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Adults and children with a history of malnutrition have worse COVID outcomes

Balanced nutritional intake during the progression of and recovery from any illness is important for improvement in health outcomes. In addition, acute and chronic malnutrition predispose patients to significantly increased risk of bacterial and viral infection and increased severity of these infections.

Therefore, it is expected that malnutrition can worsen the prognosis of COVID. A recent study published in Scientific Reports indeed showed that adults and children with a history of malnutrition are more likely to die of COVID or need mechanical ventilation. 

The researchers looked at 8,604 children (mean age, 6 years) and 94,495 adults (mean age, 53 years) hospitalized with COVID-19 across 56 US hospitals from March to June 2020 and compared those with malnutrition history from 2015 to 2019 with those without. 

Twenty-one children and 4,706 adults died. Children with malnutrition made up 7.5% of severe pediatric COVID-19 cases (39 of 520) and 1.5% of mild pediatric COVID-19 cases (125 of 7,959). As for adults, those with malnutrition made up 4% of severe COVID-19 cases (453 of 11,423), and 1.8% of mild cases (1,557 of 81,515).

Overall, 1.9% of pediatric patients (164) and 2.1% of adult patients (2,010) in the cohort had a history of malnutrition. Data indicated that children older than 5 and adults ages 18 to 78 with previous malnutrition were more likely to have severe COVID-19 than the same age groups without. 

While children younger than 5 and those older than 79 had higher odds of severe COVID-19 if they were not malnourished, the researchers say this could be due to a lack of medical data and a general high risk for COVID-19 infection, respectively.

According to the American Society of Parenteral and Enteral Nutrition (ASPEN), malnutrition is a clinical condition that may be associated with weight loss over time, inadequate energy intake compared with estimated needs, muscle loss, fat loss, fluid accumulation, and diminished grip strength. 

Malnutrition, as a global health problem for both the pediatric and adult population, will continue to overlap with the COVID-19 pandemic that has already affected millions worldwide. It is important to focus on communities at the highest risk of both malnutrition and COVID-19.*

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Dr. Melvin Sanicas (@Vaccinologist) is a physician-scientist specializing in vaccines, infectious diseases, and global health. 

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