Levels of muscle mass and body fat play a pivotal role in COVID-19 prognosis and recovery, according to new University of Alberta research.
In a review of several studies, the researchers found that abnormalities in body composition were prevalent in patients hospitalized with COVID-19 and were often associated with more severe disease and poorer outcomes, including higher risk of death.
“The amount of muscle and fat you have are key factors in determining how vulnerable you are to COVID-19 and how you will respond to it.”
Low muscle, high fat pose risks
The analysis of 62 large and small studies spanned 1.3 million people battling COVID-19 up to the fall of 2022. Overall, it showed that patients who had poor muscle health and high levels of visceral fat at the time of their COVID-19 diagnosis had a greater risk of developing complications while ill.
In 44 per cent of the studies exploring low muscle mass, the condition was associated with death from COVID-19, along with the need for intensive care unit admission, mechanical ventilation and longer hospital stays, the review showed.
Overall results also showed that up to 90 per cent of COVID-19 patients in the studies had lower muscle mass than people with other diseases such as cancer, at 69 per cent.
“That means COVID may have left many people with substantially lower amounts of muscle as they were battling the disease,” which is a difficult benefit to regain, notes Montes-Ibarra.
“Muscle loss is like a wildfire: it’s lost very quickly, but to recover it takes months and years. And those people who survive COVID may have much lower muscle than they had before.
“For someone now on a trajectory of normal aging or dealing with long COVID, that could impact their longevity.”
High fat mass was also linked to mortality in 38 per cent of the studies exploring this measure. High levels of fat in the muscle led to high rates of mortality and intensive care admission, as well as longer hospitalization in more than 50 per cent of the studies examined.
As well, high visceral fat, found around vital abdominal organs, was linked to intensive care admission in 85 per cent of the studies that considered this factor. In addition, mechanical ventilation was associated with high levels of fat in the muscle in nearly 47 per cent of studies looking at this measure.
Along with that, phase angle, an indicator of muscle health, was found to be related to mortality in 75 per cent of the studies exploring this aspect.
Muscle matters to health
The findings all highlight how important muscle mass is to health, says professor Carla Prado, a nutrition expert in the Faculty of Agricultural, Life & Environmental Sciences and senior author on the review.
“Muscle function is vital for movement, balance and posture, and for metabolizing glucose and providing amino acids for the immune system. The more muscle you lose, the greater the consequences.”
Although it is most likely that patients had low muscle mass before they contracted COVID-19, the virus itself could have contributed to rapid muscle loss, Prado says.
“Coupled with muscle loss related to hospitalization and immobility, this may lead to a pandemic of low muscle mass among these patients,” she adds.
Body composition beats BMI for assessment
Body composition could also be important in understanding and managing patients with long COVID, the researchers suggest.
Lower muscle mass could lead to longer recovery time from illnesses including COVID-19, may be linked to the fatigue that people with long COVID experience and could also influence other factors such as immune function, Montes-Ibarra notes.
“By assessing body composition, it’s possible for health-care providers to better tailor management strategies and interventions for long COVID patients, which may improve their outcomes and quality of life, reduce the risk of health complications and lead to more personalized, effective treatment, like nutritional support and physical rehabilitation.”
Body fat and muscle mass assessment should be further explored as a potential prognostic tool for COVID-19 for all patients, the researchers recommend in their review.
Those factors aren’t always considered during hospital admission, if the patient appears to have normal or even high body mass index, says Camila Orsso, one of the review’s lead authors and a PhD student in nutrition and metabolism.
“Because people with obesity bear their own body weight, they are frequently assumed to not be at risk for low muscle mass, and that they have the ‘reserves’ to fight COVID, when they may not.”
“Taking body composition into account as part of overall care can help identify people at higher risk for developing more severe complications or poorer outcomes,” Orsso notes.
“That can help health-care professionals minimize the impact of COVID-19 and improve patient outcomes in the future.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
