[en] BACKGROUND: The identification of coronavirus disease 2019 (COVID-19) risk factors is requested to implement prevention strategies. AIM: To explore the associations between the COVID-19 incidence and malnutrition, sarcopenia, and frailty, identified as potential risk factors in previous cross-sectional studies. METHODS: Malnutrition, sarcopenia, and frailty were assessed at the last available follow-up from the Sarcopenia and Physical Impairments with Advancing Age (SarcoPhAge) cohort (i.e., the fifth year that ended in 2019) according to the Mini-Nutritional Assessment short-form, the European Working Group on Sarcopenia in Older People (EWGSOP2), and the Fried criteria, respectively. Information regarding the COVID-19 was gathered by phone calls interviews in April 2021 to measure its self-declared incidence. Adjusted Cox regressions and Kaplan-Meier curves were performed. RESULTS: The present study included 241 participants [median age 75.6 (73.0-80.6) years, 63.1% women]. Among them, 27 participants (11.2%) developed the non-fatal Covid-19. No significant increased risks of COVID-19 were observed in patients with malnutrition [adjusted HR 1.14 (0.26-5.07)] and sarcopenia [adjusted HR 1.25 (0.35-4.42)]. Nevertheless, the incidence of COVID-19 was significantly higher in frail (44.4%) than in robust participants (8.5%) [Adjusted HR 7.01 (2.69-18.25)], which was confirmed by the Kaplan-Meier curves (p < 0.001). Among the frailty syndrome components, a low physical activity level was the only one significantly associated with an increased risk of COVID-19 [adjusted HR 5.18 (1.37-19.54)]. CONCLUSION: Despite some limitations in the methodology of this study (i.e., limited sample size, COVID-19 incidence self-reported and not assessed systematically using objective measurements) requiring careful consideration, an increased risk to develop COVID-19 was observed in the presence of the frailty syndrome. Further investigations are needed to elaborate on our findings.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Lengele, Laetitia ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Moutschen, Michel ; Université de Liège - ULiège > Département des sciences cliniques > Immunopath. - Maladies infect. et médec. interne gén.
Beaudart, Charlotte ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
KAUX, Jean-François ; Centre Hospitalier Universitaire de Liège - CHU > Autres Services Médicaux > Service de médecine de l'appareil locomoteur
Gillain, Sophie ; Université de Liège - ULiège > Département des sciences cliniques > Gériatrie
Reginster, Jean-Yves ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Bruyère, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Language :
English
Title :
Frailty but not sarcopenia nor malnutrition increases the risk of developing COVID-19 in older community-dwelling adults.
Belgium: WHO Coronavirus Disease (COVID-19) Dashboard With Vaccination Data|WHO Coronavirus (COVID-19) Dashboard With Vaccination Data Available online: https://covid19.who.int/region/euro/country/be. Accessed on 10 Jul 2021
Willows S, Alam SB, Sandhu JK et al (2021) A Canadian perspective on severe acute respiratory syndrome coronavirus 2 infection and treatment: how prevalent underlying inflammatory disease contributes to pathogenesis. Biochem Cell Biol 99:173–194. 10.1139/bcb-2020-0341 DOI: 10.1139/bcb-2020-0341
Li G, Fan Y, Lai Y et al (2020) Coronavirus infections and immune responses. J Med Virol 92:424–432. 10.1002/jmv.25685 DOI: 10.1002/jmv.25685
Zhang B, Zhou X, Qiu Y et al (2020) Clinical characteristics of 82 death cases with COVID-19. medRxiv. 10.1101/2020.02.26.20028191 DOI: 10.1101/2020.02.26.20028191
Lingeswaran M, Goyal T, Ghosh R et al (2020) Inflammation, immunity and immunogenetics in COVID-19: a narrative review. Indian J Clin Biochem 35:260–273. 10.1007/s12291-020-00897-3 DOI: 10.1007/s12291-020-00897-3
Schoevaerdts D, Sibille FX, Gavazzi G (2021) Infections in the older population: what do we know? Aging Clin Exp Res 33:689–701. 10.1007/s40520-019-01375-4 DOI: 10.1007/s40520-019-01375-4
Bencivenga L, Rengo G, Varricchi G (2020) Elderly at time of COronaVIrus disease 2019 (COVID-19): possible role of immunosenescence and malnutrition. Geroscience 42:1089–1092. 10.1007/s11357-020-00218-9 DOI: 10.1007/s11357-020-00218-9
Salimi S, Hamlyn JM, Le Couteur D (2020) COVID-19 and crosstalk with the hallmarks of aging. J Gerontol 75:e34–e41. 10.1093/gerona/glaa149 DOI: 10.1093/gerona/glaa149
Bajaj V, Gadi N, Spihlman AP et al (2021) Aging, immunity, and COVID-19: how age influences the host immune response to coronavirus infections? Front Physiol 11:1793. 10.3389/fphys.2020.571416 DOI: 10.3389/fphys.2020.571416
Wu C, Chen X, Cai Y et al (2020) Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 180:934–943. 10.1001/jamainternmed.2020.0994 DOI: 10.1001/jamainternmed.2020.0994
Cederholm T, Barazzoni R, Austin P et al (2017) ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 36:49–64. 10.1016/j.clnu.2016.09.004 DOI: 10.1016/j.clnu.2016.09.004
De Araújo Morais AH, Aquino JDS, Da Silva-Maia JK et al (2021) Nutritional status, diet and viral respiratory infections: perspectives for severe acute respiratory syndrome coronavirus 2. Br J Nutr 125:851–862. 10.1017/S0007114520003311 DOI: 10.1017/S0007114520003311
Suardi C, Cazzaniga E, Graci S et al (2021) Link between viral infections, immune system, inflammation and diet. Int J Environ Res Public Health 18:1–13. 10.3390/ijerph18052455 DOI: 10.3390/ijerph18052455
Barazzoni R, Bischoff SC, Breda J et al (2020) ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clin Nutr 39:1631–1638. 10.1016/j.clnu.2020.03.022 DOI: 10.1016/j.clnu.2020.03.022
Landi F, Gremese E, Bernabei R et al (2020) Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin Exp Res 32:1613–1620. 10.1007/s40520-020-01616-x DOI: 10.1007/s40520-020-01616-x
Wu D, Lewis ED, Pae M et al (2019) Nutritional modulation of immune function: analysis of evidence, mechanisms, and clinical relevance. Front Immunol 10:3160. 10.3389/fimmu.2018.03160 DOI: 10.3389/fimmu.2018.03160
Zucchelli A, Bologna E, Marengoni A (2021) Why data on frailty and SARS-CoV-2 infection are basic to progress. Aging Clin Exp Res 33:1429–1432. 10.1007/s40520-021-01846-7 DOI: 10.1007/s40520-021-01846-7
Lidoriki I, Frountzas M, Schizas D (2020) Could nutritional and functional status serve as prognostic factors for COVID-19 in the elderly? Med Hypotheses 144:109946. 10.1016/j.mehy.2020.109946 DOI: 10.1016/j.mehy.2020.109946
Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. Lancet 381:752–762. 10.1016/S0140-6736(12)62167-9 DOI: 10.1016/S0140-6736(12)62167-9
Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16–31. 10.1093/ageing/afy169 DOI: 10.1093/ageing/afy169
Okazaki T, Ebihara S, Mori T et al (2020) Association between sarcopenia and pneumonia in older people. Geriatr Gerontol Int 20:7–13. 10.1111/ggi.13839 DOI: 10.1111/ggi.13839
Wang P-Y, Li Y, Wang Q (2021) Sarcopenia: an underlying treatment target during the COVID-19 pandemic. Nutrition. 10.1016/j.nut.2020.111104 DOI: 10.1016/j.nut.2020.111104
Leij-Halfwerk S, Verwijs MH, van Houdt S et al (2019) Prevalence of protein-energy malnutrition risk in European older adults in community, residential and hospital settings, according to 22 malnutrition screening tools validated for use in adults ≥65 years: a systematic review and meta-analysis. Maturitas 126:80–89. 10.1016/j.maturitas.2019.05.006 DOI: 10.1016/j.maturitas.2019.05.006
O’Caoimh R, Sezgin D, O’Donovan MR et al (2021) Prevalence of frailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 50:96–104. 10.1093/ageing/afaa219 DOI: 10.1093/ageing/afaa219
Shafiee G, Keshtkar A, Soltani A et al (2017) Prevalence of sarcopenia in the world: a systematic review and meta- analysis of general population studies. J Diabetes Metab Disord. 10.1186/s40200-017-0302-x DOI: 10.1186/s40200-017-0302-x
Woolford SJ, D’Angelo S, Curtis EM et al (2020) COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants. Aging Clin Exp Res 32:1897–1905. 10.1007/s40520-020-01653-6 DOI: 10.1007/s40520-020-01653-6
Del Brutto OH, Costa AF, Recalde BY et al (2020) Frailty and SARS-CoV-2 infection. A population-based study in a highly endemic village. J Neurol Sci. 10.1016/j.jns.2020.117136 DOI: 10.1016/j.jns.2020.117136
Beaudart C, Reginster JY, Petermans J et al (2015) Quality of life and physical components linked to sarcopenia: the SarcoPhAge study. Exp Gerontol 69:103–110. 10.1016/j.exger.2015.05.003 DOI: 10.1016/j.exger.2015.05.003
Balestroni G, Bertolotti G (2015) EuroQol-5D (EQ-5D): an instrument for measuring quality of life. Monaldi Arch Chest Dis 78:155–159. 10.4081/monaldi.2012.121 DOI: 10.4081/monaldi.2012.121
Geerinck A, Locquet M, Bruyère O et al (2021) Evaluating quality of life in frailty: applicability and clinimetric properties of the SarQoL® questionnaire. J Cachexia Sarcopenia Muscle. 10.1002/jcsm.12687 DOI: 10.1002/jcsm.12687
Jenkinson C (1998) The SF-36 physical and mental health summary measures: an example of how to interpret scores. J Heal Serv Res Policy 3:92–96. 10.1177/135581969800300206 DOI: 10.1177/135581969800300206
Nestlé Nutrition Institute Nutrition screening as easy as MNA: a guide to complete the Mini Nutiritonal Assessment (MNA). Available online: https://www.mna-elderly.com/forms/mna_guide_english.pdf. Accessed on 17 Feb 2021
Vellas B, Villars H, Abellan G et al (2006) Overview of the MNA®—its history and challenges. J Nutr Heal Aging 10:456–463
Kaiser MJ, Bauer JM, Ramsch C et al (2009) Validation of the mini nutritional assessment short-form (MNA®-SF): a practical tool for identification of nutritional status. J Nutr Health Aging. 10.1007/s12603-009-0214-7 DOI: 10.1007/s12603-009-0214-7
Rubenstein LZ, Harker JO, Salvà A et al (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol 56:366–372. 10.1093/gerona/56.6.M366 DOI: 10.1093/gerona/56.6.M366
Corcoran C, Murphy C, Culligan EP et al (2019) Malnutrition in the elderly. Sci Prog 102:171–180. 10.1177/0036850419854290 DOI: 10.1177/0036850419854290
Guigoz Y, Vellas B (2021) Nutritional assessment in older adults: MNA® 25 years of a screening tool and a reference standard for care and research; what next ? J Nutr Health Aging. 10.1007/s12603-021-1601-y DOI: 10.1007/s12603-021-1601-y
Roberts HC, Denison HJ, Martin HJ et al (2011) A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 40:423–429. 10.1093/ageing/afr051 DOI: 10.1093/ageing/afr051
Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Med Sci 56:146–156 DOI: 10.1093/gerona/56.3.M146
Orme JG, Reis J, Herz EJ (1984) Factorial and discriminant validity of the center for epidemiological studies depression (CES-D) scale. J Clin Psychol 42:28–33 DOI: 10.1002/1097-4679(198601)42:1<28::AID-JCLP2270420104>3.0.CO;2-T
Taylor HL, Jacobs DR, Schucker B et al (1978) A questionnaire for the assessment of leisure time physical activities. J Chronic Dis 31:741–755. 10.1016/0021-9681(78)90058-9 DOI: 10.1016/0021-9681(78)90058-9
Zadak Z, Hyspler R, Ticha A et al (2013) Polypharmacy and malnutrition. Curr Opin Clin Nutr Metab Care 16:50–55. 10.1097/MCO.0b013e32835b612e DOI: 10.1097/MCO.0b013e32835b612e
Streicher M, van Zwienen-Pot J, Bardon L et al (2018) Determinants of incident malnutrition in community-dwelling older adults: a Manuel multicohort meta-analysis. J Am Geriatr Soc 66:2335–2343. 10.1111/jgs.15553 DOI: 10.1111/jgs.15553
Bokhorst-de V, van der Schueren MAE, Lonterman-Monasch S et al (2013) Prevalence and determinants for malnutrition in geriatric outpatients. Clin Nutr. 10.1016/j.clnu.2013.05.007 DOI: 10.1016/j.clnu.2013.05.007
Coelho T, Paúl C, Gobbens RJJ et al (2015) Determinants of frailty: The added value of assessing medication. Front Aging Neurosci. 10.3389/fnagi.2015.00056 DOI: 10.3389/fnagi.2015.00056
Tombaugh TN, McIntyre NJ (1992) The Mini-mental state examination: a comprehensive review. J Am Geriatr Soc 40:922–935. 10.1111/j.1532-5415.1992.tb01992.x DOI: 10.1111/j.1532-5415.1992.tb01992.x
Abate SM, Chekole YA, Estifanos MB et al (2021) Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: a systematic review and meta-analysis. Clin Nutr ESPEN 43:174–183. 10.1016/j.clnesp.2021.03.002 DOI: 10.1016/j.clnesp.2021.03.002
Wierdsma NJ, Kruizenga HM, Konings LA et al (2021) Poor nutritional status, risk of sarcopenia and nutrition related complaints are prevalent in COVID-19 patients during and after hospital admission. Clin Nutr ESPEN 43:369–376. 10.1016/j.clnesp.2021.03.021 DOI: 10.1016/j.clnesp.2021.03.021
Morley JE, Kalantar-Zadeh K, Anker SD (2020) COVID-19: a major cause of cachexia and sarcopenia? J Cachexia Sarcopenia Muscle 11:863–865. 10.1002/jcsm.12589 DOI: 10.1002/jcsm.12589
Li T, Zhang Y, Gong C et al (2020) Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. Eur J Clin Nutr 74:871–875. 10.1038/s41430-020-0642-3 DOI: 10.1038/s41430-020-0642-3
Yu Y, Ye J, Chen M et al (2021) Erratum to: malnutrition prolongs the hospitalization of patients with COVID-19 infection: a clinical epidemiological analysis (The journal of nutrition, health and aging, (2020), 10.1007/s12603-020-1541-y). J Nutr Heal Aging 25:369–373 DOI: 10.1007/s12603-020-1541-y
Mertens E, Peñalvo JL (2021) The burden of malnutrition and fatal COVID-19: a global burden of disease analysis. Front Nutr 7:1–12. 10.3389/fnut.2020.619850 DOI: 10.3389/fnut.2020.619850
Kim J-W, Yoon JS, Kim EJ et al (2021) Prognostic implication of baseline sarcopenia for length of hospital stay and survival in patients with coronavirus disease 2019. J Gerontol Ser A. 10.1093/gerona/glab085 DOI: 10.1093/gerona/glab085
Hanlon P, Nicholl BI, Jani BD et al (2018) Frailty and pre-frailty in middle-aged and older adults and its association with multimorbidity and mortality: a prospective analysis of 493 737 UK Biobank participants. Lancet Public Health 3:e323–e332. 10.1016/S2468-2667(18)30091-4 DOI: 10.1016/S2468-2667(18)30091-4
Wyper GMA, Assunção R, Cuschieri S et al (2020) Population vulnerability to COVID-19 in Europe: a burden of disease analysis. Arch Public Heal 78:1–8. 10.1186/s13690-020-00433-y DOI: 10.1186/s13690-020-00433-y
Bustos Sierra N, Bossuyt N, Braeye T et al (2020) All-cause mortality supports the COVID-19 mortality in Belgium and comparison with major fatal events of the last century. Arch Public Heal 78:1–8. 10.1186/s13690-020-00496-x DOI: 10.1186/s13690-020-00496-x
Dumitrascu F, Branje KE, Hladkowicz ES et al (2021) Association of frailty with outcomes in individuals with COVID-19: a living review and meta-analysis. J Am Geriatr Soc. 10.1111/jgs.17299 DOI: 10.1111/jgs.17299
Cederholm T (2015) Overlaps between frailty and sarcopenia definitions. Nestle Nutr Inst Workshop Ser 83:65–69. 10.1159/000382063 DOI: 10.1159/000382063
Nascimento CM, Ingles M, Salvador-Pascual A et al (2019) Sarcopenia, frailty and their prevention by exercise. Free Radic Biol Med 132:42–49. 10.1016/j.freeradbiomed.2018.08.035 DOI: 10.1016/j.freeradbiomed.2018.08.035
Sofra X, Badami S (2020) Adverse effects of sedentary lifestyles: inflammation, and high-glucose induced oxidative stress—a double blind randomized clinical trial on diabetic and prediabetic patients. Health (Irvine Calif) 12:1029–1048. 10.4236/health.2020.128076 DOI: 10.4236/health.2020.128076
Nilsson A, Bergens O, Kadi F (2018) Physical activity alters inflammation in older adults by different intensity levels. Med Sci Sports Exerc 50:1502–1507. 10.1249/MSS.0000000000001582 DOI: 10.1249/MSS.0000000000001582
da Silveira MP, da Silva Fagundes KK, Bizuti MR et al (2021) Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature. Clin Exp Med 21:15–28. 10.1007/s10238-020-00650-3 DOI: 10.1007/s10238-020-00650-3
Harvey JA, Chastin SFM, Skelton DA (2013) Prevalence of sedentary behavior in older adults: a systematic review. Int J Environ Res Public Health 10:6645–6661. 10.3390/ijerph10126645 DOI: 10.3390/ijerph10126645
Negm AM, Kennedy CC, Thabane L et al (2019) Management of frailty: a systematic review and network meta-analysis of randomized controlled trials. J Am Med Dir Assoc 20:1190–1198. 10.1016/j.jamda.2019.08.009 DOI: 10.1016/j.jamda.2019.08.009
Antonelli M, Penfold RS, Merino J et al (2021) Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 10.1016/S1473-3099(21)00460-6 DOI: 10.1016/S1473-3099(21)00460-6
Folsom AR, Jacobs DR, Caspersen CJ et al (1986) Test-retest reliability of the Minnesota leisure time physical activity questionnaire. J Chronic Dis 39:505–511. 10.1016/0021-9681(86)90195-5 DOI: 10.1016/0021-9681(86)90195-5
Richardson MT, Leon AS, Jacobs DR et al (1994) Comprehensive evaluation of the Minnesota leisure time physical activity questionnaire. J Clin Epidemiol 47:271–281. 10.1016/0895-4356(94)90008-6 DOI: 10.1016/0895-4356(94)90008-6
