Acute Crit Care.  2022 Aug;37(3):332-338. 10.4266/acc.2021.01830.

Association of nutrition risk screening 2002 and Malnutrition Universal Screening Tool with COVID-19 severity in hospitalized patients in Iran

• Eslamian G
• Sali S
• Babaei M
• Parastouei K
• Moghadam DA

• KMID: 2535296
• DOI: http://doi.org/10.4266/acc.2021.01830

Abstract

Background
Malnutrition affects normal body function and is associated with disease severity and mortality. Due to the high prevalence of malnutrition reported in patients with coronavirus disease 2019 (COVID-19), the current study examined the association between malnutrition and disease severity in hospitalized adult patients with COVID-19 in Iran.
Methods
In this prospective observational study, 203 adult patients with COVID-19 verified by real-time polymerase chain reaction test and chest computed tomography were recruited from those admitted to a university hospital in Iran. To determine COVID-19 intensity, patients were categorized into four groups. Malnutrition assessment was based on the Malnutrition Universal Screening Tool (MUST) and nutrition risk screening score (NRS-2002). An ordinal regression model was run to assess the association between malnutrition and disease severity.
Results
In the studies sample of Iranian patients with COVID-19, 38.3% of patients had severe COVID-19. According to NRS-2002, 12.9% of patients were malnourished. Based on MUST, 2% of patients were at medium, and 13.4% of patients were at high risk of malnutrition. Malnutrition was associated with a higher odds of extremely severe COVID-19 according to NRS-2002 (odds ratio, 1.38; 95% confidence interval, 0.21–2.56; P=0.021).
Conclusions
Malnutrition was not prevalent in the studies sample of Iranian patients with COVID-19; however, it was associated with a higher odds of extremely severe COVID-19.

Keyword

COVID-19; Iran; malnutrition; malnutrition universal screening tool; nutrition risk screening score

Figure

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  Figure 1. Flow diagram for patients recruitment. COVID-19: coronavirus disease 2019.

Reference

1. Bourke CD, Berkley JA, Prendergast AJ. Immune dysfunction as a cause and consequence of malnutrition. Trends Immunol. 2016; 37:386–98.

2. Holder H. Malnutrition in the elderly: a public health concern. Br J Nurs. 2020; 29:118–9.

3. Paynter S, Ware RS, Lucero MG, Tallo V, Nohynek H, Weinstein P, et al. Malnutrition: a risk factor for severe respiratory syncytial virus infection and hospitalization. Pediatr Infect Dis J. 2014; 33:267–71.

4. Short KR, Kedzierska K, van de Sandt CE. Back to the future: lessons learned from the 1918 influenza pandemic. Front Cell Infect Microbiol. 2018; 8:343.

5. Papadimitriou-Olivgeris M, Gkikopoulos N, Wüst M, Ballif A, Simonin V, Maulini M, et al. Predictors of mortality of influenza virus infections in a Swiss hospital during four influenza seasons: role of quick sequential organ failure assessment. Eur J Intern Med. 2020; 74:86–91.

6. Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: what we know. Int J Infect Dis. 2020; 94:44–8.

7. Bedock D, Bel Lassen P, Mathian A, Moreau P, Couffignal J, Ciangura C, et al. Prevalence and severity of malnutrition in hospitalized COVID-19 patients. Clin Nutr ESPEN. 2020; 40:214–9.

8. 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.

9. Larrazabal RB Jr, Perez B, Masamayor E, Chiu H, Palileo-Villanueva L. The prevalence of malnutrition and analysis of related factors among adult patients with the coronavirus disease 2019 (COVID 19) in a tertiary government hospital: the MalnutriCoV study. Clin Nutr ESPEN. 2021; 42:98–104.

10. Jia H. Pulmonary angiotensin-converting enzyme 2 (ACE2) and inflammatory lung disease. Shock. 2016; 46:239–48.

11. Frazier WJ, Hall MW. Immunoparalysis and adverse outcomes from critical illness. Pediatr Clin North Am. 2008; 55:647–68.

12. Schoeman D, Fielding BC. Leptin deficiency, caused by malnutrition, makes you susceptible to SARS-CoV-2 infection but could offer protection from severe COVID-19. mSphere. 2021; 6:e00031–21.

13. Todorovic V, Russell C, Elia M. The ‘MUST’ explanatory booklet [Internet]. Redditch: BAPEN; 2011 [cited 2022 Mar 2]. Available from: https://www.bapen.org.uk/screening-and-must/must/must-toolkit/the-must-explanatory-booklet.

14. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003; 22:321–36.

15. Javid Mishamandani Z, Norouzy A, Hashemian SM, Khoundabi B, Rezaeisadrabadi M, Safarian M, et al. Nutritional status of patients hospitalized in the intensive care unit: a comprehensive report from Iranian hospitals, 2018. J Crit Care. 2019; 54:151–8.

16. He F, Deng Y, Li W. Coronavirus disease 2019: what we know? J Med Virol. 2020; 92:719–25.

17. Patel C, Omer E, Diamond SJ, McClave SA. Can nutritional assessment tools predict response to nutritional therapy? Curr Gastroenterol Rep. 2016; 18:15.

18. Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019; 393:2312–21.

19. Shen Y, Zhou Y, He T, Zhuang X. Effect of preoperative nutritional risk screening and enteral nutrition support in accelerated recovery after resection for esophageal cancer. Nutr Cancer. 2021; 73:596–601.

20. Stratton RJ, Hackston A, Longmore D, Dixon R, Price S, Stroud M, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the 'malnutrition universal screening tool' ('MUST') for adults. Br J Nutr. 2004; 92:799–808.

21. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020; 180:934–43.

22. Liu W, Tao ZW, Wang L, Yuan ML, 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; 133:1032–8.

23. Kurtz A, Grant K, Marano R, Arrieta A, Grant K Jr, Feaster W, et al. Long-term effects of malnutrition on severity of COVID-19. Sci Rep. 2021; 11:14974.

24. Quilliot D, Gérard M, Bonsack O, Malgras A, Vaillant MF, Di Patrizio P, et al. Impact of severe SARS-CoV-2 infection on nutritional status and subjective functional loss in a prospective cohort of COVID-19 survivors. BMJ Open. 2021; 11:e048948.

25. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008; 27:5–15.

26. Hudson L, Chittams J, Griffith C, Compher C. Malnutrition identified by Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition is associated with more 30-day readmissions, greater hospital mortality, and longer hospital stays: a retrospective analysis of nutrition assessment data in a major medical center. JPEN J Parenter Enteral Nutr. 2018; 42:892–7.

27. Agarwal E, Ferguson M, Banks M, Batterham M, Bauer J, Capra S, et al. Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions, and greater in-hospital mortality: results from the Nutrition Care Day Survey 2010. Clin Nutr. 2013; 32:737–45.

28. Fedele D, De 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.

29. Anker MS, Landmesser U, von Haehling S, Butler J, Coats A, Anker SD. Weight loss, malnutrition, and cachexia in COVID-19: facts and numbers. J Cachexia Sarcopenia Muscle. 2021; 12:9–13.

30. Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional risk screening and assessment. J Clin Med. 2019; 8:1065.

31. Velasco C, García E, Rodríguez V, Frias L, Garriga R, Alvarez J, et al. Comparison of four nutritional screening tools to detect nutritional risk in hospitalized patients: a multicentre study. Eur J Clin Nutr. 2011; 65:269–74.

32. Cederholm T, Jensen GL, Correia M, Gonzalez MC, Fukushima R, Higashiguchi T, et al. GLIM criteria for the diagnosis of malnutrition: a consensus report from the global clinical nutrition community. J Cachexia Sarcopenia Muscle. 2019; 10:207–17.