Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has rapidly spread worldwide, leading to a global health crisis. Clinical manifestations of COVID-19 vary widely, ranging from asymptomatic forms to severe respiratory distress syndrome (ARDS) requiring hospitalization, assisted ventilation, and intensive care unit (ICU) admission, with high mortality risk, particularly in older and/or polymorbid patients. Beyond the well-documented respiratory effects, COVID-19 can also significantly impact body weight and nutritional status. This article delves into the complex relationship between coronavirus infection and weight loss, exploring the underlying mechanisms, clinical findings, and potential interventions.
The Link Between COVID-19 and Weight Loss
Weight loss is a common experience after contracting COVID-19, similar to other viral infections. In severe cases, this can lead to complications. However, some tips may help you regain unintentional weight loss. Several studies have highlighted the prevalence of weight loss among COVID-19 patients. Alterations of smell and taste, as well as fatigue and lack of appetite, are reported as very prevalent symptoms in COVID-19 patients that could affect food intake. Confinement at home and COVID-19 symptoms may limit the amount of physical activity, leading to loss of lean mass. These factors, on top of a systemic inflammatory response, might result in malnutrition even in non-hospitalized patients.
One study of COVID-19 patients 1 month after hospital discharge showed that 30% of people had lost more than 5% of their baseline body weight. More than half were at risk for malnutrition. Weight loss can vary after COVID. The more weight you lose, the more concerning this can be because you could be malnourished (not getting the nutrients your body needs to function at its best). As a general rule, maintaining muscle mass helps you live a healthier, more functional life. While the term “weight loss” may be positive for those wishing to lose weight, unintentional weight loss related to COVID-19 can result in malnutrition and muscle loss.
Factors Contributing to Weight Loss in COVID-19 Patients
Several mechanisms may contribute to weight loss and malnutrition in COVID-19 patients. These include:
- Systemic Inflammatory Response: COVID-19 induces severe cell damage and metabolic dysregulation through the hyperinflammatory immune response and cytokine release. This hyperinflammatory immunological response from Type 1 T helper (Th1) cells can lead to a cytokine storm, followed by the activation of monocytes, macrophages, and neutrophils. Interleukin-6 (IL-6) and tumor necrosis factor (TNF) are important cytokine components of the immune response generated by inflammatory cells, which are mostly attributable to a major change in metabolic regulation.
- Metabolic Dysregulation: Individuals with SARS-CoV-2 infection are highly susceptible to disease-related metabolic dysregulation. These changes are remarkably involved in multiple steps in adipogenesis and lipolysis.
- Loss of Appetite and Altered Taste/Smell: Alterations of smell and taste, as well as fatigue and lack of appetite, are reported as very prevalent symptoms in COVID-19 patients that could affect food intake.
- Reduced Physical Activity: Confinement at home and COVID-19 symptoms may limit the amount of physical activity, leading to loss of lean mass.
- Gastrointestinal Issues: Some patients experience gastrointestinal symptoms like diarrhea and nausea, which can affect nutrient absorption and contribute to weight loss.
- Direct Viral Infection of Adipose Tissue: A study by Stanford Medicine investigators shows that SARS-CoV-2 can infect human fat tissue. SARS-CoV-2, the virus that causes COVID-19, can directly infect adipose tissue (which most of us refer to as just plain "fat"). That, in turn, cooks up a cycle of viral replication within resident fat cells, or adipocytes, and causes pronounced inflammation in immune cells that hang out in fat tissue. Genetic material encoding SARS-CoV-2 was almost invariably present in fat tissue from various bodily regions of eight patients who'd died of COVID-19. "This was of great concern to us, as epicardial fat lies right next to the heart muscle, with no physical barrier separating them," McLaughlin said.
The Role of Obesity in COVID-19 Outcomes
Obesity is an established, independent risk factor for SARS-CoV-2 infection as well as for the patients' progression, once infected, to severe disease and death. Fat tissue's susceptibility to SARS-CoV-2 infection may be playing a role in making obesity a COVID-19 risk factor. Infected fat tissue pumps out precisely the inflammatory chemicals you see in the blood of severe COVID patients.
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Obesity is a common, serious, and costly chronic disease. Having obesity puts people at risk for many other serious chronic diseases and increases the risk of severe illness from COVID-19. Having obesity increases the risk of severe illness from COVID-19. More than 900,000 adult COVID-19 hospitalizations occurred in the United States between the beginning of the pandemic and November 18, 2020.
Clinical Evidence of Weight Loss in COVID-19 Survivors
A post-hoc analysis of a prospective observational cohort study enrolled adult patients with a confirmed diagnosis of COVID-19 who had been discharged home from either a medical ward or the Emergency Department of San Raffaele University Hospital, and were re-evaluated after remission at the Outpatient COVID-19 Follow-Up Clinic of the same Institution from April 7, 2020, to May 11, 2020. A total of 213 patients were included in the analysis (33% females, median age 59.0 [49.5-67.9] years, 70% overweight/obese upon initial assessment, 73% hospitalised). Sixty-one patients (29% of the total, and 31% of hospitalised patients vs. 21% of patients managed at home, p = 0.14) had lost >5% of initial body weight (median weight loss 6.5 [5.0-9.0] kg, or 8.1 [6.1-10.9]%). Patients who lost weight had greater systemic inflammation (C-reactive protein 62.9 [29.0-129.5] vs.48.7 [16.1-96.3] mg/dL; p = 0.02), impaired renal function (23.7% vs. 8.7% of patients; p = 0.003) and longer disease duration (32 [27-41] vs. 24 [21-30] days; p = 0.047) as compared with those who did not lose weight.
Impact on Body Composition and Metabolic Parameters
A recent study published in Cureus explored the relationship between SARS-CoV-2 infection and levels of serum insulin, body fat distribution, and insulin resistance (IR). In this follow-up study, from July 2021 to September 2021, persons referred to a university-affiliated Nutrition Counselling Clinic were randomly selected for the study samples. Those who reported mild to moderate COVID-19 infection (without hospitalization) were selected as the case group and the asymptomatic individuals as the control group. There was a statistically significant difference in the longitudinal change in total fat percentage between subjects with and without COVID-19. Also, the difference in HOMA-IR before and after COVID-19 in case groups (both males and females) was statistically significant (P-value < 0.001). Moreover, serum insulin levels were significantly increased in all cases (P-value < 0.001), while remaining stable in control groups.
When compared to their initial visit, COVID-19 patients' total fat percentage rose significantly (almost 2%) following a hypocaloric diet. Participants who were not infected with COVID-19 had a lower total fat percentage than those who were.
The Connection Between Excess Weight and Long-COVID Neurologic Symptoms
Excess bodyweight is linked to experiencing long-COVID neurologic symptoms, including headaches, vertigo, sleep problems and depression, according to a meta-analysis of studies involving almost 140,000 participants published in PLOS One. Excess weight was associated with a higher rate of depression in long COVID (risk ratio [RR], 1.21 (95% confidence interval [CI], 1.03 to 1.42), memory issues (RR 1.43; 95% CI, 1.24 to 1.65), and sleep disturbance (RR, 1.30; 95% CI, 1.16 to 1.48), or increases of 21%, 43%, and 30%, respectively. Obesity was significantly associated with persistent headache (RR 1.45; 95% CI, 1.37 to 1.53), and numbness (RR 1.61; 95% CI, 1.46 to 1.78). Obesity was also linked to persistent loss of taste and smell.
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Strategies for Regaining Weight Safely After COVID-19
If you have unintentionally lost weight after COVID, talk with a healthcare professional about safe ways to regain muscle mass.
- Consult a Nutritionist or Registered Dietitian: Seek guidance from a nutritionist or registered dietitian for personalized counseling and evaluation.
- Consider Appetite-Stimulating Medications: Talk with a healthcare professional about medications that may stimulate your appetite, like ghrelin agonists, megestrol acetate, or corticosteroids.
- Increase Caloric Intake: Consume about 27 to 30 calories per day for every kilogram of body weight (or 12.3 to 13.6 calories per day for every pound).
- Prioritize Protein Intake: Eat about 1 gram of protein per kilogram (or 0.45 grams per pound) of body weight. Protein sources include chicken, turkey, eggs, or lean cuts of beef.
- Engage in Resistance Training: Engage in resistance training 3 days a week with hand weights, resistance bands, or your own body weight. It’s best to speak with a healthcare professional before starting an exercise program to ensure you can do so safely.
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