The burden of malnutrition and fatal COVID-19: A global burden of disease analysis
Research snapshot1
The role played by population-level nutritional status in the vulnerability of countries to COVID-19 illness and death is unknown. Because childhood malnutrition is associated with high morbidity and mortality, mainly due to infectious diseases, it can be assumed that undernourished populations may be at greater risk of severe or fatal COVID-19 illness. This study aims to identify the countries where a high burden of malnutrition coincides with higher rates of fatal COVID-19 disease, indicating a potential relationship between these burdens. Analyses were conducted for 172 countries for which data were available on both COVID-19 case fatality ratios (CFR) and the country-level burden of malnutrition, quantified using death rates for child growth failure (underweight, stunting and/or wasting), years lived with disability (YLD) attributed to iron and vitamin A deficiencies and high body mass index (BMI).
There was no correlation between the rate of death for child growth failure and CFR for COVID-19. A slightly higher CFR for COVID-19 was seen in countries with very high rates of YLD for iron deficiencies. Countries’ vulnerability to fatal COVID-19 was slightly higher with increasing rates of vitamin A deficiency, with no further increases for countries with very high rates of vitamin A deficiency. Vulnerability to fatal COVID-19 was slightly higher in countries with increased rates of high BMI compared to countries with low and median rates of high BMI. No correlations were seen between the rate of YLD for high BMI and CFR for COVID-19. Increasing rates of high BMI were, however, associated with a higher vulnerability to fatal COVID-19 in low-income countries.
Countries ranking high on at least three malnutrition indicators and with elevated CFR for COVID-19 are sub-Saharan African countries, namely, Angola, Burkina Faso, Chad, Liberia, Mali, Niger, Sudan and Tanzania as well as Yemen and Guyana. The authors conclude that population-level malnutrition appears to be related to increased rates of fatal COVID-19 in areas with an elevated burden of undernutrition such as countries in the Sahel strip.
1 Mertens, E and Peñalvo, J L (2021) The burden of malnutrition and fatal COVID-19: A global burden of disease analysis. Front. Nutr. 7:619850. doi: 10.3389/fnut.2020.619850