The Association between Body Mass Index and Probiotics Supplementation with Hospital Stay Duration and Symptoms among COVID-19 Iranian Patients

Document Type : Original Article

Authors

1 Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran, University of Medical Sciences, Tehran, Iran

3 Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran

4 Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran

5 Department of Exercise Physiology, Faculty of Sport Sciences, University of Isfahan, Isfahan, Iran

Abstract

Background: Coronavirus disease-2019 (COVID-19) can cause a severe respiratory disease and systemic complications. The gut microbiota plays an important role in immune regulation, while obesity may worsen COVID-19 outcomes. This study investigated the interaction between body mass index (BMI) and probiotic supplementation on COVID-19 symptoms and length of hospital stay.
Methods: This cross-sectional study included 107 Iranian adults aged 20-60 years hospitalized with COVID-19 at Amir Alam Hospital, Tehran, Iran. Demographic characteristics, body composition, probiotic supplementation history, and COVID-19 symptoms were assessed using questionnaires and hospital records. Linear and binary logistic regression analyses were performed to evaluate associations and interactions.
Results: Probiotic consumption was negatively associated with lethargy (β=−3.09; 95%CI: −4.85, −1.32; p<0.01). BMI was positively associated with C-reactive protein (CRP) level (β=47.46; 95%CI: 5.24, 89.69; p= 0.02). A correlation was observed between probiotic intake and lower BMI for duration of hospitalization (β=−3.28; 95%CI: −7.28, 0.00; p=0.05) and
D-dimer level (β=−3.57; 95%CI: −31.35, 24.20; p=0.07). This association was also observed for diarrhea (OR=0.32; 95%CI: 0.01, 1.00; p=0.05) and stomachache (OR=0.43; 95%CI: 0.00, 1.45; p= 0.09).
Conclusion: Probiotic consumption was associated with lower lethargy, while higher BMI was correlated with an increased CRP level. The observed interactions between probiotic intake and BMI for hospitalization duration, D-dimer, and gastrointestinal symptoms warrant further investigation in larger longitudinal and randomized controlled studies.

Highlights

Atieh Mirzababaei (Google Scholar)

Keywords

References

  1. Cottini M, Lombardi C, Berti A, et al., editors. Obesity is a major risk factor for hospitalization in community-managed COVID-19 pneumonia. Mayo Clinic Proceedings; 2021: Elsevier.
  2. Ahmadi S, Firoozi D, Masoumi SJ. The Effect of Micronutrients on COVID-19 Disease: A Review of Available Evidences. Int J Nutr Sci. 2022;7:10-18. DOI: 10.30476/IJNS.2022.94162.1169.
  3. Nayebi A, Navashenaq JG, Soleimani D, et al. Probiotic supplementation: a prospective approach in the treatment of COVID-19. Nutr Health. 2022;28:163-75. DOI: 10.1177/02601060211049631. PMID: 34747257.
  4. Ghadimi Moghadam AK, Masoumi SJ, Nouri M, et al. The Effect of Nutrients Intake with an Emphasis on Immune-Boostings in Patients with COVID-19. Int J Nutr Sci. 2022;7:34-40. DOI: 10.30476/IJNS.2022.94174.1170.
  5. Mehrdad M, Eftekhari MH. Concerns on Obesity during COVID-19 Pandemic. Int J Nutr Sci. 2021;6:111-112. DOI: 10.30476/IJNS.2021.90311.1125.
  6. Kulcsar KA, Coleman CM, Beck SE, et al. Comorbid diabetes results in immune dysregulation and enhanced disease severity following MERS-CoV infection. JCI Insight. 2019;4 :e131774. DOI: 10.1172/jci.insight.131774. PMID: 31550243.
  7. Xu K, Cai H, Shen Y, et al. Management of COVID-19: the Zhejiang experience. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49:147-157. DOI: 10.3785/j.issn.1008-9292.2020.02.02. PMID: 32391658.
  8. Hosseini-Asl SMK, Mehrabani G, Masoumi SJ. Key Focus Areas in Pouchitis Therapeutic Status: A Narrative Review. Iran J Med Sci. 2024;49:472-486. DOI: 10.30476/ijms.2024.100782.3326. PMID: 39205822.
  9. Masoumi SJ, Mehrabani  D, Saberifiroozi  M, et al. The effect of yogurt fortified with Lactobacillus acidophilus and Bifidobacterium sp. probiotic in patients with lactose intolerance. Food Sci Nutr. 2021;9:1704-1711. DOI: 10.1002/fsn3.2145. PMID: 33747481.
  10. Belančić A. Gut microbiome dysbiosis and endotoxemia-Additional pathophysiological explanation for increased COVID-19 severity in obesity. Obes Med. 2020;20:100302. DOI: 10.1016/j.obmed.2020.100302. PMID: 32984641.
  11. Mullish BH, Marchesi JR, McDonald JA, et al. Probiotics reduce self-reported symptoms of upper respiratory tract infection in overweight and obese adults: should we be considering probiotics during viral pandemics? Gut Microbes. 2021;13:1-9. DOI: 10.1080/19490976.2021.1900997. PMID: 33764850.
  12. McNeill JN, Lau ES, Paniagua SM, et al. The role of obesity in inflammatory markers in COVID-19 patients. Obes Res Clin Pract. 2021;15:96-9. DOI: 10.1016/j.orcp.2020.12.004. PMID: 33390322.
  13. Sherafati N, Behzadi M, Bideshki MV,et al. Global Leadership Initiative on Malnutrition and Mini Nutritional Assessment in Evaluation of Nutritional Status of COVID-19 Patients. Int J Nutr Sci. 2024;9:14-22. DOI: 10.30476/ijns.2024.100096.1267.
  14. Soeroto AY, Soetedjo NN, Purwiga A, et al. Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis. Diabetes Metab Syndr. 2020;14:1897-904. DOI: 10.1016/j.dsx.2020.09.029. PMID: 33007661.
  15. Watanabe M, Risi R, Tuccinardi D, et al. Obesity and SARS‐CoV‐2: a population to safeguard. Diabetes Metab Rese Rev. 2020;36:e3325. DOI: 10.1002/dmrr.3325. PMID: 32314503.
  16. Stefan N, Birkenfeld AL, Schulze MB, et al. Obesity and impaired metabolic health in patients with COVID-19. Nat Rev Endocrinol. 2020;16:341-2. DOI: 10.1038/s41574-020-0364-6. PMID: 32327737.
  17. Ruan Q, Yang K, Wang W, et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020;46:846-8. DOI: 10.1007/s00134-020-05991-x. PMID: 32125452.
  18. Sindhu S, Thomas R, Shihab P, et al. Obesity is a positive modulator of IL-6R and IL-6 expression in the subcutaneous adipose tissue: significance for metabolic inflammation. PLoS One. 2015;10:e0133494. DOI: 10.1371/journal.pone.0133494. PMID: 26200663.
  19. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62. DOI: 10.1016/S0140-6736(20)30566-3. PMID: 32171076.
  20. Ryan PM, Caplice NM. Is adipose tissue a reservoir for viral spread, immune activation, and cytokine amplification in coronavirus disease 2019? Obesity. 2020;28:1191-4. DOI: 10.1002/oby.22843. PMID: 32314868.
  21. Huttunen R, Syrjänen J. Obesity and the risk and outcome of infection. Int J Obes. 2013;37:333-40. DOI: 10.1038/ijo.2012.62. PMID: 22546772.
  22. Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111:1805-12. DOI: 10.1172/JCI18921. PMID: 12813013.
  23. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507-13. DOI: 10.1016/S0140-6736(20)30211-7. PMID: 32007143.
  24. Santus P, Radovanovic D, Saderi L, et al. Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study. BMJ Open. 2020;10:e043651. DOI: 10.1136/bmjopen-2020-043651. PMID: 33040020.
  25. Gupte M, Thatcher SE, Boustany-Kari CM, et al. Angiotensin converting enzyme 2 contributes to sex differences in the development of obesity hypertension in C57BL/6 mice. Arterioscler Thromb Vasc Biol. 2012;32:1392-9. DOI: 10.1161/ATVBAHA.112.248559. PMID: 22460555.
  26. Zhao L. Obesity accompanying COVID-19: the role of epicardial fat. Obesity (Silver Spring). 2020;28:1367. DOI: 10.1002/oby.22867. PMID: 32365275.
  27. Faber D, De Groot PG, Visseren F. Role of adipose tissue in haemostasis, coagulation and fibrinolysis. Obes Rev. 2009;10:554-63. DOI: 10.1111/j.1467-789X.2009.00593.x. PMID: 19460118.
  28. Lichey J, Reschofski I, Dissmann T, et al Fibrin degradation product D-dimer in the diagnosis of pulmonary embolism. Klin Wochenschr. 1991;69:522-6. DOI: 10.1007/BF01649289. PMID: 1921237.
  29. Polimeni A, Leo I, Spaccarotella C, et al. Differences in coagulopathy indices in patients with severe versus non-severe COVID-19: a meta-analysis of 35 studies and 6427 patients. Sci Rep. 2021;11:10464. DOI: 10.1038/s41598-021-89967-x. PMID: 34001992.
  30. Yao Y, Cao J, Wang Q, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020;8:1-11. DOI: 10.1186/s40560-020-00466-z. PMID: 32665858
  31. Zareshahrabadi Z, Zomorodian K, Pakshir K, et al. Morphogenesis and pathogenesis regulation of candida albicans by probiotic bacterium – pediococcus acidilactici. J Microbiol Biotech Food Sci. 2021;10:5-11. DOI: 10.15414/jmbfs.2020.10.1.5-11.
  32. Budden KF, Gellatly SL, Wood DL, et al. Emerging pathogenic links between microbiota and the gut–lung axis. Nat Rev Microbiol. 2017;15:55-63. DOI: 10.1038/nrmicro.2016.142. PMID: 27694885.
  33. Dumas A, Bernard L, Poquet Y, et al. The role of the lung microbiota and the gut–lung axis in respiratory infectious diseases. Cell Microbiol. 2018;20:e12966. DOI: 10.1111/cmi.12966. PMID: 30329198.
  34. Roman P, Carrillo-Trabalón F, Sánchez-Labraca N, et al. Are probiotic treatments useful on fibromyalgia syndrome or chronic fatigue syndrome patients? A systematic review. Benef Microbes. 2018;9:603-11. DOI: 10.3920/BM2017.0125. PMID: 29695180.
  35. Corbitt M, Campagnolo N, Staines D, et al. A systematic review of probiotic interventions for gastrointestinal symptoms and irritable bowel syndrome in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). Probiotics Antimicrob Proteins. 2018;10:466-77. DOI: 10.1007/s12602-018-9397-8. PMID: 29464501.
  36. Azad A, Ranjbaran AR, Zareshahrabadi Z, et al. Protective effects of the probiotic bacterium streptococcus thermophilus on candida albicans morphogenesis and a murine model of oral candidiasis. Iran J Med Sci. 2021;46:207-217. DOI: 10.30476/ijms.2020.82080.0. PMID: 34083853.
  37. Kim N, Yun M, Oh YJ, et al. Mind-altering with the gut: Modulation of the gut-brain axis with probiotics. J Microbiol. 2018;56:172-82. DOI: 10.1007/s12275-018-8032-4. PMID: 29492874.
  38. Marotta A, Sarno E, Del Casale A, et al. Effects of probiotics on cognitive reactivity, mood, and sleep quality. Front Psychiatry. 2019;10:164. DOI: 10.3389/fpsyt.2019.00164. PMID: 30971965.
  39. Williamson CB, Burns CM, Gossard CM, et al. Probiotics and disease: A comprehensive summary—Part 3, Cardiometabolic disease and fatigue syndromes. Integr Med (Encinitas). 2017;16:30-41. PMID: 28223906.
  40. Ng QX, Peters C, Ho CYX, et al. A meta-analysis of the use of probiotics to alleviate depressive symptoms. J Affect Disord. 2018;228:13-9. DOI: 10.1016/j.jad.2017.11.063. PMID: 29197739.
International Journal of Nutrition Sciences
Volume 11, Issue 3 - Serial Number 3
September 2026
Pages 452-462

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