Skip to content
2000
image of Long-Term Effects of Malnutrition Risk on Sleep Disorders and Physical Activity among COVID-19 Survivors

Abstract

Introduction/Objective

The coronavirus disease 2019 (COVID-19) pandemic has left survivors with long-term health consequences, including malnutrition, sleep disorders, and reduced physical activity. This study aimed to investigate the effects of changes in malnutrition risk on sleep quality and physical activity in COVID-19 survivors after hospitalization.

Methods

This was a retrospective cohort study with prospective follow-up. Comprehensive screening of 2700 electronic medical records identified eligible participants who were hospitalized with COVID-19 at King Salman Specialist Hospital in Ha’il, Saudi Arabia, between 2021 and 2023. The impact of malnutrition risk on sleep quality and physical activity was evaluated in 103 patients with COVID-19 after hospitalization. Nutritional status was assessed using the malnutrition screening tool, while sleep quality and physical activity were self-reported.

Results

Malnutrition risk increased from 32% at admission to 42.7% at follow-up. Sleep quality was significantly worse among malnourished patients, especially those with comorbidities ( = 0.048), and only 16.9% reported uninterrupted sleep. Physical activity remained low overall, with 46.5% of non-malnourished patients with comorbidities reporting reduced activity. Obesity rates decreased slightly (from 59.2% to 54.4%); however, patients with obesity maintained unhealthy sleep and lifestyle habits. Reduced screen time (0–3 hours/day) correlated with better dietary habits and weight management ( = 0.040).

Conclusion

The findings have emphasized the interrelation of malnutrition risk, sleep disorders, and physical inactivity in COVID-19 recovery. Multidisciplinary rehabilitation programs should integrate nutritional support, sleep hygiene, and personalized exercise plans, especially for high-risk groups, such as older adults and patients with comorbidities. Combating physical inactivity and promoting a healthier lifestyle can improve long-term recovery prospects. Multidisciplinary care and continuous monitoring are crucial for mitigating the lasting effects of COVID-19.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/cnf/10.2174/0115734013430996250912060209
2025-09-30
2025-10-29

  • From This Site

    /content/journals/cnf/10.2174/0115734013430996250912060209
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. Coronavirus (COVID-19) dashboard > Cases [Dashboard] WHO. 2023 Available from: https://data.who.int/dashboards/covid19/cases
  2. Tosato M Calvani R Ciciarello F Malnutrition in COVID-19 survivors: Prevalence and risk factors. Aging Clin Exp Res 2023 35 10 2257 2265 Gemelli Against COVID-19 Post-Acute Care Team. 10.1007/s40520‑023‑02526‑4 37665556
    [Google Scholar]
  3. Joaquín C. Bretón I. Ocón Bretón M.J. Nutritional and morphofunctional assessment of Post-ICU patients with COVID-19 at hospital discharge: NutriEcomuscle study. Nutrients 2024 16 6 886 10.3390/nu16060886 38542797
    [Google Scholar]
  4. Browne A. Fallon L. Wrenne A. Mellett H. Brady S. Cunningham C. An evaluation of nutritional status and specific nutritional issues during a rehabilitation period post COVID-19 infection. Clin. Nutr. ESPEN 2022 48 502 10.1016/j.clnesp.2022.02.063
    [Google Scholar]
  5. Pink I. Wiestler M. Pueschel L. Exploring physical activity, sleep, and nutrition’s role in fatigue among post-COVID-19 Patients. Nutrients 2024 16 23 4056 10.3390/nu16234056 39683450
    [Google Scholar]
  6. Bastani F. Amirijavid A. Sleep quality in the survivors of COVID-19. J Client Cent Nurs Care 2023 9 3 199 206 10.32598/JCCNC.9.3.447
    [Google Scholar]
  7. Kampouridou K. Georgakopoulou V.E. Chadia K. Nena E. Steiropoulos P. Evaluating sleep disturbances in patients recovering from COVID-19. Pneumon 2024 37 3 1 11 10.18332/pne/191219
    [Google Scholar]
  8. Nowakowski S. Kokonda M. Sultana R. Association between sleep quality and mental health among patients at a Post-COVID-19 recovery clinic. Brain Sci. 2022 12 5 586 10.3390/brainsci12050586 35624973
    [Google Scholar]
  9. Peng P. Wang Y. Li Z. A network analysis of the long-term quality of life and mental distress of COVID-19 survivors 1 year after hospital discharge. Front. Public Health 2023 11 1223429 10.3389/fpubh.2023.1223429 37575111
    [Google Scholar]
  10. Henríquez-Beltrán M. Labarca G. Cigarroa I. Sleep health and the circadian rest-activity pattern four months after COVID-19. J. Bras. Pneumol. 2022 48 3 e20210398 10.36416/1806‑3756/e20210398 35508066
    [Google Scholar]
  11. Gonçalves D. Costa J.P. Silva S. Tavares M. Barros H. Meireles P. The association between probable post‐COVID ‐19 condition and sleep‐related parameters: A longitudinal study of non‐hospitalised patients. J. Sleep Res. 2024 33 6 e14215 10.1111/jsr.14215 38750610
    [Google Scholar]
  12. Barghchi H. Araste A. Varasteh N. Food quality is associated with depression, anxiety, and stress among recovered COVID-19 patients: Finding from a case-control study. Clin. Nutr. Res. 2025 14 1 17 29 10.7762/cnr.2025.14.1.17 39968276
    [Google Scholar]
  13. Kawabata K Nakamura K Kanda N Risk factors for longterm nutritional disorders one year after COVID-19: A post hoc analysis of COVID-19 recovery study II. Nutrients 2024 16 23 4234.COVID-19 Recovery Study II Group 10.3390/nu16234234 39683627
    [Google Scholar]
  14. Ponce J Anzalone AJ Schissel M Association between malnutrition and post–acute COVID‐19 sequelae: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2024 48 8 906 916.National COVID Cohort Collaborative (N3C) Consortium. 10.1002/jpen.2662 38924100
    [Google Scholar]
  15. Muaddi M.A. Alharbi A.A. Mahfouz M.S. Changes in nutritional habits and lifestyles associated with COVID-19 in jazan, Saudi Arabia: A 2022 cross-sectional survey. Cureus 2024 16 7 e65425 10.7759/cureus.65425 39184620
    [Google Scholar]
  16. Tami S.H. Khan S. Bano R. Impact of the coronavirus disease 2019 (COVID-19) curfew restrictions on the body mass index and dietary and physical activity behaviors of saudi adults: A cross-sectional study. Cureus 2024 16 1 e52669 10.7759/cureus.52669 38384642
    [Google Scholar]
  17. Hamed A.M. Javaid H.A. Abbasi S. The impact of COVID-19 on physical activity among adults in saudi arabia: a cross-sectional study. Cureus 2022 14 7 e26586 10.7759/cureus.26586 35936172
    [Google Scholar]
  18. Almousa L.A. Alagal R.I. Effects of the COVID-19 pandemic on diet and physical activity and the possible influence factors among saudi in riyadh. Front. Nutr. 2022 9 1029744 10.3389/fnut.2022.1029744 36337667
    [Google Scholar]
  19. Shamlan G. Albreiki M. Almasoudi H.O. Nutritional status of elderly patients previously ill with COVID-19: Assessment with nutritional risk screening 2002 (NRS-2002) and mini nutritional assessment (MNA-sf). J. Infect. Public Health 2024 17 2 372 377 10.1016/j.jiph.2023.11.005 38217931
    [Google Scholar]
  20. Feng X. Liu Z. He X. Risk of malnutrition in hospitalized COVID-19 patients: A systematic review and meta-analysis. Nutrients 2022 14 24 5267 10.3390/nu14245267 36558436
    [Google Scholar]
  21. Green S.B. How many subjects does it take to do a regression analysis. Multivariate Behav. Res. 1991 26 3 499 510 10.1207/s15327906mbr2603_7 26776715
    [Google Scholar]
  22. Dassum S.R. Ferguson R. Woods P. Patient- reported reasons for non-participation in a COVID-19 therapeutics clinical trial: Findings from a multi-center investigation. Contemp. Clin. Trials 2023 126 107082 10.1016/j.cct.2023.107082 36632925
    [Google Scholar]
  23. Nalbandian A. Sehgal K. Gupta A. Post-acute COVID-19 syndrome. Nat. Med. 2021 27 4 601 615 10.1038/s41591‑021‑01283‑z 33753937
    [Google Scholar]
  24. Sudre C.H. Murray B. Varsavsky T. Attributes and predictors of long COVID. Nat. Med. 2021 27 4 626 631 10.1038/s41591‑021‑01292‑y 33692530
    [Google Scholar]
  25. Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020 396 10255 874 10.1016/S0140‑6736(20)32000‑6 32979964
    [Google Scholar]
  26. Patel J.A. Nielsen F.B.H. Badiani A.A. Poverty, inequality and COVID-19: The forgotten vulnerable. Public Health 2020 183 110 111 10.1016/j.puhe.2020.05.006 32502699
    [Google Scholar]
  27. Davis H.E. Assaf G.S. McCorkell L. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine 2021 38 101019 10.1016/j.eclinm.2021.101019 34308300
    [Google Scholar]
  28. Pironi L. Sasdelli A.S. Ravaioli F. Malnutrition and nutritional therapy in patients with SARS-CoV-2 disease. Clin. Nutr. 2021 40 3 1330 1337 10.1016/j.clnu.2020.08.021 32900518
    [Google Scholar]
  29. Anker M.S. Landmesser U. von Haehling S. Butler J. Coats A.J.S. Anker S.D. Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers. J. Cachexia Sarcopenia Muscle 2021 12 1 9 13 10.1002/jcsm.12674 33382211
    [Google Scholar]
  30. Grecco B.H. Araújo-Rossi P.A.O. Nicoletti C.F. Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review. J Intensive Med 2022 2 4 249 256 10.1016/j.jointm.2022.04.004 36785649
    [Google Scholar]
  31. Wirth K.J. Scheibenbogen C. Pathophysiology of skeletal muscle disturbances in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). J. Transl. Med. 2021 19 1 162
    [Google Scholar]
  32. Jimeno-Almazán A. Pallarés J.G. Buendía-Romero Á. Post-COVID-19 syndrome and the potential benefits of exercise. Int. J. Environ. Res. Public Health 2021 18 10 5329
    [Google Scholar]
  33. Jahrami H.A. Alhaj O.A. Humood A.M. Sleep disturbances during the COVID-19 pandemic: A systematic review, meta-analysis, and meta-regression. Sleep Med. Rev. 2022 62 101591 10.1016/j.smrv.2022.101591 35131664
    [Google Scholar]
  34. Besedovsky L. Lange T. Born J. Sleep and immune function. Pflugers Arch. 2012 463 1 121 137 10.1007/s00424‑011‑1044‑0 22071480
    [Google Scholar]
  35. Alsudairy M.N. Alharbi S.T. Alghamdi M.M.A. Sleep quality and sleep disorders post COVID-19 infection: Review article. Saudi Med Horiz J 2022 2 3 103 112 10.54293/smhj.v2i3.50
    [Google Scholar]
  36. Irwin M.R. Sleep and inflammation: Partners in sickness and in health. Nat. Rev. Immunol. 2019 19 11 702 715 10.1038/s41577‑019‑0190‑z 31289370
    [Google Scholar]
  37. Stamenković M. Pantelić S. Bubanj S. Physical activity and mental health after COVID-19 recovery: Age and sex differences. Life 2025 15 4 531 10.3390/life15040531 40283086
    [Google Scholar]
  38. Nikolic M. Simovic S. Novkovic L. Obesity and sleep apnea as a significant comorbidities in COVID-19 — A case report. Obes. Res. Clin. Pract. 2021 15 3 281 284 10.1016/j.orcp.2021.04.008 33933379
    [Google Scholar]
  39. Mashaqi S. Kallamadi R. Matta A. Obstructive sleep apnea as a risk factor for covid-19 severity—the gut microbiome as a common player mediating systemic inflammation via gut barrier dysfunction. Cells 2022 11 9 1569 10.3390/cells11091569 35563874
    [Google Scholar]
  40. Du W. Xu H. Chang Y. Feng B. Wang Q. Li W. Impact of obstructive sleep apnea on inpatient outcomes of COVID-19: A propensity-score matching analysis of the us nationwide inpatient sample 2020. Front. Med. 2025 12 1472176 10.3389/fmed.2025.1472176 40182850
    [Google Scholar]
  41. de Frel D.L. Atsma D.E. Pijl H. The impact of obesity and lifestyle on the immune system and susceptibility to infections such as COVID-19. Front. Nutr. 2020 7 597600 10.3389/fnut.2020.597600 33330597
    [Google Scholar]
/content/journals/cnf/10.2174/0115734013430996250912060209
Loading
Long-Term Effects of Malnutrition Risk on Sleep Disorders and Physical Activity among COVID-19 Survivors
Bentham Science Publishers ; https://doi.org/10.2174/0115734013430996250912060209
/content/journals/cnf/10.2174/0115734013430996250912060209
/content/journals/cnf/10.2174/0115734013430996250912060209
Loading

Data & Media loading...


  • Article Type:     Research Article
Keywords: obesity,sarcopenia ; physical inactivity ; Post-COVID-19 malnutrition ; sleep disturbances ; malnutrition screening tool

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test