{"doi":"10.1002/jpen.2600","title":"Harry M. Vars Award Candidate Abstracts","abstract":"Background: Post-COVID conditions consist of a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with the virus that causes COVID-19 and may ultimately result in death.However, little is known about which individuals develop post-COVID conditions or long COVID and why.While the association between malnutrition and acute SARS-CoV-2 infection is well documented, less is known about its influence on post-acute outcomes.Therefore, we aimed to address this knowledge gap by evaluating malnutrition's impact on post-COVID-19 sequelae, including death, the development of long COVID, and SARS-CoV-2 reinfection.Methods: Using data collected through April 2023, this retrospective cohort study leveraged the rich data infrastructure of the National COVID Cohort Collaborative (N3C), a secure enclave from more than 80 US sites contributing electronic health record (EHR) data collected during routine care on COVID-19 patients.Malnutrition, as defined by the presence of specific ICD-10-CM codes within the EHR before a diagnosis of COVID-19, served as the primary exposure of the study.Patients were separated into groups based on malnutrition status (malnutrition vs. no malnutrition).Multivariable Cox proportional hazard models were used to evaluate adjusted hazard ratios (aHRs) on the following post-acute (day 28-180) sequelae of severe acute respiratory syndrome coronavirus 2 (PASC): (a) death, (b) a diagnosis of long COVID, and (c) COVID-19 reinfection >90 days after initial infection.In a subgroup analysis limited to patients without a history of malnutrition who were hospitalized within 14 days of COVID-19 diagnosis, subjects were separated into 2 groups: (1) no malnutrition and (2) hospital-acquired (HAC) malnutrition.HAC malnutrition was defined as the addition of one of the above-mentioned diagnostic codes to a patient's medical record between days 5 and 27 of hospitalization. Results:The final cohort included 3,817,493 individuals with COVID-19, of which 55,749 (1.5%) had a history of malnutrition (Table 1).Following adjustment for confounders, individuals with malnutrition had 2.14 times (aHR: 2.14; 95% CI: 2.02, 2.27) higher risk of death in the post-acute period than those without malnutrition (Figure 1) but had a lower risk (aHR: 0.92; 95% CI: 0.87, 0.97) to be diagnosed with long COVID in the post-acute period (Figure 1).Patients with malnutrition had a 1.60 (aHR: 1.62; 95% CI: 1.51, 1.74) higher risk of having a SARS-CoV-2 reinfection greater than 90 days after initial infection than individuals without.Of 136,648 patients in the subgroup analysis, 3153 (2.3%) were diagnosed with malnutrition between hospital days 5 and 27 (Table 2).Patients in the HAC malnutrition group had a 1.70 (aHR: 1.7; 95% CI: 1.44, 2.01) higher risk of death in the post-acute period and 1.50 (aHR: 1.5; 95% CI: 1.3, 1.73) higher risk of being diagnosed with long COVID (Figure 2).No difference in SARS-CoV-2 reinfection greater than 90 days after initial infection was observed between groups. Conclusion:Both pre-existing and HAC malnutrition have significant associations with post-COVID-19 sequelae.Early identification and intervention of malnutrition in patients with COVID-19 may mitigate PASC.","journal":"Journal of Parenteral and Enteral Nutrition","year":2024,"id":494588,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9639,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-19T02:09:11.736910Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}