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Preventing Nutritional Deficiencies during COVID-19
The COVID-19 (Coronavirus disease 2019) pandemic is posing a threat to communities and healthcare systems worldwide. Malnutrition, in all its forms, may negatively impact the susceptibility and severity of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) infection in both children and older adults. Both undernutrition and obesity have been evoked as conditions associated with a higher susceptibility to the infection and poor prognosis. In turn, the COVID-19 infection may worsen the nutritional status through highly catabolic conditions, exposing individuals to the risk of malnutrition, muscle wasting, and nutritional deficiencies. Accordingly, the relationship between malnutrition and COVID-19 is likely to be bidirectional. Furthermore, the modification of nutritional behaviors and physical activity, required to limit the spread of the virus, are posing a challenge to health at both the extremes of life. Thus far, even the most advanced healthcare systems have failed to address the alarming consequences of malnutrition posed by this pandemic. If not properly addressed, we may run the risk that new and old generations will experience the consequences of COVID-19 related malnutrition.
2. Malnutrition at the Two Extremes of Life during the COVID-19
2.1. The Context
2.2. Older Persons
|Reference||Study Design and Sample||Aim||Relevant Results|
|Pan et al., 2020 ||Cross-sectional study;
204 COVID-19 patients; mean age 52.9 (SD 16) years
|Investigate the prevalence and outcomes of COVID-19 patients with digestive symptoms.||103 patients (50.5%) reported digestive symptoms, including lack of appetite (81 [78.6%] cases), diarrhea (35 [34%] cases), vomiting (4 [3.9%] cases), and abdominal pain (2 [1.9%] cases).|
|Zheng et al., 2020 ||Cross-sectional study; 1320 patients; median age 50 (IQR 40–57) years.||Compare clinical characteristics and outcomes between patients with and without GI symptoms.||192 patients (14.5%) reported gastrointestinal symptoms, including diarrhea (107 [55.7%] cases), abdominal pain (11 [5.7%] cases), anorexia (62 [32.3%] cases), nausea and vomiting (57 [29.7%] cases).|
|Redd et al., 2020 ||Multicenter cohort study; 318 patients; mean age 63.4 (SD 16.6) years.||Examine prevalence and features of GI manifestations associated with SARS-CoV-2 infection||61.3% of patients reported at least 1 gastrointestinal symptom on presentation, most commonly loss of appetite (34.8%), diarrhea (33.7%), and nausea (26.4%).|
|Meng et al., 2020 ||Review||Assess the relationship between olfactory dysfunction and COVID-19.||Anosmia ranged from 33.9 to 68% with female dominance.|
|Parasa et al., 2020 ||Systematic review and meta-analysis of 23 published and 6 preprint studies; 4805 patients; mean age 52.2 (SD 14.8) years||Examine incidence rates of gastrointestinal symptoms among patients with COVID-19 infection.||12% of patients with COVID-19 infection reported gastrointestinal symptoms, including diarrhea (7.4%), nausea, and vomiting (4.6%).|
|Bedock et al., 2020 ||Observational longitudinal study; 114 COVID-19 patients, mean age 59.9 (SD 15.9) years.||Examine the association between malnutrition and disease severity at admission and the impact of malnutrition on clinical outcomes (i.e., ICU transfer or death).||The overall prevalence of malnutrition was 42.1% (moderate: 23.7%, severe: 18.4%). The prevalence of malnutrition reached 66.7% in patients admitted from ICU.|
|Rouget et al., 2020 ||Prospective observational cohort study; 80 COVID-19 patients; median age 59.5 (IQR 49.5–68.5).||Evaluate the prevalence of malnutritionin patients hospitalized for COVID-19.||The prevalence of malnutrition was 37.5% with 26% of hospitalized patients who presented severe malnutrition.|
|Li et al., 2020 ||Cross-sectional study; 182 COVID-19 older patients; mean age 68.5 (SD 8.8) years.||Investigate the prevalence of malnutrition and its related factors in older patients with COVID-19.||96 patients (52.7%) were malnourished and 50 patients (27.5%) were at risk of malnutrition|
|Yu et al., 2020 ||Retrospective survey study; 139 patients with COVID-19; mean age 61.47 (SD 14.76) years.||Examine the association of malnutrition with duration of hospitalization in patients with COVID-19.||75 patients had nutritional risk (53.96%). Compared with the patients in the normal nutrition group, the hospitalization time was longer (15.67 [SD 6.26] days versus 27.48 [SD 5.04] days, p = 0.001)|
|Allard et al., 2020 ||Retrospective study; 108 COVID-19 patients; mean age 61.8 (SD 15.8).||Determine the percentage of malnutrition and its prognosis in patients admitted for COVID-19.||42 (38.9%) patients were malnourished. Moderate or severe nutritional risk was found in 83 (84.7%) patients. Malnutrition was not associated with COVID-19 severity, while nutritional risk was associated with severe COVID-19 (p < 0.01).|
|Suleyman et al., 2020 ||Case series; 463 patients with COVID-19; mean age 57.5 (SD 16.8) years||Describe the clinical characteristics and outcomes of patients with COVID-19 infection.||Severe obesity (i.e., BMI ≥ 40) was independently associated with intensive care unit admission (OR: 2.0; 95% CI: 1.4–3.6; p = 0.02)|
|Petrilli et al., 2020 ||Prospective cohort study; 5279 COVID-19 patients; median age 54 (IQR 38–66) years.||Examine outcomes of people admitted to hospital with COVID-19.||Any increase in BMI (i.e., BMI > 40) was strongly associated with hospital admission (OR: 2.5; CI: 1.8–3.4; average marginal effect: 14%)|
|Simonnet et al., 2020 ||Retrospective cohort study; 124 COVID-19 patients admitted in ICU; median age 60 (IQR 51–70) years.||Analyze the relationship between clinical characteristics, including BMI, and the requirement for invasive mechanical ventilation.||Obesity (BMI > 30 kg/m2) and severe obesity (BMI > 35 kg/m2) were present in 47.6% and 28.2% of cases, respectively. The proportion of patients who required IMV increased with BMI categories (p < 0.01, Chi square test for trend)|
|Hajifathalian et al., 2020 ||Retrospective review; 770 COVID-19 patients; mean age of 63.5 (SD 17) years||Examine the role of obesity in the clinical course of COVID-19 patients.||Obese patients were more likely to present with fever, cough and shortness of breath. Obesity was also associated with a significantly higher rate of ICU admission or death (RR = 1.58, p = 0.002)|
|Busetto et al., 2020 ||Retrospective cohort study; 92 COVID-19 patients; mean age 70.5 (SD 13.3) years||Assess the relationship between the severity of COVID-19 and obesity classes according to BMI.||A higher need for assisted ventilation and a higher admission to intensive or semi-intensive care units were observed in patients with overweight and obesity (p < 0.01 and p < 0.05, respectively)|
|Malik et al., 2021 ||Meta-analysis of 14 studies; 10, 233 confirmed COVID-19 patients;||Assess the effect of obesity on outcomes in the COVID-19 hospitalizations.||The overall prevalence of obesity was 33.9% (3473/10,233). COVID-19 patient with obesity had higher odds of poor outcomes (OR: 1.88; 95% CI: 1.25–2.80; p = 0.002).|
|Ho et al., 2020 ||Systematic Review and Meta-analysis of 61 studies; 270, 241 patients.||Examine the relationship between COVID-19 and obesity.||The pooled prevalence of obesity was 27.6% (95% CI: 22.0–33.2). Obesity was not significantly associated with increased ICU admission or critical illness (OR: 1.25, 95% CI: 0.99–1.58, p = 0.062) but was significantly associated with more severe disease (OR: 3.13, 95% CI: 1.41–6.92, p = 0.005), mortality (OR: 1.36, 95% CI: 1.09–1.69, p = 0.006) and a positive COVID-19 test (OR: 1.50, 95% CI: 1.25–1.81, p < 0.001).|
|Huang et al., 2020 ||Systematic review and meta-analysis of 33 studies (30 studies defined obesity via BMI and 3 studies using VAT adiposity); 45, 650 subjects.||Investigate the effects of obesity with the risk of severe disease among patients with COVID-19.||Higher BMI was associated with severe COVID-19 (OR 1.67, 95% CI: 1.43–1.96; p < 0.001), hospitalization (OR 1.76; 95% CI: 1.21–2.56, p = 0.003), ICU admission (OR 1.67, 95% CI: 1.26–2.21, p < 0.001), IMV requirement (OR: 2.19, 95% CI: 1.56–3.07, p < 0.001), and death (OR 1.37, 95% CI: 1.06–1.75, p = 0.014). Severe COVID-19 cases showed significantly higher VAT (SMD: 0.50, 95% CI: 0.33–0.68, p < 0.001), hospitalization (SMD: 0.49, 95% CI: 0.11–0.87; p = 0.011), ICU admission (SMD: 0.57, 95% CI: 0.33–0.81; p < 0.001) and IMV support (SMD: 0.37, 95% CI: 0.03–0.71; p = 0.035).|
2.3. Infants and Children
|Reference||Study Design and Sample||Aim||Relevant Results|
|Lu et al., 2020 ||Observational study;
171 children with COVID-19; median age 6.7 years (range 1 day–15 years)
|Describe the epidemiologic characteristics, clinical features, and radiologic findings of children with COVID-19.||Children had a milder clinical course compared to adults. GI symptoms were not very common in children. 15 patients presented diarrhea (8.8%) and 11 (6.4%) vomiting.|
|Garazzino et al., 2020 ||Observational multicentre study; 168 children with COVID-19.||Collect preliminary data on COVID-19 presentation in children||In children, GI symptoms were frequent (18%).|
|Giacomet et al., 2020 ||Observational retrospective multicentre study; 127 children with COVID-19||Explore the presence of GI symptoms in children with COVID-19 and the potential correlation between GI symptoms and severity of illness||GI symptoms were present in 28.3% of the children enrolled. COVID-19 severity was positively correlated with the presence of GI symptoms.|
|Akseer et al., 2020 ||Review||Identify main risk factors for maternal and child undernutrition during the COVID-19 pandemic and provide guidance to reduce the consequent undernutrition||Children and mothers’ risk of undernutrition may be increase during the pandemic due to food insecurity/poor diet quality, reduced income/limited financial resources, restricted health services, interrupted education, unhealthy household environment.|
|Headey et al., 2020 ||Global health projection study||Provide an overview on the impact of COVID-19 on childhood malnutrition and nutrition-related mortality using three different projection models.||Low- and middle-income countries are expected to have an average 7.9% decrease in the gross national income, which might associate to an increase in moderate to severe wasting (chronic malnutrition) in children (up to 14.3%). Together with a projected year average reduction in nutrition and health services coverage of about 25% such event may lead to about 128,605 additional death in children <5 years during 2020.|
|Roberton et al., 2020 ||Global health projection study||Estimate the additional child (<5 years) and maternal deaths resulting from potential health systems disruption and decreased access to food.||A reduction by 9.8–51.9% of the coverage of essential maternal and child health interventions might result in increased prevalence of wasting by 10–50% and additional child and maternal death in 2020.|
|Nogueira-de-Almeida et al., 2020 ||Clinical review||Examine the factors contributing to increased COVID-19 susceptibility and severity in obese children and adolescents.||Obesity related risk factors such as chronic subclinical inflammation, impaired immune response, and association with communicable diseases may explain the increased evidence of higher severity and mortality rate for COVID-19 in the adult as well as in the young population.|
|Storz, 2020 ||Review||Present supporting evidence that the COVID-19 pandemic will aggravate the childhood obesity||Through multiple factors (lockdown and movement restrictions, quarantine, home-confinement, and social distancing, school closures, pandemic insecurity and economic hardship) COVID-19 will create an obesogenic environment, increasing childhood obesity|
|Browne et al., 2020 ||Report||Address the impact of COVID-19 on children with obesity and propose potential interventions to reduce the negative outcome.||Children with obesity may face biopsychosocial risks during COVID-19, which may lead to stress and consequent impaired inflammation and immune response to COVID-19
Access to timely, comprehensive healthcare is critical during the pandemic.
|Leon-Abarca, 2020 ||Observational study; 21,161 subjects under 18 years old||Identify risk factors and pre-existing conditions associated with COVID-19 illness in childhood.||Obesity (3.1%) was among the most common pre-existing condition in children with COVID-19. Children with obesity had 4.5-fold probability of presenting pneumonia and 2.5-fold probability of being hospitalized.|
|Kass et al., 2020 ||Observational study;
265 COVID-19 patients admitted to hospital
|Investigate the correlation between BMI and age in COVID-19 patients admitted to the ICU||Significant inverse correlation between age and BMI was observed, suggesting that younger individuals with COVID-19 admitted to hospital and those requiring ICU support are more likely to be obese.|
|Zhang et al., 2020 ||Observational retrospective study;
53 young patients (20 to 45 years).
|Examine the risk factors of mortality in young patients with COVID-19 with specific attention to the relationships between obesity and COVID-19 mortality.||In young patients, obesity (high BMI) was strongly associated with high risk of mortality for SARS-CoV-2 infection. In addition, aggravated inflammatory response, enhanced cardiac injury and increased coagulation activity were also reported as contributing mechanism to the high mortality, compared to the COVID-19 survivor counterpart.|
|Deng et al., 2020 ||Observational retrospective study; 65 COVID-19 hospitalized patients aged 18 to 40 years||Explore the indicators for COVID-19 severity in young patients aged 18 to 40 years.||In young adults, severe COVID-19 cases had higher BMI compared to moderate cases (average 29.23 vs. 22.79 kg/m2, p < 0.01).|
|An R., 2020 ||National health
|Project the impact of the COVID-19 pandemic on childhood obesity by simulating the BMI z-score trajectory of a representative cohort under a control scenario without COVID-19 or under 4 alternative scenarios with COVID-19.||Relative to the control scenario without COVID-19, scenarios 1, 2, 3, and 4 were associated with an increase in the mean BMI z-score|
3. Management of Nutritional Status at the Two Extremes of Life during COVID-19
The entry is from 10.3390/nu13051616
- Gandhi, R.T.; Lynch, J.B.; Del Rio, C. Mild or Moderate Covid-19. N. Engl. J. Med. 2020, 383, 1757–1766.
- Cesari, M.; Vanacore, N.; Agostoni, C. The two extremes meet: Pediatricians, geriatricians and the life-course approach. Pediatr. Res. 2019, 86, 432–435.
- Bedock, D.; Lassen, P.B.; Mathian, A.; Moreau, P.; Couffignal, J.; Ciangura, C.; Poitou-Bernert, C.; Jeannin, A.-C.; Mosbah, H.; Fadlallah, J.; et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin. Nutr. ESPEN 2020, 40, 214–219.
- Leon-Abarca, J.A. Obesity and immunodeficiencies are the main pre-existing conditions associated with mild to moderate COVID-19 in children. Pediatr. Obes. 2020, 15, e12713.
- Kass, D.A.; Duggal, P.; Cingolani, O. Obesity could shift severe COVID-19 disease to younger ages. Lancet 2020, 395, 1544–1545.
- Zhang, F.; Xiong, Y.; Wei, Y.; Hu, Y.; Wang, F.; Li, G.; Liu, K.; Du, R.; Wang, C.; Zhu, W. Obesity predisposes to the risk of higher mortality in young COVID-19 patients. J. Med. Virol. 2020, 92, 2536–2542.
- Deng, M.; Qi, Y.; Deng, L.; Wang, H.; Xu, Y.; Li, Z.; Meng, Z.; Tang, J.; Dai, Z. Obesity as a Potential Predictor of Disease Severity in Young COVID-19 Patients: A Retrospective Study. Obesity 2020, 28, 1815–1825.
- Elia, M. Defining, Recognizing, and Reporting Malnutrition. Int. J. Low. Extrem. Wounds 2017, 16, 230–237.
- Devine, A.; Lawlis, T. Nutrition and Vulnerable Groups. Nutrients 2019, 11, 1066.
- Barker, L.A.; Gout, B.S.; Crowe, T.C. Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System. Int. J. Environ. Res. Public Health 2011, 8, 514–527.
- Liu, L.; Bopp, M.M.; Roberson, P.K.; Sullivan, D.H. Undernutrition and risk of mortality in elderly patients within 1 year of hospital discharge. J. Gerontol. Ser. A Biol. Sci. Med. Sci. 2002, 57, M741–M746.
- Bourke, C.D.; Berkley, J.A.; Prendergast, A.J. Immune Dysfunction as a Cause and Consequence of Malnutrition. Trends Immunol. 2016, 37, 386–398.
- Ibrahim, M.K.; Zambruni, M.; Melby, C.L.; Melby, P.C. Impact of Childhood Malnutrition on Host Defense and Infection. Clin. Microbiol. Rev. 2017, 30, 919–971.
- Browne, N.T.; Snethen, J.A.; Greenberg, C.S.; Frenn, M.; Kilanowski, J.F.; Gance-Cleveland, B.; Burke, P.J.; Lewandowski, L. When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity. J. Pediatr. Nurs. Nurs. Care Child. Fam. 2021, 56, 90–98.
- Kuh, D.; New Dynamics of Ageing (NDA) Preparatory Network. A life course approach to healthy aging, frailty, and capability. J. Gerontol. A Biol. Sci. Med. Sci. 2007, 62, 717–721.
- Lu, X.; Zhang, L.; Du, H.; Zhang, J.; Li, Y.Y.; Qu, J.; Zhang, W.; Wang, Y.; Bao, S.; Li, Y.; et al. SARS-CoV-2 Infection in Children. N. Engl. J. Med. 2020, 382, 1663–1665.
- Garazzino, S.; Montagnani, C.; Donà, D.; Meini, A.; Felici, E.; Vergine, G.; Bernardi, S.; Giacchero, R.; Vecchio, A.L.; Marchisio, P.; et al. Multicentre Italian study of SARS-CoV-2 infection in children and adolescents, preliminary data as at 10 April 2020. Eurosurveillance 2020, 25, 2000600.
- Giacomet, V.; Barcellini, L.; Stracuzzi, M.; Longoni, E.; Folgori, L.; Leone, A.; Zuccotti, G.V. Gastrointestinal Symptoms in Severe COVID-19 Children. Pediatr. Infect. Dis. J. 2020, 39, e317–e320.
- Akin, H.; Kurt, R.; Tufan, F.; Swi, A.; Ozaras, R.; Tahan, V.; Hammoud, G. Newly Reported Studies on the Increase in Gastrointestinal Symptom Prevalence withCOVID-19 Infection: A Comprehensive Systematic Review and Meta-Analysis. Diseases 2020, 8, 41.
- Nogueira-de-Almeida, C.A.; Del Ciampo, L.A.; Ferraz, I.S.; Del Ciampo, I.R.L.; Contini, A.A.; Ued, F.D.V. COVID-19 and obesity in childhood and adolescence: A clinical review. J. Pediatr. 2020, 96, 546–558.
- Astrup, A.; Bügel, S. Overfed but undernourished: Recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. Int. J. Obes. 2019, 43, 219–232.
- Visser, M.; Schaap, L.A.; Wijnhoven, H.A.H. Self-Reported Impact of the COVID-19 Pandemic on Nutrition and Physical Activity Behaviour in Dutch Older Adults Living Independently. Nutrients 2020, 12, 3708.
- Butler, M.J.; Barrientos, R.M. The impact of nutrition on COVID-19 susceptibility and long-term consequences. Brain Behav. Immun. 2020, 87, 53–54.
- Rouget, A.; Vardon-Bounes, F.; Lorber, P.; Vavasseur, A.; Marion, O.; Marcheix, B.; Lairez, O.; Balardy, L.; Fourcade, O.; Conil, J.-M.; et al. Prevalence of malnutrition in coronavirus disease 19: The NUTRICOV study. Br. J. Nutr. 2020, 1–8.
- Parasa, S.; Desai, M.; Chandrasekar, V.T.; Patel, H.K.; Kennedy, K.F.; Roesch, T.; Spadaccini, M.; Colombo, M.; Gabbiadini, R.; Artifon, E.L.A.; et al. Prevalence of Gastrointestinal Symptoms and Fecal Viral Shedding in Patients with Coronavirus Disease 2019. JAMA Netw. Open 2020, 3, e2011335.
- Zhong, P.; Xu, J.; Yang, D.; Shen, Y.; Wang, L.; Feng, Y.; Du, C.; Song, Y.; Wu, C.; Hu, X.; et al. COVID-19-associated gastrointestinal and liver injury: Clinical features and potential mechanisms. Signal Transduct. Target. Ther. 2020, 5, 1–8.
- Morley, J.E.; Kalantar-Zadeh, K.; Anker, S.D. COVID-19: A major cause of cachexia and sarcopenia? J. Cachex Sarcopenia Muscle 2020, 11, 863–865.
- Pan, L.; Mu, M.; Yang, P.; Sun, Y.; Wang, R.; Yan, J.; Li, P.; Hu, B.; Wang, J.; Hu, C.; et al. Clinical Characteristics of COVID-19 Patients With Digestive Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am. J. Gastroenterol. 2020, 115, 766–773.
- Zheng, T.; Yang, C.; Wang, H.-Y.; Chen, X.; Yu, L.; Wu, Z.-L.; Sun, H. Clinical characteristics and outcomes of COVID-19 patients with gastrointestinal symptoms admitted to Jianghan Fangcang Shelter Hospital in Wuhan, China. J. Med. Virol. 2020, 92, 2735–2741.
- Redd, W.D.; Zhou, J.C.; Hathorn, K.E.; Mccarty, T.R.; Bazarbashi, A.N.; Thompson, C.C.; Shen, L.; Chan, W.W. Prevalence and Characteristics of Gastrointestinal Symptoms in Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection in the United States: A Multicenter Cohort Study. Gastroenterology 2020, 159, 765–767.
- Meng, X.; Deng, Y.; Dai, Z.; Meng, Z. COVID-19 and anosmia: A review based on up-to-date knowledge. Am. J. Otolaryngol. 2020, 41, 102581.
- Li, T.; Zhang, Y.; Gong, C.; Wang, J.; Liu, B.; Shi, L.; Duan, J. Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur. J. Clin. Nutr. 2020, 74, 871–875.
- Yu, Y.; Ye, J.; Chen, M.; Jiang, C.; Lin, W.; Lu, Y.; Ye, H.; Li, Y.; Wang, Y.; Liao, Q.; et al. Erratum to: Malnutrition Prolongs the Hospitalization of Patients with COVID-19 Infection: A Clinical Epidemiological Analysis. J. Nutr. Health Aging 2021, 25, 369–373.
- Allard, L.; Ouedraogo, E.; Molleville, J.; Bihan, H.; Giroux-Leprieur, B.; Sutton, A.; Baudry, C.; Josse, C.; Didier, M.; Deutsch, D.; et al. Malnutrition: Percentage and Association with Prognosis in Patients Hospitalized for Coronavirus Disease 2019. Nutrients 2020, 12, 3679.
- Suleyman, G.; Fadel, R.A.; Malette, K.M.; Hammond, C.; Abdulla, H.; Entz, A.; Demertzis, Z.; Hanna, Z.; Failla, A.; Dagher, C.; et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw. Open 2020, 3, e2012270.
- Petrilli, C.M.; Jones, S.A.; Yang, J.; Rajagopalan, H.; O’Donnell, L.; Chernyak, Y.; Tobin, K.A.; Cerfolio, R.J.; Francois, F.; Horwitz, L.I. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: Prospective cohort study. BMJ 2020, 369, m1966.
- Simonnet, A.; Chetboun, M.; Poissy, J.; Raverdy, V.; Noulette, J.; Duhamel, A.; Labreuche, J.; Mathieu, D.; Pattou, F.; Jourdain, M.; et al. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity 2020, 28, 1195–1199.
- Hajifathalian, K.; Kumar, S.; Newberry, C.; Shah, S.; Fortune, B.; Krisko, T.; Ortiz-Pujols, S.; Zhou, X.K.; Dannenberg, A.J.; Kumar, R.; et al. Obesity is Associated with Worse Outcomes in COVID-19: Analysis of Early Data from New York City. Obesity 2020, 28, 1606–1612.
- Busetto, L.; Bettini, S.; Fabris, R.; Serra, R.; Dal Pra, C.; Maffei, P.; Rossato, M.; Fioretto, P.; Vettor, R. Obesity and COVID-19: An Italian snapshot. Obesity 2020, 28, 1600–1605.
- Malik, P.; Patel, U.; Patel, K.; Martin, M.; Shah, C.; Mehta, D.; Malik, F.A.; Sharma, A. Obesity a predictor of outcomes of COVID-19 hospitalized patients-A systematic review and meta-analysis. J. Med. Virol. 2021, 93, 1188–1193.
- Ho, J.S.; Fernando, D.I.; Chan, M.Y.; Sia, C.-H. Obesity in COVID-19: A Systematic Review and Meta-analysis. Ann. Acad. Med. Singap. 2020, 49, 996–1008.
- Huang, Y.; Lu, Y.; Huang, Y.-M.; Wang, M.; Ling, W.; Sui, Y.; Zhao, H.-L. Obesity in patients with COVID-19: A systematic review and meta-analysis. Metabolism 2020, 113, 154378.
- Landi, F.; Calvani, R.; Tosato, M.; Martone, A.M.; Ortolani, E.; Savera, G.; Sisto, A.; Marzetti, E. Anorexia of Aging: Risk Factors, Consequences, and Potential Treatments. Nutrients 2016, 8, 69.
- Silverio, R.; Gonçalves, D.C.; Andrade, M.F.; Seelaender, M. Coronavirus Disease 2019 (COVID-19) and Nutritional Status: The Missing Link? Adv. Nutr. 2020.
- Sullivan, D.H.; Sun, S.; Walls, R.C.; Kovacevich, D.S. Protein-Energy undernutrition among elderly hospitalized patients: A Prospective Study. Nutr. Clin. Pract. 1999, 14, 327–328.
- Persson, M.D.; Brismar, K.E.; Katzarski, K.S.; Nordenström, J.; Cederholm, T.E. Nutritional Status Using Mini Nutritional Assessment and Subjective Global Assessment Predict Mortality in Geriatric Patients. J. Am. Geriatr. Soc. 2002, 50, 1996–2002.
- Dupertuis, Y.M.; Kossovsky, M.P.; Kyle, U.G.; Raguso, C.A.; Genton, L.; Pichard, C. Food intake in 1707 hospitalised patients: A prospective comprehensive hospital survey. Clin. Nutr. 2003, 22, 115–123.
- Morley, J.E. COVID-19—The Long Road to Recovery. J. Nutr. Health Aging 2020.
- Orlandoni, P.; Venturini, C.; Peladic, N.J.; Costantini, A.; Di Rosa, M.; Cola, C.; Giorgini, N.; Basile, R.; Fagnani, D.; Sparvoli, D.; et al. Malnutrition upon Hospital Admission in Geriatric Patients: Why Assess It? Front. Nutr. 2017, 4, 50.
- Braunschweig, C.; Gomez, S.; Sheean, P.M. Impact of Declines in Nutritional Status on Outcomes in Adult Patients Hospitalized for More Than 7 days. J. Am. Diet. Assoc. 2000, 100, 1316–1322.
- Stefan, N.; Birkenfeld, A.L.; Schulze, M.B.; Ludwig, D.S. Obesity and impaired metabolic health in patients with COVID-19. Nat. Rev. Endocrinol. 2020, 16, 341–342.
- Ye, Q.; Wang, B.; Mao, J. The pathogenesis and treatment of the ‘Cytokine Storm’ in COVID-19. J. Infect. 2020, 80, 607–613.
- Sattar, N.; McInnes, I.B.; McMurray, J.J.V. Obesity Is a Risk Factor for Severe COVID-19 Infection: Multiple Potential Mechanisms. Circulation 2020, 142, 4–6.
- Li, M.-Y.; Li, L.; Zhang, Y.; Wang, X.-S. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect. Dis. Poverty 2020, 9, 45.
- Al-Benna, S. Association of high level gene expression of ACE2 in adipose tissue with mortality of COVID-19 infection in obese patients. Obes. Med. 2020, 19, 100283.
- Dicker, D.; Bettini, S.; Farpour-Lambert, N.; Frühbeck, G.; Golan, R.; Goossens, G.; Halford, J.; O’Malley, G.; Mullerova, D.; Salas, X.R.; et al. Obesity and COVID-19: The Two Sides of the Coin. Obes. Facts 2020, 13, 430–438.
- Xanthakos, S.A. Nutritional Deficiencies in Obesity and After Bariatric Surgery. Pediatr. Clin. N. Am. 2009, 56, 1105–1121.
- Wells, J.C.; Sawaya, A.L.; Wibaek, R.; Mwangome, M.; Poullas, M.S.; Yajnik, C.S.; Demaio, A. The double burden of malnutrition: Aetiological pathways and consequences for health. Lancet 2020, 395, 75–88.
- Azzolino, D.; Cesari, M. Obesity and COVID-19. Front. Endocrinol. 2020, 11.
- Cruz-Jentoft, A.J.; Sayer, A.A. Sarcopenia. Lancet 2019, 393, 2636–2646.
- Zamboni, M.; Mazzali, G.; Fantin, F.; Rossi, A.; Di Francesco, V. Sarcopenic obesity: A new category of obesity in the elderly. Nutr. Metab. Cardiovasc. Dis. 2008, 18, 388–395.
- Schrager, M.A.; Metter, E.J.; Simonsick, E.; Ble, A.; Bandinelli, S.; Lauretani, F.; Ferrucci, L. Sarcopenic obesity and inflammation in the InCHIANTI study. J. Appl. Physiol. 2007, 102, 919–925.
- Akseer, N.; Kandru, G.; Keats, E.C.; Bhutta, Z.A. COVID-19 pandemic and mitigation strategies: Implications for maternal and child health and nutrition. Am. J. Clin. Nutr. 2020, 112, 251–256.
- Kluge, H.H.P.; Wickramasinghe, K.; Rippin, H.L.; Mendes, R.; Peters, D.H.; Kontsevaya, A.; Breda, J. Prevention and control of non-communicable diseases in the COVID-19 response. Lancet 2020, 395, 1678–1680.
- Martinez-Ferran, M.; De La Guía-Galipienso, F.; Sanchis-Gomar, F.; Pareja-Galeano, H. Metabolic Impacts of Confinement during the COVID-19 Pandemic Due to Modified Diet and Physical Activity Habits. Nutrients 2020, 12, 1549.
- Di Renzo, L.; Gualtieri, P.; Pivari, F.; Soldati, L.; Attinà, A.; Cinelli, G.; Leggeri, C.; Caparello, G.; Barrea, L.; Scerbo, F.; et al. Eating habits and lifestyle changes during COVID-19 lockdown: An Italian survey. J. Transl. Med. 2020, 18, 229.
- Sidor, A.; Rzymski, P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients 2020, 12, 1657.
- Mehta, S. Nutritional status and COVID-19: An opportunity for lasting change? Clin. Med. 2020, 20, 270–273.
- Headey, D.; Heidkamp, R.; Osendarp, S.; Ruel, M.; Scott, N.; Black, R.; Shekar, M.; Bouis, H.; Flory, A.; Haddad, L.; et al. Impacts of COVID-19 on childhood malnutrition and nutrition-related mortality. Lancet 2020, 396, 519–521.
- Roberton, T.; Carter, E.D.; Chou, V.B.; Stegmuller, A.R.; Jackson, B.D.; Tam, Y.; Sawadogo-Lewis, T.; Walker, N. Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: A modelling study. Lancet Glob. Health 2020, 8, e901–e908.
- Fore, H.H.; Dongyu, Q.; Beasley, D.M.; Ghebreyesus, T.A. Child malnutrition and COVID-19: The time to act is now. Lancet 2020, 396, 517–518.
- Zemrani, B.; Gehri, M.; Masserey, E.; Knob, C.; Pellaton, R. A hidden side of the COVID-19 pandemic in children: The double burden of undernutrition and overnutrition. Int. J. Equity Health 2021, 20, 1–4.
- Storz, M.A. The COVID-19 pandemic: An unprecedented tragedy in the battle against childhood obesity. Clin. Exp. Pediatr. 2020, 63, 477–482.
- An, R. Projecting the impact of the coronavirus disease-2019 pandemic on childhood obesity in the United States: A microsimulation model. J. Sport Heath Sci. 2020, 9, 302–312.
- Finch, A.; Tribble, A.G. The path ahead: From global pandemic to health promotion. Prev. Med. Rep. 2021, 21, 101271.
- Hales, C.N.; Barker, D.J. Type 2 (non-insulin-dependent) diabetes mellitus: The thrifty phenotype hypothesis. Diabetologia 1992, 35, 595–601.
- Koletzko, B.; Godfrey, K.M.; Poston, L.; Szajewska, H.; Van Goudoever, J.B.; De Waard, M.; Brands, B.; Grivell, R.M.; Deussen, A.R.; Dodd, J.M.; et al. Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. Ann. Nutr. Metab. 2019, 74, 93–106.
- Ba, J.T.H.; Brown, C.J.; DiMaria-Ghalili, R.A.; Locher, J.L. Undernutrition in Hospitalized Older Adults: Patterns and Correlates, Outcomes, and Opportunities for Intervention with a Focus on Processes of Care. J. Nutr. Elder. 2010, 29, 4–41.
- Arlinghaus, K.R.; Truong, C.; Johnston, C.A.; Hernandez, D.C. An Intergenerational Approach to Break the Cycle of Malnutrition. Curr. Nutr. Rep. 2018, 7, 259–267.
- Azzolino, D.; Passarelli, P.C.; D’Addona, A.; Cesari, M. Nutritional strategies for the rehabilitation of COVID-19 patients. Eur. J. Clin. Nutr. 2020, 75, 728–730.
- Barazzoni, R.; Bischoff, S.C.; Breda, J.; Wickramasinghe, K.; Krznaric, Z.; Nitzan, D.; Pirlich, M.; Singer, P. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin. Nutr. 2020, 39, 1631–1638.
- Caccialanza, R.; Laviano, A.; Lobascio, F.; Montagna, E.; Bruno, R.; Ludovisi, S.; Corsico, A.G.; Di Sabatino, A.; Belliato, M.; Calvi, M.; et al. Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol. Nutrition 2020, 74, 110835.
- The WHO Child Growth Standards. Available online: (accessed on 27 January 2021).
- Screening for Malnutrition at Home during Covid-19—Haiti. Available online: (accessed on 20 March 2021).
- Krznarić, Ž.; Bender, D.V.; Laviano, A.; Cuerda, C.; Landi, F.; Monteiro, R.; Pirlich, M.; Barazzoni, R. A simple remote nutritional screening tool and practical guidance for nutritional care in primary practice during the COVID-19 pandemic. Clin. Nutr. 2020, 39, 1983–1987.
- Becker, P.J.; Bellini, S.G.; Vega, M.W.; Corkins, M.R.; Spear, B.A.; Spoede, E.; Hoy, M.K.; Piemonte, T.A.; Rozga, M. Validity and Reliability of Pediatric Nutrition Screening Tools for Hospital, Outpatient, and Community Settings: A 2018 Evidence Analysis Center Systematic Review. J. Acad. Nutr. Diet. 2020, 120, 288–318.
- Kache, S.; Chisti, M.J.; Gumbo, F.; Mupere, E.; Zhi, X.; Nallasamy, K.; Nakagawa, S.; Lee, J.H.; Di Nardo, M.; De La Oliva, P.; et al. COVID-19 PICU guidelines: For high- and limited-resource settings. Pediatr. Res. 2020, 88, 705–716.
- Mehta, N.M.; Skillman, H.E.; Irving, S.Y.; Coss-Bu, J.A.; Vermilyea, S.; Farrington, E.A.; McKeever, L.; Hall, A.M.; Goday, P.S.; Braunschweig, C. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. J. Parenter. Enter. Nutr. 2017, 41, 706–742.
- Tume, L.N.; Valla, F.V.; Joosten, K.; Chaparro, C.J.; Latten, L.; Marino, L.V.; MacLeod, I.; Moullet, C.; Pathan, N.; Rooze, S.; et al. Nutritional support for children during critical illness: European Society of Pediatric and Neonatal Intensive Care (ESPNIC) metabolism, endocrine and nutrition section position statement and clinical recommendations. Intensiv. Care Med. 2020, 46, 411–425.
- Cruz-Jentoft, A.J.; Kiesswetter, E.; Drey, M.; Sieber, C.C. Nutrition, frailty, and sarcopenia. Aging Clin. Exp. Res. 2017, 29, 43–48.
- Joosten, K.; Embleton, N.; Yan, W.; Senterre, T.; Braegger, C.; Bronsky, J.; Cai, W.; Campoy, C.; Carnielli, V.; Darmaun, D.; et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy. Clin. Nutr. 2018, 37, 2309–2314.
- Volkert, D.; Beck, A.M.; Cederholm, T.; Cruz-Jentoft, A.; Goisser, S.; Hooper, L.; Kiesswetter, E.; Maggio, M.; Raynaud-Simon, A.; Sieber, C.C.; et al. ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin. Nutr. 2019, 38, 10–47.
- Keller, U. Nutritional Laboratory Markers in Malnutrition. J. Clin. Med. 2019, 8, 775.
- Bharadwaj, S.; Ginoya, S.; Tandon, P.; Gohel, T.D.; Guirguis, J.; Vallabh, H.; Jevenn, A.; Hanouneh, I. Malnutrition: Laboratory markers vs nutritional assessment. Gastroenterol. Rep. 2016, 4, 272–280.
- Zhang, Z.; Pereira, S.L.; Luo, M.; Matheson, E.M. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2017, 9, 829.
- Volkert, D.; Beck, A.M.; Cederholm, T.; Cereda, E.; Cruz-Jentoft, A.; Goisser, S.; De Groot, L.; Großhauser, F.; Kiesswetter, E.; Norman, K.; et al. Management of Malnutrition in Older Patients—Current Approaches, Evidence and Open Questions. J. Clin. Med. 2019, 8, 974.
- Allen, K.; Hoffman, L. Enteral Nutrition in the Mechanically Ventilated Patient. Nutr. Clin. Pract. 2019, 34, 540–557.
- Pereira, M.; Dantas Damascena, A.; Galvão Azevedo, L.M.; de Almeida Oliveira, T.; da Mota Santana, J. Vitamin D deficiency aggravates COVID-19: Systematic review and meta-analysis. Crit. Rev. Food Sci. Nutr. 2020, 1–9.
- Zhang, L.; Liu, Y. Potential interventions for novel coronavirus in China: A systematic review. J. Med. Virol. 2020, 92, 479–490.
- Ribeiro, K.D.D.S.; Garcia, L.R.S.; Dametto, J.F.D.S.; Assunção, D.G.F.; Maciel, B.L.L. COVID-19 and Nutrition: The Need for Initiatives to Promote Healthy Eating and Prevent Obesity in Childhood. Child Obes. 2020, 16, 235–237.
- Ilie, P.C.; Stefanescu, S.; Smith, L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin. Exp. Res. 2020, 32, 1195–1198.
- Allegra, A.; Tonacci, A.; Pioggia, G.; Musolino, C.; Gangemi, S. Vitamin deficiency as risk factor for SARS-CoV-2 infection: Correlation with susceptibility and prognosis. Eur. Rev. Med. Pharmacol. Sci. 2020, 24, 9721–9738.
- Cereda, E.; Bogliolo, L.; De Stefano, L.; Caccialanza, R. A brief discussion of the benefit and mechanism of vitamin D supplementation on coronavirus disease 2019. Curr. Opin. Clin. Nutr. Metab. Care 2021, 24, 102–107.
- Maghbooli, Z.; Sahraian, M.A.; Ebrahimi, M.; Pazoki, M.; Kafan, S.; Tabriz, H.M.; Hadadi, A.; Montazeri, M.; Nasiri, M.; Shirvani, A.; et al. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS ONE 2020, 15, e0239799.
- Rhodes, J.M.; Subramanian, S.; Laird, E.; Griffin, G.; Kenny, R.A. Perspective: Vitamin D deficiency and COVID-19 severity—Plausibly linked by latitude, ethnicity, impacts on cytokines, ACE2 and thrombosis. J. Intern. Med. 2021, 289, 97–115.
- Nanri, A.; Nakamoto, K.; Sakamoto, N.; Imai, T.; Akter, S.; Nonaka, D.; Mizoue, T. Association of serum 25-hydroxyvitamin D with influenza in case-control study nested in a cohort of Japanese employees. Clin. Nutr. 2017, 36, 1288–1293.
- Lee, M.-D.; Lin, C.-H.; Lei, W.-T.; Chang, H.-Y.; Lee, H.-C.; Yeung, C.-Y.; Chiu, N.-C.; Chi, H.; Liu, J.-M.; Hsu, R.-J.; et al. Does Vitamin D Deficiency Affect the Immunogenic Responses to Influenza Vaccination? A Systematic Review and Meta-Analysis. Nutrients 2018, 10, 409.
- Biesalski, H.K. Obesity, vitamin D deficiency and old age a serious combination with respect to coronavirus disease-2019 severity and outcome. Curr. Opin. Clin. Nutr. Metab. Care 2021, 24, 18–24.
- Wallace, T.C. Combating COVID-19 and Building Immune Resilience: A Potential Role for Magnesium Nutrition? J. Am. Coll. Nutr. 2020, 39, 685–693.
- Tan, C.W.; Ho, L.P.; Kalimuddin, S.; Cherng, B.P.Z.; Teh, Y.E.; Thien, S.Y.; Wong, H.M.; Tern, P.J.W.; Chandran, M.; Chay, J.W.M.; et al. Cohort study to evaluate the effect of vitamin D, magnesium, and vitamin B12 in combination on progression to severe outcomes in older patients with coronavirus (COVID-19). Nutrition 2020, 79–80, 111017.
- Annweiler, G.; Corvaisier, M.; Gautier, J.; Dubée, V.; Legrand, E.; Sacco, G.; Annweiler, C. Vitamin D Supplementation Associated to Better Survival in Hospitalized Frail Elderly COVID-19 Patients: The GERIA-COVID Quasi-Experimental Study. Nutrition 2020, 12, 3377.
- Murai, I.H.; Fernandes, A.L.; Sales, L.P.; Pinto, A.J.; Goessler, K.F.; Duran, C.S.C.; Silva, C.B.R.; Franco, A.S.; Macedo, M.B.; Dalmolin, H.H.H.; et al. Effect of a single high dose of Vitamin D3 on hospital length of stay in patients with moderate to severe COVID-19: A randomized clinical trial. JAMA 2021, 325, 1053–1060.
- Castillo, M.E.; Costa, L.M.E.; Barrios, J.M.V.; Díaz, J.F.A.; Miranda, J.L.; Bouillon, R.; Gomez, J.M.Q. Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study. J. Steroid Biochem. Mol. Biol. 2020, 203, 105751.
- Ling, S.F.; Broad, E.; Murphy, R.; Pappachan, J.M.; Pardesi-Newton, S.; Kong, M.-F.; Jude, E.B. High-Dose Cholecalciferol Booster Therapy is Associated with a Reduced Risk of Mortality in Patients with COVID-19: A Cross-Sectional Multi-Centre Observational Study. Nutrition 2020, 12, 3799.
- Carlucci, P.M.; Ahuja, T.; Petrilli, C.; Rajagopalan, H.; Jones, S.; Rahimian, J. Zinc sulfate in combination with a zinc ionophore may improve outcomes in hospitalized COVID-19 patients. J. Med. Microbiol. 2020, 69, 1228–1234.
- Yao, J.S.; Paguio, J.A.; Dee, E.C.; Tan, H.C.; Moulick, A.; Milazzo, C.; Jurado, J.; Penna, N.D.; Celi, L.A. The Minimal Effect of Zinc on the Survival of Hospitalized Patients with COVID-19: An Observational Study. Chest 2021, 159, 108–111.
- Patterson, T.; Isales, C.M.; Fulzele, S. Low level of Vitamin C and dysregulation of Vitamin C transporter might be involved in the severity of COVID-19 Infection. Aging Dis. 2021, 12, 14–26.
- Zhang, J.; Rao, X.; Li, Y.; Zhu, Y.; Liu, F.; Guo, G.; Luo, G.; Meng, Z.; Backer, D.D.; Xiang, H.; et al. Pilot Trial of High-dose vitamin C in critically ill COVID-19 patients. Ann. Intensive Care 2020, 11, 5.
- Di Matteo, G.; Spano, M.; Grosso, M.; Salvo, A.; Ingallina, C.; Russo, M.; Ritieni, A.; Mannina, L. Food and COVID-19: Preventive/Co-therapeutic Strategies Explored by Current Clinical Trials and in Silico Studies. Foods 2020, 9, 1036.
- Lordan, R.; Rando, H.M.; Covid-Review Consortium; Greene, C.S. Dietary Supplements and Nutraceuticals under Investigation for COVID-19 Prevention and Treatment. arXiv 2021, arXiv:2102.02250v1.