COVID‐19 patients are prone to develop significant weight loss, malnutrition, and deterioration of body composition which are caused by many different factors. According to research, 81% of patients on the rehab wards post COVID-19 required dietetic input.

The main factors are as follows.

  1. COVID-19 infection can cause major inflammation, particularly pronounced in patients with severe and critical diseases.
  2. Malnutrition is frequently seen in COVID‐19 patients. Disease‐associated reductions in food intake and malnutrition can contribute to tissue wasting.
  3. Immobilization can also significantly contribute to muscle wasting and sarcopenia in COVID‐19. Ultimately, the negative ‘synergy’ of all these factors together can cause significant body wasting in COVID‐19 patients as clinically often observed.

Then how does the body composition change after COVID-19 infection and during the recovery? 

 

Body Composition Change After Infection

Through the actual case of a patient who recovered from COVID-19, we will see how body composition changed after being infected with COVID-19 and in the recovery, and how the InBody results can help COVID-19 patients.

On December 19th of 2020, this person was infected with COVID-19 and hospitalized from the 4th to the 9th of January. This 50-year-old male used to maintain good body composition status (with an InBody score over 80).

Below is his InBody result before & after COVID-19.


If you see the change of his body composition before and after the COVID-19 infection, you can see :
1) The weight decreased from 90.3kg to 85.5kg
2) Muscle mass decreased from 40.2kg to 37.2kg
3) ECW Ratio increased from 0.369 to 0.374
4) Phase Angle decreased, especially the trunk Phase Angle from 9.5 to 5.7.

 

After the infection, not only the patients’ body composition changes but also their lungs might become inflamed, making it tough for them to breathe. For some people, the infection becomes more serious and the lung tissue itself becomes swollen and filled with fluid and debris from dead cells.

This man had similar symptoms as above. COVID-19 made him difficult to have proper breathing. After the treatment, the function of the lung, immunity system, and breathing ability got slowly well with the effort of doctors and nurses, but he also tried some exercises to accelerate the recovery process and get back to the condition before the infection.

 

His Efforts for the Recovery

In the beginning, he started doing exercise as usual. He tried running, swimming, and other exercises. However, his heart rate dramatically went up as soon as he tried those exercises. Even when he tried to climb the stairs in his home, his heart rate increased up to 130bpm with SvO2 dropping to 88%. Then it took more than 5 mins to get his breath back. This is because hard/strong exercise for someone who has respiratory diseases makes the condition worse. It is proved by several research studies conducted about how hard exercise negatively affects lung function.

Then how did he manage it? He started to exercise in a controlled condition. Starting with slowly walking between the kitchen and room. Then he tried several exercises with monitoring his SvO2 and HR rate to find the best exercise which does not affect his body condition. He found that indoor cycling at zero effort can maintain his SvO2 between 88-92% and HR between 78-90. He exercised his lung systematically to breathe deeper and deeper. He also monitored blood glucose levels as COVID-19 gave the pancreas beating.

 

Body Composition Change during the Recovery

As shown above, after the exercise,

  1. His weight increased from 85.5kg to 89.4kg,
  2. His muscle mass, which had been reduced to 37.2kg, increased to 39kg.

Most of the COVID patients suffer from weight loss/muscle loss (about 61% decreases by more than 5% of the total body weight), and it is difficult for them to increase their muscle and weight, but it is very important.

 

Use of Body Composition for COVID-19 Patient

In order to return to a healthy status same as before the COVID-19, close body composition monitoring is necessary. During the recovery process, if you only focus on the weight gain, important nutritional indicators (ECW ratio, Phase Angle) and fat/muscle management are not able to be achieved. Without management of key factors, the nutritional status may not return to normal.

If we take a look at the results of the 50-year-old man, some of the parameters were recovered, but the ECW Ratio or Phase angle did not return to the previous status, and at the same time he thought that the body condition is not the same as before.

In many cases of COVID-19 patients, they tend to focus on the weight only to monitor the recovery, but in fact, the perfect recovery can be achieved when we monitor and manage the body composition.

• Muscle Loss (Sarcopenia)

1) While the patients are suffering from disease, physical activity decreases.
2) One of the most common post-COVID symptoms is fatigue, which refrains post-COVID patients from physical exercises.

The above two can lead to muscle loss. To prevent sarcopenia, it is important to monitor the muscle mass and have some proper treatments not to lose muscle.

• ECW ratio (Inflammation)

ECW ratio, the ratio of Extracellular Water to Total Body Water is an important indicator to check the balance of body water. Acute systematic inflammation that can occur during the disease can raise the ECW ratio.
Moreover, since the ECW ratio sensitively reflects your body condition, it can be used to track the recovery of the patient.

• Phase Angle (Nutrition)

Phase Angle is a clinically important bioimpedance parameter used for nutritional assessment and evaluating the severity of various diseases.
Low Phase Angle tends to be consistent in individuals with malnutrition, infection, cancer, and old age.

Phase Angle can be also used to monitor the recovery of the post- COVID patients.

 

If you want to know more about the body composition analyzer which shows ECW ratio, Phase Angle, please contact us.