key: cord-0864710-p9k2hax4 authors: Sikaroudi, Masoumeh Khalighi; Zonooz, Sanaz Rezaei; Ebrahimi, Zohreh; Jebraili, Hanieh; Farsi, Farnaz; Talebi, Atefeh; Masoodi, Mohsen title: Assessment of Anorexia and Weight Loss during the Infection and Recovery Period of Patients with Coronavirus Disease 2019 (COVID-19) date: 2021-11-13 journal: Clin Nutr Open Sci DOI: 10.1016/j.nutos.2021.11.001 sha: 6bca02d8580ab6da3d72668dda38dbb4459a2185 doc_id: 864710 cord_uid: p9k2hax4 Objectives Patients with coronavirus disease 2019 (COVID-19) can present anorexia and weight loss due to their symptoms and eating disorder which can lead to immune system weakness and increase the duration of recovery time. We aim to assess the severity and duration of anorexia and weight loss within the infection and recovery period in these patients. Method We retrospectively identified 233 COVID-19 patients (older than 18 years) were admitted to the Rasoul-e Akram Hospital, from August to December 2020. Their medical records were reviewed by researchers. Then, patients who had inclusion criteria were asked about duration and severity of anorexia, and also weight alternation during the infection and after the recovery period. Result Analyzed data were collected from 233 COVID-19 patients showed the mean duration of anorexia was 7.08 ± 10.41 days with a significant loss of appetite (- 75.55 ± 88.09, P-value < 0.001) at the period of anorexia compare to appetite improvement. Also, results demonstrated patients, especially males and severe illness subjects, significantly lost weight (P-value <0.001). Conclusion: anorexia and weight loss occur in people infected with the coronavirus and may affect the recovery process of these patients by reducing their food intake. The underlying mechanisms of SARS-CoV-2 related to interaction to the gastrointestinal tract and development of anorexia in these patients need to clarify in future studies. weakness and increase the duration of recovery time. We aim to assess the severity and duration 23 of anorexia and weight loss within the infection and recovery period in these patients. 24 Method: We retrospectively identified 233 COVID-19 patients (older than 18 years) were 25 admitted to the Rasoul-e Akram Hospital, from August to December 2020. Their medical records 26 were reviewed by researchers. Then, patients who had inclusion criteria were asked about 27 duration and severity of anorexia, and also weight alternation during the infection and after the 28 recovery period. 29 Result: Analyzed data were collected from 233 COVID-19 patients showed the mean duration 30 of anorexia was 7.08 ± 10.41 days with a significant loss of appetite (-75.55 ± 88.09, P-value < 31 0.001) at the period of anorexia compare to appetite improvement. Also, results demonstrated 32 patients, especially males and severe illness subjects, significantly lost weight (P-value <0.001). Conclusion: anorexia and weight loss occur in people infected with the coronavirus and may 34 affect the recovery process of these patients by reducing their food intake. The underlying 35 mechanisms of SARS-CoV-2 related to interaction to the gastrointestinal tract and development 36 of anorexia in these patients need to clarify in future studies. A novel coronavirus, named as SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) 49 has infected people worldwide since January 7, 2020. Thus, the World Health Organization 50 declared this novel spread as public health emergency of international concern (PHEIC) [ COVID-19 on central nervous system, and also anxiety, quarantine, and hospitalization period 73 can lead a person to eating disorder and negatively affect appetite [14] . Due to anorexia, 74 insufficient food intake, and weight loss, macro and micronutrient deficiency (malnutrition) and 75 immune system weakness can occur [15, 16] . 76 To the best of our knowledge, no prior studies have been performed to evaluate the anorexia 77 status and weigh loss in COVID-19 patients. Therefore, present study set for evaluate the 78 severity and duration of anorexia and weight loss within the infection and recovery period in 79 COVID-19 patients. A retrospective cohort study was conducted on SARS-COV-2 patients in January 2021 at the 83 Rasoul-Akram Hospital, Tehran, Iran. We examined patients who were hospitalized or referred 84 to Infectious Diseases Clinic from August to December, 2020 (in second wave), and had one of 85 the diagnostic criteria (nasopharyngeal positive polymerase chain reaction (PCR) or chest scan). 86 We included patients who were i) adult (18 years and older), ii) suffered mild, moderate, or 87 severe symptoms of COVID-19, iii) had no critical symptoms and history of ICU addmision and 88 connection to the ventilator, iv) without any malignant disease which can affect appetite such as 89 cancer, renal or liver or heart failure, neurological diseases, etc., v) not being pregnant or 90 lactating women. Also, we excluded patients reluctant to continue cooperation with the 91 researchers or patients who died after discharge from the hospital. severe SARS-CoV-2 but have no symptoms, 2. Mild illness: Individuals with any of various hospitalization) and after relief symptoms (may be during the hospitalization or after discharge). 117 The VASs were designed to reflect retrospective ratings of motivation to eat rather than the state 118 at the time and according to studies, the average VAS score above 50 was considered suitable for 119 the patient, and the score below 50 was assumed poor [19] . 120 We used Hospital Anxiety and Depression Scales (HADs) [20] questionnaire, which is a 14-item 121 self-rating scale, assessing anxiety and depression symptoms in different diseases associated with 122 psychological disorders. The questionnaire consisted of seven questions related to anxiety, and 123 seven questions to depression. Each item has a rating of 0 to 3; the higher rates indicate greater 124 anxiety or depression symptoms. The total score ranged in each part from 0 to 21. Scores from 0 125 to 7 indicated a normal scale, 8 to 10 borderline, and scores 11 to 21 illustrated clinical problems. 126 This questionnaire was asked telephonically after the discharge of patients. Data was analysed by SPSS 25 for Windows. Descriptive statistics were reported for qualitative 129 variables using frequencies with number and percentages, and for quantitative variables using 130 mean and standard deviation (SD). Chi-square or Fisher exact test were also be used to examine 148 The mean duration of anorexia during infection and recovery was 7.08 ± 10.41 days. There was 149 no significant difference in the duration of anorexia between female and male patients. The 150 longest duration of anorexia was seen in patients with severe disease. Also, patients who had past 151 history of GI problem with nausea and vomiting as COVID-19 symptoms, had experienced a 152 longer period of anorexia. Full data are shown in Table 2 . 154 Totally anorexia was observed significantly (-75.55 ± 88.09, P-value < 0.001) in patients during 155 the illness and recovery as compared to appetite improvement. Also, each item for appetite 156 assessment including hungry, desire to eat, and fullness, it decreased significantly (-27.17 ± 162 The mean body weight and BMI of patients before infection were 75.62 ± 18.28 and 26.29 ± J o u r n a l P r e -p r o o f Eating disorders in the time of COVID-19 Protein energy 285 malnutrition decreases immunity and increases susceptibility to influenza infection in mice Protein-energy malnutrition: a risk factor 288 for various ailments COVID-19) Patients: What is the incubation 291 period for coronavirus disease 2019 (COVID-19)?, What is the range of illness severity of 292 patients with coronavirus disease 2019 (COVID-19)?, What are the signs and symptoms of 293 patients Clinical 295 spectrum of SARS-CoV-2 infection and protection from symptomatic re-infection Appetite Assessment Tools Among Patients Receiving Hemodialysis The hospital anxiety and depression scale Receptor Recognition by the Novel 304 Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS 305 The digestive system is a potential 307 route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes Profiling ACE2 expression in colon 310 tissue of healthy adults and colorectal cancer patients by single-cell transcriptome analysis Leptin levels in SARS-CoV-2 infection related respiratory failure: A cross-sectional 314 study and a pathophysiological framework on the role of fat tissue Leptin Functions in Infectious Diseases COVID-319 19 and implications for eating disorders The Implications of COVID-19 for Mental Health and 322 Environmental stress effects on appetite: Changing desire for high-325 and low-energy foods depends on the nature of the perceived threat COVID-19 pandemic-onset 328 anorexia nervosa: Three adolescent cases COVID-19 and binge eating: Patient perceptions of eating 331 disorder symptoms, tele-therapy, and treatment implications Anorexia Nervosa and the Immune System-A Narrative Review The relationship between nutrition and infectious diseases: A 336 review COVID-19 is 339 associated with clinically significant weight loss and risk of malnutrition, independent of 340 hospitalisation: A post-hoc analysis of a prospective cohort study The authors would like to acknowledge the ongoing support of the Rasoul-e-Akram Hospital 230 staffs and honorable participants who patiently helped us to advance this project.