Nutritional status of hospitalised COVID-19 patients impacts life expectancy

The results of a recent study on patients hospitalised with COVID-19 indicate that nutritional status impacts their length of stay in hospital. All hospitalised patients during the first waves of the pandemic were likely to suffer from malnutrition and mortality rates were higher among patients at high risk of malnutrition. Also taken into consideration were patients` BMI (body mass index) and patients with a high BMI (≥30 kg/m2) were more likely to be admitted to intensive care. The results of the study were published in the science journal Clinical Nutrition ESPEN.

“The aim of the study was to look at the nutritional condition of patients in Landspitali Haskolasjukrahus [The National University Hospital of Iceland] due to COVID-19 during the first waves of the pandemic in Iceland. The aim was also to investigate whether the risk of malnutrition, BMI and vitamin D levels were connected to the duration of hospital stay, ICU admissions and mortality rates,” says Áróra Rós Ingadóttir, PhD in Nutrition and assistant professor at the Faculty of Food Science and Nutrition at the University of Iceland.

Many COVID-19 patients showed signs of malnutrition

During the first waves of the COVID-19 pandemic dietitians at the Landspitali Department of Dietetics worked mostly from home. Some took on other roles, for example, the supervision of patients at the COVID outpatient centre at Birkiborg and some of the hospital’s departments were turned into COVID departments. “Since little was known about COVID at the time it was decided to offer patients and departments at Landspitali consultation as needed. We quickly saw that many of the patients were having difficulties eating; they were experiencing a lack of appetite, weight loss, changes in their sense of taste and so forth. Therefore, we thought it was important to research their nutritional status and see whether it would impact a few outcomes,” Áróra says, asked about the motivation behind the study.

The study is, in fact, closely related to Áróra’s interest in the nutritional status and treatments of patients; since she became a researcher, she has dedicated herself to research on this particular topic. “The rate of malnutrition among hospitalised patients is generally high and research has shown that 20-60% of patients at Landspitali are at risk of malnutrition. Malnutrition is associated with longer duration of hospital stay, more frequent readmissions, increased infections, and higher mortality rates. As a result, it’s highly important to prevent, diagnose and treat malnutrition according to our best available knowledge,” Áróra explains.

Descriptive retrospective study including 273 patients

Participants in the study were 273 patients who were admitted to Landspitali with COVID-19 from February 2020 to March 2021. Information on participants was collected from medical records and all patients were screened for risk of malnutrition using a validated screening tool. Patients’ vitamin D levels were assessed, and logistic regression analysis was used to assess the association between indicators of nutritional status and duration of stay over 7 days, ICU admission, and mortality while in hospital.

The study was Sandra Dögg Guðnadóttir’s master’s thesis in clinical nutrition and was written under the direction of Áróra. Sandra Dögg graduated from the University of Iceland in the spring of 2022 and now works as a pharmacologist and dietician at Landspitali. “Along with me and Sandra Dögg, participants in the study were Jenný Kaaber, a dietitian, who acted as a consultant. She worked at the COVID outpatient centre and provided nutrition counselling for COVID patients at Landspitali’s Department of Infectious Diseases; Ingibjörg Gunnarsdóttir, professor at the Food Science and Nutrition at the University of Iceland. She has extensive experience at interpreting research data and writing academic papers in this field; and Ubaldo Benitez Hernandez, a statistician at the Landspitali Science Department, who assisted with statistical consulting,” Áróra says of the group of researchers.

Results show connection between malnutrition and length of hospital stay

Out of 273 patients screened, 74% showed signs of medium to high risk of malnutrition. These individuals were more likely to stay in the hospital for over 7 days compared to those who were at low risk for malnutrition. During the study period, 41 patients were admitted to the ICU and they were all at risk for malnutrition; 32% were at medium risk and 68% at high risk. Mortality rates were higher among patients who were at high risk of malnutrition than those who were at low risk.

The results also indicated that patients with a BMI of ≥30 kg/m2 were more likely to be admitted to the ICU than patients with a lower BMI. „On the other hand, there doesn’t seem to be a connection between a high BMI, vitamin D deficiency and hospital stay of more than 7 days or mortality.”

When asked about the possible impact of the results Áróra points out that when the research was being conducted little was known about the nutritional status of patients with the COVID-19 disease and that it hadn’t been researched before in Iceland. “So, the study provides important information on the nutritional status of these patients and what to emphasise in their treatment. It also provides the science community with important information since this is a new disease that seems to have had a considerable effect on problems related to patients’ nutrition."