The combination of poor dietary intake and increased healthcare needs predisposes COVID-19 patients to malnutrition and sarcopenia. The scope of this narrative review is tο present epidemiology and etiology of malnutrition and sarcopenia in COVID-19 patients, their consequences as well as the content and delivery mode of optimum nutritional services for malnourished/sarcopenic COVID-19 patients in the rehabilitation setting. This narrative review also summarizes nutritional recommendations, consensus statements and treatment pathways developed by scientific societies for COVID-19 patients. COVID-19 patients are prone to malnutrition and sarcopenia due to inactivity, comorbidities, cytokine response, nutritional deficiencies, anosmia, loss of taste, anorexia and treatment with dexamethasone. Thus, all COVID-19 patients, including those who are overweight or obese, should be regularly screened for malnutrition and sarcopenia at admission to the rehabilitation setting, using a validated tool to identify those with (or at risk of) malnutrition. As a consequence of malnutrition and sarcopenia, COVID-19 patients demonstrate diminished immune potential, lower respiratory function, swallowing dysfunction, and low resilience to metabolic stress. COVID-19 patients have increased energy (27-30 kcal/day) and protein needs (1-1.5 g/kg body weight/day). Personalized nutritional education and counseling, food fortification with energy dense and/or protein rich whole foods or with powdered supplements and use of high protein, energy dense oral nutritional supplements are recommended.

Background/Objectives: Nutritional disorders are common conditions in older people. This study aimed to determine nutritional disorders in a Mediterranean cohort of nursing home residents without cognitive or functional impairment. Methods: A multicentre cross-sectional observational study was conducted in 10 Spanish geriatric centres. Socio-health, clinical, and laboratory data were recorded from the participants’ medical records. The Mini-Nutritional Assessment (MNA) and Global Leadership Initiative in Nutrition (GLIM) diagnostic criteria [weight loss and serum C-reactive protein (CRP)] were used. Frailty risk was assessed using the FRAIL questionnaire. Anthropometric parameters [body mass index, weight loss, triceps skinfold thickness (TSF), muscle mass circumference (MAMC), and calf-circumference] were evaluated. Body composition [hydration pattern, fat-free mass, muscle mass (MM), fat mass, and phase angle (PhA)] was measured by bioelectrical impedance analysis. Laboratory parameters, such as haemoglobin, total lymphocyte count, serum albumin, transferrin, and CRP, were recorded. Participants were classified into two groups: the disease-related malnutrition (DRM) group and the no-DRM group. Using multivariate regression analysis, predictive factors for nutritional status were tested. Results: Among 340 participants, 63.2% were over 85 years old, 28.2% were men, and the median length of stay was 24 months (range: 6–119). Nutritional risk or malnutrition, as assessed by the MNA, was present in 60.8% of the residents. DRM was diagnosed in 39.4%, and frailty risk was diagnosed in 57.6%. Older adults with DRM had significantly lower MAMC, calfcircumference, MM, and serum albumin, as well as higher CRP concentrations compared with their No-DRM counterparts (all, at least, p < 0.05). The frailty risk (OR = 3.317), MM (OR = 0.732), PhA (OR = 0.033), serum albumin (OR = 0.070), and EuroQol visual analogue scale (OR = 0.961) were risk predictors of DRM in nursing home residents. Conclusions: This study supports the importance of conducting comprehensive nutritional assessments to ensure the earliest recognition of nutrition disorders in nursing homes. Older adults with DRM had greater unintentional weight loss, inflammation, and a high risk of frailty, as well as reduced MM, compared to those without DRM. Subclinical low-grade systemic inflammation is a risk factor for DRE and functional decline in older adults living in nursing homes. The generalisation of the study results is limited to institutionalised older adults without cognitive impairment who are clinically stable and functionally independent.