The syndromic triad of COVID-19, type 2 diabetes, and malnutrition

Jeffrey I Mechanick; Elena A Christofides; Albert E Marchetti; Kristin K Hoddy; Jim Joachim; Refaat Hegazi; Osama Hamdy

doi:10.3389/fnut.2023.1122203

The syndromic triad of COVID-19, type 2 diabetes, and malnutrition

Front Nutr. 2023 Feb 21:10:1122203. doi: 10.3389/fnut.2023.1122203. eCollection 2023.

Authors

Jeffrey I Mechanick^{1

2}, Elena A Christofides³, Albert E Marchetti^{4

5}, Kristin K Hoddy⁶, Jim Joachim⁷, Refaat Hegazi⁸, Osama Hamdy^{9

10}

Affiliations

¹ The Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, New York, NY, United States.
² Icahn School of Medicine at Mount Sinai, New York, NY, United States.
³ Endocrinology Associates, Inc., Columbus, OH, United States.
⁴ Medical Education and Research Alliance (Med-ERA, Inc.), New York, NY, United States.
⁵ Rutgers New Jersey Medical School, Newark, NJ, United States.
⁶ Novo Nordisk Inc., Plainsboro Township, NJ, United States.
⁷ Internal Medicine and Medical Nutrition, San Diego, CA, United States.
⁸ Abbott Nutrition, Columbus, OH, United States.
⁹ Joslin Diabetes Center, Boston, MA, United States.
¹⁰ Harvard Medical School, Boston, MA, United States.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype-the COVID-Related Cardiometabolic Syndrome-linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.

Keywords: COVID-19; COVID-related cardiometabolic syndrome; SARS-CoV-2; cardiometabolic; cardiometabolic-based chronic disease; coronavirus; malnutrition; type 2 diabetes.

Publication types

Review

Grants and funding

This study received funding from Abbott Nutrition. The funder was not involved in the study design, collection, analysis, interpretation of data, and the writing of this article or the decision to submit it for publication.