity of COVID-19? Ther Adv Respir Dis. 2021;15:17534666211025221. https://doi.org/10.1177/17534666211025221
Sallis R, Young DR, Tartof SY, Sallis JF, Sall J, Li Q, et al. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. Br J Sports Med. 2021;55:1099-105. https://doi.org/10.1136/bjsports-2021-104080
37 - Zhang X, Li X, Sun Z, He Y, Xu W, Campbell H, et al. Physical activity and COVID-19: an observational and Mendelian randomisation study. J Glob Health. 2020;10(2):020514. https://doi.org/10.7189/jogh.10.020514
Fuzeki E, Groneberg DA, Banzer W. Physical activity during COVID-19 induced lockdown: recommendations. J Occup Med Toxicol. 2020;15:25. https://doi.org/10.1186/s12995-020-00278-9
Milogia MN, Vito G, Franchi M, Paoli A, Moro T, Marcolin G, et al. Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. Eur J Sport Sci. 2021;21(4):614-35. https://doi.org/10.1080/17461391.2020.1761076
Berger MM. Nutrition Status Affects COVID-19 Patient Outcomes. JPEN J Parenter Enteral Nutr 2020;44(7):1166-7. https://doi.org/10.1002/jpen.1954