International Journal of Nutrition Sciences

International Journal of Nutrition Sciences

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
Atieh Mirzababaei 1, 2
Farideh Shiraseb 2
Zeinab Zarrinvafa 3
Azam Mohamadi 4
Sahar Noori 3
Sajedeh Habibi 2
Mahnaz Sadid 2
Darya Khosravania 3
Atousa Zandvakili 5
Khadijeh Mirzaei 2
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
10.30476/ijns.2026.108984.1581
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
Body mass index
Probiotics
COVID-19
Hospitalization
Iran
  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
Summer 2026
Pages 452-462