Nutritional Risk and Persistent Gastrointestinal Symptoms in COVID-19 Survivors: A Retrospective–Prospective Cohort Study

Background/Objectives: Gastrointestinal (GI) manifestations may persist in COVID-19 survivors, potentially worsening pre-existing conditions and increasing the risk of malnutrition. Understanding the long-term association between GI symptoms and nutritional risk is essential. This study aimed to investigate this relationship in COVID-19 survivors, regardless of comorbidities. Methods: A retrospective cohort study with prospective follow-up was conducted among 103 adults (52 males and 51 females) with PCR-confirmed COVID-19 admitted to King Salman Specialist Hospital, Ha’il, Saudi Arabia, between January 2021 and January 2023. Participants were grouped based on the presence of comorbidities, mainly type 2 diabetes mellitus (DM) and hypertension (HTN), and GI symptoms. Demographic characteristics, COVID-19 severity, and clinical data were obtained from medical records and structured interviews. Nutritional risk was assessed using the Malnutrition Screening Tool (MST). Statistical analysis was performed using Chi-Square tests, with p < 0.05 considered significant. Results: Over a mean follow-up of 26.6 months, 40.8% of participants reported at least one persistent GI symptom. Patients with comorbidities were older than those without comorbidities (mean age 58.24 ± 13.23 vs. 48.22 ± 14.83 years), and malnutrition risk was commonly observed in both groups during hospitalization and follow-up. The most frequently reported symptoms were abdominal pain (15.5%), diarrhea (12.6%), appetite loss (9.7%), and vomiting (7.8%), with no significant differences between groups. GI symptoms were significantly associated with reduced food intake, weight loss, and increased malnutrition risk (p < 0.05). Conclusions: Some COVID-19 survivors reported persistent GI symptoms during long-term follow-up, with no significant differences based on comorbidity status. GI symptoms were associated with nutritional risk and lifestyle changes, supporting the need for nutritional screening in post-COVID-19 care.